Flashcards in Testicular Tumors Deck (62):
What is a seminoma?
Undifferentiated germ cell tumor that accounts for half of all germ cell tumors.
Presents as a firm intratesticular poorly demarcated masss that bulges from the cut surface of the testis
Is seminoma common before puberty?
No, not found before puberty and is found in most patients between the ages of 25 to 55
What is the major type of seminomas? Which ones are rare?
90% are the classic type. Rare ones are anaplastic and spermatocytic seminomas.
How often is the entire testis replaced by the seminoma tumor?
In over half the cases
What is the appearance of testis afflicted by seminoma?
Yellow-white with rare focal areas of hemorrhage and necrosis
What do seminomas look display histologically?
They display solid nests of proliferating tumor cells b/w scattered fibrovascular trabeculae and lymphocytes
What is the cellular structure of seminomas?
Cells have well-defined borders with glycogen rich clear cytoplasm and normal appearing nuclei with coarse granular chromatin
Are seminomas sensitive to radiation?
Yes, exquisitely sensitive
What is the effectiveness of radiation treatment of seminomas? What about chemo therapy?
Results in five year survival rates of 85-95%.
Chemo is curative in over 90%
Are there any serologic tumor markers for seminoma?
None, unlike for other germ cell tumors
What is another term for Yolk Sac Tumor?
Endodermal sinus tumor
What is yolk sac tumor?
A tumor that enlarges the testes and presents as poorly defined, lobulated masses that are yellow-gray on cut section, with focal areas of hemorrhage and necrosis
How common is yolk sac tumor in adults?
What is the histology of yolk sac tumor?
Tumor consists of dilated tubular spaces lined by flattened cells w/ edematous stroma
What do yolk sac tumor cells surround?
A Schiller-Duval Body
What is a Schiller-Duval body?
A microcyst containing a glomerulus-like structure with a central fibrovascular core
What marker do yolk sac tumor cells contain?
AFP - alpha fetoprotein
What can the presence of AFP in yolk sac tumor cells be used for?
Diagnosis, and purposes of metastasis and monitoring of the disease.
Whereas, seminoma cells are undifferentiated, embryonal Carcinoma cells are __________
What is an embryonal carcinoma?
A small tumor that replaces the entire testis.
What is the appearance of embryonal carcinoma on sectioning?
Gray-white, poorly demarcated, and bulging, with varying degrees of hemorrhage and necrosis
How common is embryonal carcinoma?
Second most common germ cell tumor, accounting for 15-35% of these neoplasms
When do embryonal carcinoma occur?
Most are found between ages 20 and 35. Do not occur before puberty
Which is more aggressive and lethal, seminoma or embryonal carcinoma?
How often is the tunica albuginea and epididymis invaded in embryonal carcinoma?
20% of the cases
What is the histology of embryonal carcinoma?
Exhibit variable patterns, forming sheets of cells, with clefts, acini, and papillary structures
What is the quality of embryonal carcinoma cells borders?
They are indistinct, with dense nuclei and prominent nucleoli
What are the nucleoli of embryonal carcinoma cells marked by?
Pleomorphism and mitotic activity.
What are embryonal carcinoma tissues often admixed with?
Other tissues such as Choriocarcinoma and yolk sac tumor - therefore tumor markers may be positive
Do embryonal carcinoma cells stain for beta-HCG and AFP?
T/F At time of diagnosis of embryonal carcinoma, patients usually already have metastasis to lymph nodes and distant organs
How effective is chemo therapy for embryonal carcinoma with no metastasis? W/ metastasis?
Have a very high cure rate. If metastasis then the cure rate drops
What are the most frequent patterns of mixed germ cell tumors?
1. Teratoma with embryonal (teratocarcinoma)
2. Teratoma, embryonal carcinoma, and seminoma
3. embryonal carcinoma and seminoma
What is testicular teratoma?
When embryonal carcinoma undergo differentiation and become a teratoma
What germs layers are found in testicular teratoma?
All three germ layers
How frequent are testicular teratomas in children? In adults?
Almost half of germ cell tumors in infants and children.
In adults less than 5% of tumors
What are the three classifications of testicular teratoma?
1. Mature, immature, and malignant teratomas
What are teratomas called when they arise from the ovary?
Dermoid cysts - the most common ovarian tumor in women of reproductive years
What is the most important predictor of the biological behavior of a testicular teratoma?
Age of the patient
Are teratomas malignant infants and children?
No, they are invariably benign. In adults, on the other hand, they are commonly malignant.
What are mature teratomas?
A solid and multicystic lesion that enlarges the testis. The cut surface exhibits mucinous cysts, with solid cartilaginous and osseous foci
What is the histology of mature teratomas?
Haphazard arrangement of cells and organoid structures such as neural skeletal bone, cartilage, thyroid, respiratory epithelium, squamous epithelium, GI tract epithelium and other tissues within a fibrous or myxoid matrix
What are Leydig cell tumors?
Neoplasms that are functionally active secreting androgens, estrogens, or both
When do Leydig cell tumors occur?
Boys older than 4 years of age and men in their 3rd to 6th decades
What is the appearance of Leydig cell tumors?
Well-circumscribed and encapsulated
Tumor reveals _____ of polygonal cells with abundant ________ cytomplasm
How malignant are Leydig cell tumors?
90% are benign with endocrine effects
What are the endocrine effects of Leydig cell tumors?
Causes precocious physical and sexual development in prepubertal boys, or feminization and gynecomastia are seen in other adults.
What are Sertoli cell tumors?
Is a sex cord-gonadal stromal tumor that are 80% benign
When do Sertoli cell tumors develop?
In the first four decades of life
What is the appearance of Sertoli cell tumors?
Well-circumscribed, yellow-gray solid tumors. Have a tubular arrangement with solid cords of cells with a fibrous trabecular network
What brings Sertoli cell tumors to medical attention?
A mass in the scrotum or endocrine effects (gynecomastia).
How can sertoli and leydig cell tumors be cured?
Orchiotomy is curative
What is a testicular choriocarcinoma?
A highly malignant testicular tumor, which represents germ cell extraembryonic differentiation to the components of the placenta, namely cyto- and syncytiotrophoblast
Does testicular choriocarcinoma cause testicular enlargement?
No enlargement and is detected only as a small painless nodule
What does the cut surface of a testicular choriocarcinoma contain?
Marked hemorrhage and necrosis
Where are trophoblastic tissues found microscopically in a testicular choriocarcinoma?
in areas of hemorrhage
What are syncytiotrophoblasts?
Large multinucleated giant cells with abundant vacoulated cytoplasm
What does the cytoplasm of syncytiotrophoblast contain?
What are cytotrophoblasts?
Polygonal cells, with round, hyperchromic nuclei and sparse cytoplasm
How frequent are pure tumors of testicular choriocarcinoma?
They are rare and mostly observed as a component of a mixed germ cell tumor