Bod: Male Repro: Testicular Tumors

Front 1

List the types of seminoma

Back 1

1. Classic
2. Spermatocytic

Front 2

List the types of non-seminoma germ cell tumors

Back 2

1. Embryonal carcinoma
2. Yolk sac tumor (endodermal sinus tumor)
3. Choriocarcinoma
4. Teratoma (mature, immature, with malignant transformation)
5. Mixed malignant germ cell tumors.

Front 3

Testicular tumors: age

Back 3

In young men from 15-45 (except for spermatocytic seminoma)

Front 4

Testicular tumors: incidence

Back 4

Increased progressively in the 20th century.

5-6 white males per 100,000

Front 5

Testicular tumors: racial factors

Back 5

White males have a higher rate of testicular tumors.

Front 6

Testicular tumors: socioeconomic factors

Back 6

Occur more commonly in those of higher economic status.

Front 7

Testicular tumors: risk factors

Back 7

- Cryptorchidism (10-15x risk of cancer, also increased risk of bilateral cancer in unilateral cryptorchidism)

- Prior hx of GCT

- FH

- Hx of gonadal dysgenesis

Front 8

ITGCN: what does it stand for?

Back 8

Intratubular Germ Cell Neoplasia

Front 9

ITGCN: microscopic

Back 9

Cells have clear or retracted cytoplasm and enlarged hyperchromic nuclei with one or more nuclei. Spermatogenesis is absent and the tubular BM is thickened.

Front 10

What is the most common type of germ cell tumor?

Back 10

Seminoma

Front 11

Classic seminoma: what percentage of seminomas are classic?

Back 11

93%

Front 12

Classic seminoma: average age of onset?

Back 12

40

Front 13

Classic seminoma: histology

Back 13

Lobules and nests of tumor cells with typical fibrous septa and lymphocytes.

Clear cytoplasm and centrally located hyperchromatic nuclei.

Front 14

Classic seminoma: tumor marker

Back 14

PLAP (placental alkaline phosphatase) is elevated in 40% of cases.

AFP is usually negative
HCG is usually negative

Front 15

Spermatocytic seminoma: age

Back 15

Older, > 65

Front 16

Spermatocytic seminoma: location?

Back 16

More frequently bilateral and sometimes multifocal

Front 17

Spermatocytic seminoma: prognosis

Back 17

Excellent! Slow growing tumor that rarely produces metastises.

Front 18

Spermatocytic seminoma: only found where? Seen with other tumors?

Back 18

Only found in the testes, never seen in combination with other germ cell tumors.

Front 19

Spermatocytic seminoma: histology

Back 19

Sheets suppoted by fibrous trabeculae

A mixture of 3 types of cells: medium sized, giant cells, and small cells.

Front 20

c/c Classical seminoma and spermatocytic seminoma: lymphocytic infiltration

Back 20

With spermatocytic seminoma there is NO lymphocytic infiltrate

Front 21

Embryonal carcinoma: age

Back 21

20-30

Front 22

Embryonal carcinoma vs. seminomas: personalities

Back 22

Embryonal carcinoma is more aggressive.

Front 23

Embryonal carcinoma: histology

Back 23

Anaplastic with numerous mitoses and exhibit prominent variation in size and shape. Angry-looking hyperchromatic nuclei.

Front 24

Embryonal carcinoma vs. seminoma: can you see cell borders?

Back 24

Not with embryonal carcinoma - cell borders are usually indistinct.

Front 25

Choriocarcinoma: personality

Back 25

Highly malignant with aggressive behavior

Front 26

Choriocarcinoma: prevalence

Back 26

extremely rare (less than 1% of all GCT)

Front 27

Choriocarcinoma: age

Back 27

20-30s

Front 28

Choriocarcinoma: tumor marker?

Back 28

HCG is elevated.

Front 29

Choriocarcinoma: presentation

Back 29

Ususally symptomatic because of metastises of because of gynecomastia (due to production of HCG).

Front 30

Choriocarcinoma: histology

Back 30

See syncytiotrophoblastic and cytotrophoblastic cells.

Front 31

Choriocarcinoma: gross

Back 31

Primary tumors are very small. See hemorrhage.

Front 32

Yolk sac (Endodermal sinus) tumor: prevalence

Back 32

Most common testicular tumor in children and infants under 3 y.o.

Rare in adults, usually presents as part of a mixed germ cell tumor.

Front 33

Yolk sac (Endodermal sinus) tumor: clinical presentation

Back 33

Usually presents as a testicular mass. Can be large.

Front 34

Yolk sac (Endodermal sinus) tumor: histology

Back 34

Most characteristic: Schiller-Duval Body.

Also see intracytoplasmic hyaline droplets (AFP) and alpha-1-antitrypsin in neoplastic cells.

Front 35

Yolk sac (Endodermal sinus) tumor: tumor marker

Back 35

AFP!

Front 36

Teratoma: definition

Back 36

Tumors of three histologically identifiable germ layers

Front 37

Teratoma: age

Back 37

Any age. Common in infants, rare in adults.

Front 38

Teratoma: clinical

Back 38

Painless/painful enlargement of the testes.

Front 39

Teratoma: what do you NOT see on gross appearance?

Back 39

No hemorrhage or necrosis

Front 40

Teratoma: types

Back 40

- Mature teratoma

- Immature teratoma

- Teratoma with malignant transformation

Front 41

Teratoma in children vs. adults: malignant?

Back 41

In prepubertal males, teratomas are usually mature and benign.

In adult males, teratomas ALL are potentially malignant.

Front 42

Teratocarcinoma: what are they?

Back 42

Mixed GCTs composed of embryonal carcinoma and teratoma.

Front 43

What percentage of GCTs are mixed?

Back 43

About 60% (usually a non-seminoma pattern)

Front 44

Teratocarcinoma: spread

Back 44

Local: scrotum, spermatic cord, epididymis

Lymphatic: preaortic LN, iliac LN. Later to mediastinal and left supraclavicular nodes (Virchow's node)

Hematogenous spread: lungs, liver, bone, brain.

Front 45

Which testicular tumors metastisize early?

Back 45

Choriocarcinoma and embryonal carcinoma.

Choriocarcinoma is usually metastisized at diagnosis.

Front 46

Testicular tumors: AFP elevation indicates what?

Back 46

Yolk sac (endodermal sinus) tumor

Front 47

Testicular tumors: PLAP elevation indicates what?

Back 47

(Classical seminoma) But not very specific.

Front 48

Testicular tumors: HCG elevation indicates what?

Back 48

Chorinocarcinoma

Front 49

Testicular tumor: staging

Back 49

Stage I: tumor confined to the testis

Stage II: distant spread to the retroperitoneal nodes below the diaphragm.

Stage III: Metastases outside the retroperitoneal nodes or above the diaphragm

Front 50

Germ cell tumors: chromosome

Back 50

Chromosome isochromosome (12p) is usually abnormal.

Front 51

How does the treatment of a seminoma and a non-seminoma GCT differ?

Back 51

Seminoma: orchiectomy + radiation therapy

Non-seminoma GCT: chemotherapy + retroperitoneal LN dissection.

Front 52

ITGCN: most often progresses to what?

Back 52

Seminoma

Front 53

ITGCN: NOT associated with what?

Back 53

Spermatocytic seminoma