This document provides an overview of approaches to testicular tumors. It discusses updates to classifications including changing ITGCN to GCNIS. A new classification system is presented that divides tumors into GCT derived from GCNIS, GCT unrelated to GCNIS, sex cord stromal tumors, and other rare tumors. Factors like age, medical history, tumor site, and gross appearance can provide clues before histological examination. Histological patterns including cells with pale cytoplasm, glandular/tubular patterns, microcystic patterns, and oxyphilic cells can indicate tumor types.

1. Approach to Testicular Tumors

2. What is new in 2016?
• ITGCN is now GCNIS
• Germ cell neoplasia in situ
• Does not involve entire tubule
• Add ‘Intratubular’ if it involves entire tubule
– Intratubular seminoma
– Intratubular embryonal

3. New classification
GCT derived
from GCNIS
GCT unrelated to
GCNIS
Sex cord Stromal
Misc tumors Hematolymphoid
Tumors of
collecting duct
and rete testis

4. Most neoplastic scrotal masses
ultimately prove to be germ cell
tumours and are recognisable
with routine haematoxylin and
eosin‐stained sections

5. Age
Medical
history
Tumour site
(testicular vs
paratesticular)
Gross
Before we see the slide !

6. Age
Congenital / <6
mths
• Juvenile
granulosa cell
tumour
Children
>6 mths
• YST
• Teratoma
• Sex
cord‐stromal
tumours
Young men
• GCT –
seminomatous
• Sex
cord‐stromal
tumours
Older men
• Spermatocytic
tumor
• Sex
cord‐stromal
tumours
• Metastasis
• Lymphoma

7. History
Undescended testis
Previous diagnosis of a germ
cell tumour or GCNIS or IT
GCT
Possibility of a GCT very high
Previous or current
carcinoma, lymphoma or
leukaemia
Likely secondary tumour

8. Gross
Seminomas
• Nodules of
homogenous white
or tan tissue
Non‐seminomatous
germ cell tumours
• Zones of
haemorrhage or
necrosis
Teratoma
• Cystic
• Tooth
• Cartilage
Sex cord stromal
• Yellow or tan

10. Tumor markers
LDH : Seminomas and
non‐seminomatous GCT
AFP : YST ; correlates with
the amount of tumour in
mixed germ cell tumours.
hCG : choriocarcinoma and
in seminoma and mixed
germ cell tumours as
syncytiotrophoblast cells
are commonly present in a
scattered fashion
Inhibin : Leydig cell tumour,
Sertoli cell tumour

11. Hormones
Small minority
Rare androgen
excess or
gynaecomastia
resulting from hCG
hCG also has thyroid
stimulating activity -
hyperthyroidism
Hypercalcaemia:
parathyroid
hormone‐like
substance –
seminoma
Steroid producing :
leydig –
Pseudopuberty
Gynecomastia : Sex
cord stromal

12. Patterns on histology
Diffuse cells with
pale to clear
cytoplasm
Glandular/tubular Microcystic
Oxyphilic cells Spindle cells

13. Cells with pale to clear cytoplasm
in a diffuse arrangement

14. Seminoma
Spermatocytic tumor
Solid variant of embryonal carcinoma
Solid pattern yolk sac tumour
Sertoli cell tumour and Leydig cell tumour
Metastases
Lymphoma

16. Tumours with a glandular/tubular
pattern

17. Embryonal carcinoma and yolk sac tumour
Occasional cases of seminoma
Sertoli cell tumours usually have tubular
architecture in at least some foci of the tumour
Rete testis
Metastases

19. Tumours with a microcystic pattern

20. Yolk sac tumour
Seminomas
Leydig cell tumours
Sertoli cell tumours
Paratesticular adenomatoid
tumours.

22. Oxyphilic tumours

23. Leydig cell tumours
Large cell calcifying Sertoli cell tumour
Hepatoid yolk sac tumour
Carcinoid tumour
Intratesticular adenomatoid tumour
Metastatic tumours

25. Tumours in children

26. Yolk sac tumour
Juvenile granulosa
cell tumour

27. Intratubular atypical cells

28. Paratesticular tumours with a glandular‐like,
tubular or papillary pattern

29. Metastatic adenocarcinoma
Mullerian‐type epithelial
tumours
Adenomatoid tumour
Mesothelioma

31. Tumours with spindle cell morphology

32. Leydig cell tumours
Gonadal stromal fibromas
Malignant mesotheliomas
Rhabdomyosarcoma

33. Renike crystals

34. Hyaline globules

35. Schiller Duval bodies

36. Call Exner bodies

37. Synchiotrophoblasts

38. Summarise

39. Thank You