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Testicular tumors.pptx

-Classify testicular Tumors -Epidemiology -Pathogenesis -Presenting and distinguishing features -Serum Biomarkers -Diagnostic tests of testicular tumors -Gross -Microscopy -IHC markers -15 MCQs

1 of 64
TESTICULAR
TUMORS
Dr.Utkarsh Singhal
M.D Pathology
L.L.R.M Medical College,Meerut
CONTENTS
 Classify testicular tumors
 Pathogenesis
 Presenting and distinguishing features
 diagnostic tests of testicular tumors
Testicular tumors.pptx
GERM CELL TUMORS
 Most common cancer in this age group.
 Affect Caucasian males between 15 and 45 years of age.
Testicular tumors.pptx
PATHOGENESIS
ENVIRONMENTAL FACTORS
• Associated with testicular dysgenesis
syndrome.
• Includes-cryptorchidism(most common),
hypospadias, and poor sperm quality.
• Klinefilter Syndrome is associated with
mediastinal GCT.
• Risk increases with in utero exposure to
pesticides and nonsteroidal estrogens.
GENETIC FACTORS- Inherited
and Acquired
• Relative risk of GCTs is four times
higher than normal in fathers.
• 8 to 10 times higher in brothers
• Mutation in genes encoding the
ligand for the receptor tyrosine
kinase KIT and BAK.
• Associated with genes involved in
sex hormone metabolism.

