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TUMORS of the TESTIS - Coggle Diagram

- - - - Leydig cell agenesis
        
        deficit in testosterone synthesis
        
        insensitivity to androgens --> Morris syndrome, undifferentiated tubules, Leydig cell hyperplasia
    - - isolated LH deficit
        
        Klinefelter syndrome (testicular atrophy, azoospermia, gynecomastia)
    - - 5% males at birth
        
        trans-abdominal and inguino-scrotal phases
        
        unknown causes (hormones, trisomy 13?)
        
        25-30% bilateral
        
        isolated or associated with other anomalies
      - decreased volume and increase consistency of the testis
        
        micro: maturation arrest of germ cells (atypia), decrease in Sertoli cell number, tubular hyalinization and basal membrane thickening
        
        risk of malignant transformation: 3-5 (7-11) x
  - - - ischemia
        
        post-inflammatory
        
        cryptorchidism
        
        hypopituitarism
        
        iatrogenic
        
        peritumoral
  - - - gonococcus from urethritis
      - mumps --> rare complication in children, 20% in adults, 70% monolateral, with lymphocytes and plasma cells
      - testicular TBC
        
        post-primary
        
        uni-/bilateral
        
        granulomatous, productive caseous process
        
        fistulae
        
        primary of the epididymis, late testicular lesions
        
        hematogenous spread or canalicular from the urinary tract
      - syphilis
        
        epididymitis:
        
        congenital
        
        acquired
        
        obliterative endoarteritis with perivascular infiltrate of lymphocytes and plasma cells
        
        granulomatous lesions: scar --> gumma
  - - - no epididymitis (important for TBC DD)
- - - - SEMINOMA
        
        the most frequent
        
        4th decade, pure or mixed
        
        94% at 4 ys
        
        12p isochromosome
        
        histology
        
        classic 85%
        
        anaplastic 10%
        
        with SCT
        
        pathology
        
        macro:
        
        white-to-gray
        
        lobulated
        
        homogeneous
        
        without hemorrhage or necrosis
        
        with no involvement of the tunica albuginea
        
        micro:
        
        round-to-polygonal cells
        
        medium size
        
        aboundant clear cytoplasm (glycogen, PAS+)
        
        hyperchromic nuclei, large nucleoli
        
        dyscohesive pattern of growth
        
        intratumoral lymphoid infiltrate
        
        exception
        
        seminoma with SCT cells beta-hCG+ variant
        
        mixed
      - SPERMATOCYTIC TUMOR
        
        5% seminomatous
        
        for the remaining %, specific tumor entity
        
        cells generally smaller than in seminoma
        
        more heterogeneous
        
        similar to type II spermatocytes
        
        not associated to GCNIS, no ovarian counterpart, no 12p anomalies, excellent prognosis, age >50
    - - 70% of non-seminomatous
        
        with or without seminoma
        
        any combination
      - distant metastases: 10% morphology not similar to primary
        
        a minimum of 10 blocks for larger homogeneous tumors and complete blocking of smaller ones if entire tumor can be submitted in 10 blocks or less
    - - found in cryptorchidism, infertility
        
        risk of controlateral germ cell tumor in 25-50x
        
        morphology: large clear/vacuolated cells (PAS+), with large irregular nuclei
      - no 12p gain
      - pathological relevance
        
        to be differentiated from vascular invasion / intratubular spread
        
        helps distinguish germ cell tumors vs sex chord tumors
        
        helps to distinguish seminoma from spermatocytic tumor
        
        may be found in biopsies for infertility
        
        may be found in cryptorchidism
      - two pathways
        
        default
        
        SE
        
        it can also undergo the reprogramming path
        
        reprogramming
        
        EC
    - - EMBRYONAL CARCINOMA
        
        pathology
        
        macro:
        
        small testicular nodules with necrosis and hemorrhage
        
        infiltration of the tunica albuginea
        
        micro:
        
        tubular
        
        alveolar
        
        papillary
        
        chordonal growth of epithelioid cells with high grade atypia
        
        CD30+ and CEA+
        
        2-10% pure, usually mixed
        
        age 20-30 y
        
        EARLY DEVELOPMENT OF DISTANT METASTASES (lung)
      - YOLK SAC TUMOR
        
        types:
        
        prebuperal:
        
        children <3 y,
        
        pure,
        
        good prognosis
        
        post-puberal:
        
        adults <30 y,
        
        mixed,
        
        highly malignant
        
        pathology:
        
        micro:
        
        irregular sheets of cuboidal cells
        
        papillae
        
        tubules
        
        centrifugal pattern
        
        macro:
        
        similar to embryonal carcinoma
        
        PAS+ and AFP+
        globules in the cytoplasm
      - CHORIOCARCINOMA
        
        pure form <1%
        
        mixed in 8% of germ cell tumors
        
        25-30 y
        
        highly malignant
        
        pathology
        
        macro:
        
        small lesions
        
        marked hemorrhage
        
        necrosis
        
        micro:
        
        large cells with cyto-syncytio-trophoblastic differentiation
        
        pale-to-eosinophilic cytoplasm
      - TERATOMA
        
        heterogeneous tumor
        
        pure in children (pre-pubertal type, benign, desmoid/epidermoid cysts)
        
        complex forms in adults (post-pubertal type), including mixed with embryonal carcinoma
        
        pathology
        
        macro:
        
        heterogeneous
        
        micro:
        
        mature
        
        mixed histologies: nervous tissue, muscle, thyroid, bronchi, cartilage, intestine, epidermis, connective tissue
        
        immature
        
        same as mature, but embryonal-like with some degree of cytological atypia
        
        malignant transformation
        
        rhabdomyosarcoma, PNET, wilms, squamous cell carcinoma, adenocarcinoma
        
        expansile and infiltrative growth of epithelial or mesenchymal component measuring >5mm
        
        prognostic impact: not completely known in the primary, in metastatic lesions poor response to chemotherapy
  - - - yellowish
        
        <5 cm
        
        Leydig cells with Reinke crystals
        
        lipofuscins
        
        mostly benign
        
        rare
      - in children: precocious puberty
      - in adults: gynecomastia and feminization
      - IHC markers: alpha inhibitin, SF1, melan A
    - - aka androblastoma
        
        yellow-to-white
        
        very rare
        
        chords or trabeculae or tubules
        
        prominent stroma in some cases
        
        broad spectrum of DD: SF1+, CD99+, melan A+, chromogranin A+, cytokeratins
        
        asymptomatic / gynecomastia
        
        malignant in 5% of cases
    - - rete testis invasion
        
        size of tumor
        
        epididymal invasion
        
        tunica vaginalis invasion
        
        vascular invasion
        
        soft tissue invasion
        
        cord invasion
- - - - seminoma
    - - embryonal carcinoma
  - - - yolk sac tumor
    - - spermatocytic seminoma
    - - choriocarcinoma