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A 24 year old man comes to the physician for a physical before starting school. On physical exam his right testicle is palpably enlarged. He said he hadn't noticed the enlargement and he's had no accompanying symptoms. Blood reveals elevated PLAP. Based on the gross specimen removed and his presentation, what would his diagnosis and treatment be?

Seminoma: malignant painless testicular germ cell tumor
- Affects males 25-35
- Increased PLAP= placental alkaline phosphatase
- Radiosensitive= excellent prognosis
- Mets LATE


Yolk sac (endodermal sinus) tumor

- Yellow, mucinous tumor
- Analogous to ovarian yolk sac tumor: Schiller-Duval bodies= produce AFP (alpha fetoprotein), ressemble glomeruli


Choriocarcinoma of testes:
- Malignant--> mets to lungs
- Increased hCG--> gynecomastia (b-hCG= LH analog, can also induce hyperthyroidism as it mimics TSH)
Histo: disordered synctiotrophoblastic (beta-hCG), cytotrophoblastic elements


NSGCT: teratoma
- Increased hCG and/or AFP in 50% cases
- More often malignant than in females
Composed of tissues of the three germ cell layers: endoderm, mesoderm and ectoderm.
• Second most common tumor in prepuberal testis presenting at 20 months.
• Present in 50% of the mixed GCT • In adults, teratomas are malignant

Tissue from all germ layers resembling normal adult tissue
• May show malignant transformation (sarcoma, primitive neuroectodermal tumor, carcinomas) with worse prognosis
• There are no useful markers other than histology and AFP to exclude yolk sac tumor


Testicular Embryonal carcinoma

Testicular embryonal carcinoma:
- Malignant, painful, worse prognosis than seminoma
- Glandular, papillary morphology
- Rarely "pure" embryonal carcinoma
- most commonly associated with increased hCG, normal AFP when pure (increased AFP when mixed


Testicular non-germ cell tumors
10% are malignant
Orchiectomy is curative

Leydig cell tumor:
- crystalloids of Reinke
- Androgen-producing--> gynecomastia in adults, precocious puberty in boys

- Testicular swelling
• Can secrete androgens, estrogens, and corticosteroids: – Precocious physical - sexual development and feminization – Gynecomastia
• Two distinct peaks, in childhood and adults 3rd - 6th decade
• Grossly are well circumscribed, from 1 to 10 cm in diameter, yellow to brown, and larger tumors have fibrous trabeculae

Histo: uniform cells with round nuclei and eosinophilic or vacuolated cytoplasm


Sertoli cell tumor= androblastoma

• Testicular mass < age of 40
• Grossly are small (1 to 3 cm), solid, well-circumscribed, yellow–gray nodules
• Large Cell Calcifying Sertoli Cell Tumor (LCCSCT) is a subtype associated with Peutz-Jeghers Syndrome and a component of Carney’s Complex

columnar tumor cells arranged into tubules or cords in a fibrous trabecular framework reminiscent of seminiferous tubules


Testicular lymphoma

Lymphoma mets to testes