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Testicular tumors.pptx

  • 2. CONTENTS  Classify testicular tumors  Pathogenesis  Presenting and distinguishing features  diagnostic tests of testicular tumors
  • 4. GERM CELL TUMORS  Most common cancer in this age group.  Affect Caucasian males between 15 and 45 years of age.
  • 6. PATHOGENESIS ENVIRONMENTAL FACTORS • Associated with testicular dysgenesis syndrome. • Includes-cryptorchidism(most common), hypospadias, and poor sperm quality. • Klinefilter Syndrome is associated with mediastinal GCT. • Risk increases with in utero exposure to pesticides and nonsteroidal estrogens. GENETIC FACTORS- Inherited and Acquired • Relative risk of GCTs is four times higher than normal in fathers. • 8 to 10 times higher in brothers • Mutation in genes encoding the ligand for the receptor tyrosine kinase KIT and BAK. • Associated with genes involved in sex hormone metabolism.
  • 8. Clinical features of testicular Germ cell tumor  Painless enlargement of the testis is a characteristic feature  of GCTs  Any solid testicular mass should be considered neoplastic until proven otherwise.  Biopsy of a testicular neoplasm is associated with a risk of tumor spillage, which would necessitate excision of the scrotal skin in addition to orchiectomy.
  • 12. Serum Biomarkers in Germ Cell Tumors  GCTs secrete polypeptide hormones and enzymes that can be detected in the patient’s peripheral blood.  These include hCG, AFP, and lactate dehydrogenase.
  • 13.  The elevation of lactate dehydrogenase correlates with the mass of tumor cells and provides a tool to assess tumor burden.  Marked elevation of serum AFP or hCG levels is produced by yolk sac tumor and syncytiotrophoblastic elements, respectively. Both of these markers are elevated in more than 80% of individuals with nonseminomatous GCTs at the time of diagnosis.
  • 14. Serum markers are valuable in several  different ways: • In the initial evaluation of testicular masses • In the staging of testicular GCTs; for example, after orchiectomy, persistent elevation of hCG or AFP concentrations indicates metastatic spread • In assessing tumor burden • In monitoring the response to therapy
  • 19. SEMINOMA  Most common type of GCT  peak incidence is in the fourth decade.  Arise from undifferentiated germ cells.  Gross: large tumor,replaces entire testis, shape is maintained. Cut Surface shows greyish white,homogenous,rubbery and lobulated.Tunica albuginea is intact.  Microscopy: sheets of uniform cells divided into poorly demarcated lobules by delicate fibrous septa containing a lymphocytic infiltrate.  The classic seminoma cell is round to polyhedral and has a distinct cell membrane; clear or watery- appearing cytoplasm; and a large, central nucleus with one or two prominent nucleoli.  IHC: KIT, OCT3/4,and podoplanin- Positive Cytokeratin-Negative
  • 22. SPERMATOCYTIC TUMOR  uncommon, representing 1% to 2% of all testicular germ cell neoplasms.  affects older individuals (usually more than 65 years old).  slow-growing tumor does not metastasize, and when treated by surgical resection it has an excellent prognosis.  Gross: Circumscribed, fleshy, occasionally myxoid, sometimes with cystic regions  Microscopy: three intermixed cell populations- (1) medium-sized cells containing a round nucleus,spireme-type with occasional nucleoli, and eosinophilic cytoplasm; (2) smaller cells with dense chromatin and with a narrow rim of eosinophilic cytoplasm resembling secondary spermatocytes; (3) scattered giant cells, either uninucleate or multinucleate  IHC: SAL4,CR117-Positive PLAP,OCT 3/4-Negative
  • 23. Intermediate and giant cells feature spireme- like chromatin, different from the dark blue nuclei of small cells
  • 24. Embryonal Carcinoma  peak incidence is in the 20- to 30-year-old age group.  Gross: locally aggressive, frequently extending through the tunica albuginea into the epididymis or spermatic cord,cut surface often has a variegated appearance.  Microscopy: cells grow in alveolar or tubular patterns, sometimes with papillary folds. neoplastic cells have an epithelial appearance, are large and anaplastic, and have hyperchromatic nuclei with prominent nucleoli, cell borders are usually indistinct, nuclear pleomorphism,tumor giant cells and mitotic figures are seen.  IHC: Cytokeratin, OCT3/4 - Positive KIT,podoplanin-Negative
  • 26. YOLK SAC TUMOR/ENDODERMAL SINUS TUMOR  Prepubertal yolk sac tumors are the most common testicular tumor in infants and children up to 3 years of age.  Postpubertal yolk sac tumor is rarely “pure” and more frequently occurs in combination with embryonal carcinoma or other germ cell components.  Gross: Prepubertal yolk sac tumors-Relatively homogenous,lobulated,solid to gelatinous. Postpubertal yolk sac tumor-Poorly circumscribed,unencapsulated,solid,greyish yellow,gelatinous surface  Microscopy: lace-like(reticular) network of medium-sized cuboidal, flattened, or spindled cells  Schiller-Duval bodies- mesodermal core with a central capillary and a visceral and parietal layer of cells resembling primitive glomeruli, Eosinophilic, hyaline-like globules.  IHC: Cytokeratin, α-Fetoprotein, α1-antitrypsin - Positive
