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

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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

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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

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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).

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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

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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

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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)

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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

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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)

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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

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