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Monthly Archives: May 2010
Yolk Sac Tumour
Yolk Sac Tumour
Clinical Information
- most common testicular tumor are in kids <3 and young adults, serum AFP most important
Gross Appearance
- yellow-gray nodule, often with hemorrhage and necrosis
Microscopic Appearance
Variants of yolk sac tumours
- endodermal sinus pattern (Schiller-Duval bodies)
-microcystic (reticular)
-others: hepatoid, solid, glandular
-hyaline globules (DPAS, AFP, AAT+) (outside cells)
Yolk Sac Immunohistochemistry
-diffuse AFP alpha feto protein, cytokeratin CK
Embryonal Carcinoma
Embryonal Carcinoma
Clinical Information
- patients are often 30 years old, may have elevated serum beta-hCG and AFP levels
- frequently present with metastatic disease
Gross Appearance
- friable, hemorrhagic and necrotic areas, firm and gray
Microscopic Appearance
-usually part of a mixed germ cell tumor
- ill-defined cell borders
- atypical cells, large nuclei, large nucleoli
- nuclear overlapping
- coagulative necrosis
- mitoses
- vascular invasion common
Embryonal Carcinoma Immunohistochemistry
- CD30, CK, patchy PLAP positivity
Posted in Testis
Tagged , afp, cd30, clinical information, Embryonal Carcinoma, germ cell tumor, gross appearance, microscopic, mixed germ cell tumor, necrosis, PLAP, Testicular Cancer, Testis, tumor, vascular invasion
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Seminoma
Seminoma
Clinical and Symptoms
40 year old patients, mass, pain, increased serum beta-hCG
Gross Appearance
tan, fleshy, bulges out
Microscopic Features
-fibrous bands with lymphocytes (also mingle with seminoma cells)
-sheets of polygonal cells with clear cytoplasm (can be eosinophilic)
-central nuclei with 1-2 nucleoli
-50% granulomatous reaction †’ differential diagnosis granulomatous orchitis
Immunohistochemistry Stains
-PAS (glycogen)
-c-kit
-PLAP
-synctiotroblast-like cells †’ beta-hCG +
Prognosis
- Excellent with treatments both chemotherapy and radiation therapy
Seminoma variants
-anaplastic seminoma (>3 mitoses/HPF)
-seminoma with trophoblast giant cells
-seminoma with yolk sac elements
Posted in Testis
Tagged , anaplastic seminoma, appearance, beta-hcg, c-kit, gross, histology, immunohistochemistry, microscopic, pas, PLAP, prognosis, Seminoma, seminoma variants, stains, symptoms, trophoblast giant cells, yolk sac elements
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Testicular Cancer Causes
Causes of Testicular Cancer
Genetic features of most germ cell tumours
1. hyperdiploidy
2. 12p amplifications, isochromosome 12 [i(12p)]
Totipotent cells and germ cells tumours
1. Germ cell tumours are thought to be derived from totipotent cells that become seminoma or non-seminomatous tumours. Metastases of one germ cell tumour may be different from another (eg. yolk sac tumor can metstatsize to the lung and appear as a teratomatous metastasis).
Posted in Testis
Tagged , 12p amplification, causes, Genetics, hyperdiploidy, Testicular Cancer, Testicular Cancer Causes, totipotent cells, tumor, tumour
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Testicular Tumor Ages
Testicular Tumors are associated with different age groups
Seminoma 40 year olds
Spermatocytic seminoma 50-60 year olds
Embryonal carcinoma 30 year olds
Choriocarcinoma 10-20 year olds
Yolk sac tumor and teratoma less than 3 years old and adults
Leydig cell and Sertoli cell tumors are found in kids to adults
Testis Tumours
Testis Tumours
Classification of testicular tumours: Germ cell tumours versus Non-germ cell tumours.
GERM CELL TUMOURS
Precursor germ cell lesion
Intratubular Germ Cell Neoplasia
SGCT
Seminoma
-Spermatocytic seminoma
NSGCT
Embryonal carcinoma
Yolk sac tumour
Teratoma
-mature
-immature
-with malignant transformation
-monodermal variants: (struma ovarii, struma carcinoid, PNET)
Choriocarcinoma
Mixed (60% of germ cell tumours)
Polyembryoma
Diffuse embryoma
NON-GERM CELL TUMOURS
Sex-cord stromal tumours
Sertoli cell
Leydig
Sertoli-Leydig
Granulosa
-juvenile
-adult
Mixed germ cell/sex cord
Gonadoblastoma
Types of Infertility
Types of Infertility
Types of Infertility include:
1. pre-testicular: changes in the pituitary and adrenal glands2. testicular
3. post-testicular: obstructive causes
Causes of infertility associated with a normal testis
Post-obstructive causes secondary to:
- congenital, post-surgical, Young s syndrome (obstructive azospermia and sinopulmonary infections)
Posted in Testis
Tagged , adrenal gland, congenital, infertility, Infertility types, obstruction, pituitary, post-testicular, pre-testicular, testicular, youngs syndrome
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Testicular Biopsy
Testicular Biopsy
Reasons for doing a testicular biopsy include:
1. cryptorchidism
2. infertility syndromes (gonadal dysgenesis, androgen insensitivity synd)
3. previous germ cell tumor
Germ Cell Tumor Risk Factors
Germ Cell Tumor Risk Factors
1. cryptorchidism
2. infertility syndromes such as gonadal dysgenesis and androgen insensitivity syndrome 3. previous germ cell tumor
4. oligospermic infertility (e.g. low sperm count infertility) 5. family history of germ cell tumours
6. intratubular germ cell neoplasia, unclassified (IGCNU)
Posted in Testis
Tagged , androgen insensitivity syndrome, cryptorchidism, familty history, Germ Cell, Germ Cell Tumor Risk Factors, gonadal dysgenesis, igcnu, infertility, infertility syndromes, intertubular germ cell neoplasia, intratubular germ cell neoplasia, oligospermic infertility, risk factors, unclassified
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Testis Histology
Testis Histology
Epididymis: pseudostratified epithelium with cilia
Rete testis: flat cuboidal epithelium
Seminiferous tubules: cellular atypia and lipofushcin
Vas deferens: columnar epithelium and lymphocytes
Posted in Testis
Tagged , Anatomy, Epididymis, histology, Rete testis, Seminiferous tubules, Testis, testis histology, Vas deferens
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