  • 28. TERATOMA  Various cellular or organoid components reminiscent of the normal derivatives of more than one germ layer.  Occur at any age  Prepubertal type-Pure teratoma,common in infants and children,benign  Post pubertal-in adults,malignant  Gross: large, 5 to 10 cm in diameter. The presence of a variety of tissues imparts a heterogeneous appearance, with solid, sometimes cartilaginous, and cystic areas  Microscopy: collections of differentiated cells or organoid structures, such as neural tissue, muscle bundles, islands of cartilage, squamous epithelium lining epidermal-like surfaces with or without skin adnexal structures, structures reminiscent of thyroid gland, bronchial epithelium, and bits of intestinal wall or brain substance, are seen embedded in a fibrous or myxoid stroma.
  • 30. CHORIOCARCINOMA  highly malignant type of GCT  Serum hCG is invariably elevated  Gross: small, rarely larger than 5 cm in diameter. Hemorrhage and necrosis are extremely common.  Microscopy:Solid nests and sheets of syncytiotrophoblasts and cytotrophoblasts.  Syncytiotrophoblasts- large multinucleated cells with abundant eosinophilic vacuolated cytoplasm containing hCG.  Cytotrophoblasts- are more regular and tend to be polygonal, with distinct borders and clear cytoplasm; they grow in cords or sheets and have a single, fairly uniform nucleus
  • 32. TUMORS OF SEX CORD–GONADAL STROMA 1. SERTOLI CELL TUMOR:  hormonally silent and present as a testicular mass.  associated with Carney complex(caused by germline mutations in the gene PRKAR1A, which encodes a cyclic adenosine monophosphate– dependent protein kinase), Peutz-Jeghers syndrome and familial adenomatosis polyposis syndrome.  Gross: firm, small nodules with a homogeneous gray-white to yellow cut surface.  Microscopy:cells are arranged in distinctive trabeculae that tend to form cord-like structures and tubules
  • 33. 2. LEYDIG CELL TUMOR-  arise in children or adults  most common presenting feature is testicular swelling  associated with Klinefelter syndrome,cryptorchidism, and hereditary leiomyomatosis and renal cell carcinoma syndrome  Gross: circumscribed nodules, usually less than 5 cm in diameter, that have a distinctive golden brown, homogeneous appearance on cut surfaces./  Microscopy: cells are large in size and have round or polygonal cell outlines, abundant granular eosinophilic cytoplasm, and a round central nucleus.  Cytoplasm frequently contains lipid droplets, vacuoles, or lipofuscin pigment and, most characteristically, rod-shaped crystalloids of Reinke.
  • 34. MCQ
  • 35. C
  • 36.  Q2. NS GCT spreads through  A. Direct spread  B. Lymphatic spread  C. Hematogenous spread  D. All of the above
  • 37. c
  • 38. Q3. A 38 year old man presents with a unilateral, painless palpable mass in the left testis. His serum AFP and hCG are normal with mild LDH elevation. The histology of his orchiectomy specimen is shown. Where would be the most typical first site for metastasis? A. Bone B. Brain C. Lung D. Retroperitoneal nodes
  • 39. D
  • 40.  Q3. Schiller-Duval bodies are characteristic of :  A. Seminoma  B. Yolk Sac Tumor  C. Embryonal Carcinoma  D. Choriocarcinoma
  • 41. B
  • 42.  Q.4 What do yolk sac tumor secrete?  A. AFP  B. hcg  C. PLAP  D. LDH
  • 43. A
  • 44. Q5. Seminoma is an example of which of the following categories of testicular tumors? A. Germ cell tumors derived from germ cell neoplasia in situ B. Germ cell tumors unrelated to germ cell neoplasia in situ C. Sex cord stromal tumors D. Tumor containing both germ cell and sex cord stromal elements
  • 45. A
  • 46. Q6. A 27 year old man presents with a painless enlarging testicular mass. He undergoes appropriate workup and orchiectomy confirms diagnosis of a pure postpubertal teratoma. Which of the following is likely to be true? A. AFP is likely elevated B. Cytogenetic analysis will reveal chromosomal abnormalities C. Few mitotic figures will be identified microscopically D. Hair follicles are likely to be seen microscopically
  • 47. B
  • 48. Q.7 Crystalloids of Reinke is seen in which type of testicular tumors? A.Leydig cell tumor B.Sertoli Cell tumor C.Seminoma D.Choriocarcinoma
  • 49. A
  • 50. Q.8 Which of the following tumor shows cytotrophoblast and syncytiotrophoblast? A.Leydig cell tumor B.Sertoli Cell tumor C.Seminoma D.Choriocarcinoma
  • 51. D
  • 52. Q.9 Which of the following sex cord tumor is associated with Carney complex? A.Leydig cell tumor B.Sertoli Cell tumor C.Seminoma D.Choriocarcinoma
  • 53. B
  • 54. Q.10 Which of the following tumor shows OCT3/4,and podoplanin positivity ? A.Leydig cell tumor B.Sertoli Cell tumor C.Seminoma D.Choriocarcinoma
  • 55. c
  • 56. Q.11 Which of the following tumor shows Cytokeratin, OCT3/4 positivity ? A.Leydig cell tumor B.Sertoli Cell tumor C.Seminoma D.Embryonal carcinoma
  • 57. D
  • 58. Q.12 Which of the following tumor shows : Cytokeratin, α-Fetoprotein, α1-antitrypsin positivity ? A.Leydig cell tumor B.Sertoli Cell tumor C.Seminoma D.Yolk sac tumor
  • 59. D
  • 60. Q.13 Which of the following sex cord tumor is associated with Peutz-Jeghers syndrome ? A.Leydig cell tumor B.Sertoli Cell tumor C.Seminoma D.Choriocarcinoma
  • 61. B
  • 62. Q.14 Which of the following sex cord tumor is associated with cryptorchidism, and hereditary leiomyomatosis ? A.Leydig cell tumor B.Sertoli Cell tumor C.Seminoma D.Choriocarcinoma
  • 63. A

Editor's Notes

  1. C
  2. D
  3. B
  4. A
  5. A
  6. B
  7. A
  8. D
  9. B
  10. C