Repro - 1-13 Male Pathology (Tumors Of Testis And Diseases Of Prostate)

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Normal testis structure

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Seminiferous tubules have germ cells (spermatogonia, prim and secondary spermatocytes and spermatids) and sertoli cells
(sertoli's secrete fluid to ensure maturation and prolif of germ cells)

Interstitium has leydig cells (produce testosterone and other androgens necessary to maintain spermatogenesis)

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Most tumors in testis later in age are...

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lymphomas

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Categories of tumors of the testis

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Germ cell tumors (96%) and non GCT (4%)

Seminoma or non-seminomatous germ cell tumors
non-sem recapitulate features of normal embryogenesis

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Types of non-seminomatous tumors

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Embryonal carcinoma - Most primitive - undiff

Teratoma - Somatic diff of any of the 3 germ cell layers (meso, endo, ecto)

Choriocarcinoma - differentiation to extra-embryonic trophoblast of the placenta.

Yolk sac tumor - recapitulates extraemb mesoderm and endoderm

COMBOS OF THESE ARE VERY COMMON

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aLL GERM CELL TUMORS (EXCEPT spermatocytic seminomas) are derived from...

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intratubular (in situ) germ cell neoplasia

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Cells of intratubular germ cell neoplasia

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identical in many respects

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Beta-HCG

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Produced by syncytiotrophoblast cells in choriocarcinoma

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Alpha fetoprotein

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Produced by yolk sac tumors

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Seminoma

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Lymphocytes almost invariable.
Granulomas in half.
Good px
40% of all testicular tumors are this in the pure form.

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Spermatocytic seminoma

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Older pts
Excellent px
Never outside the testis
Rare sarcomatous transformation (not benign anymore now)
Sometimes a betaHCG increase

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Embryonal carcinoma

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Most common of the nonseminomous germ cell tumors
Invariable cells.

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Yolk sac tumors

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Multiple histo patterns
Alpha fetoprotein
Perivascular Schiller-Duval bodies
PAS inclusions, hyaline globules

Most common testicular neoplasm in children

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Choriocarcinoma

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Often hemorrhagic, aggressive, correlation with betaHCG

Testicular enlargement is common

the pure type has a worse px

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Teratoma

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Age peaks - infancy and young adulthood

Mature and immature types.

Has somatic type malignancies. (development of conventional carcinomas and sarcomas). Sarcomas most common

Mature - strcutres from all 3 germ layers
Immat - resembles embryonic tissues

Prepubertal - behaves benignly
Postpubertal - can give mets and be malignant

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Mixed germ cell tumors

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Most common thing seen.

Even in presence of a seminomatous component these are considered non-seminomatous ebcause behavior and px are trumped by the non-seminomatous element

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LDH

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A non-specific marker that is associated with tumor burden.

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Serum tumor markers

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Part of tumor staging.

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Dx of testicular tumors

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ultrasound is first line.

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Germ cell tumor mets

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Pattern and components may differ btwn primary and metastatic sites.

Metastatic spread - usually lymphangitic, disseminated pattern is common, bone inv is uncommon.

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Which tumor is very radiosensitive?

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Sseminomas

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Non germ cell tumors

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Leydig cell tumors
Sertoli cell
Granulosa cell
Fibroma-thecoma group

Can be hormonally active.

These often aren't malignant, whereas germ cell tumors pretty much are.

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Gross appearance of sex-cord stromal tumors

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Well-circumscribed, small, solid, usually homogenous.

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Lymphoma

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Most common one in men over 60

Most common bilateral testicular tumor.

Rarely only in the testis

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4 zones of the prostate

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Peripheral zone - biopsy here. 70% of mass. Most CA arises here.

Central zone - comprises the base of the prostate

Transition zone - where BPH occurs

Periurethral gland region

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Old view of prostate

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Innter/central prostate - hyperplasia/BPH

Outer/peripheral/posterior prostate - cancer. This part is accessible on rectal exam

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Periph zone can have... (of prostate)

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inflammation and cancer

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transition zone of prostate can have...

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BPH and cancer

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Periurethral zone can have...

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BPH

(this zone can't be targeted with a needle)

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Where is prostate?

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at the base of the bladder.

Most needly biopsies are through the rectal mucosa.

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BPH

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Both hypertrophy and hyperplasia

Has glandular and stromal components.

Can result in hydronephrosis

Dx by seeing change in volume over time

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Other benign conditions of the prostate

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Prostatitis - acute, chronic, granulomatous

Infarct

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Prostate CA

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Pt likely will not die of this.

Incidence depends on race/ethnicity

Found in posterior (peripheral) part of prostate in subcapsular zone

Has indistinct margins and is firm and yellow.

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Histology of prostate CA

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Most important things are macronuclei and loss of basal cell layer

Looking for smaller glands, prom nucleolus, viscous material in lumen, invasion

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Grading of prostate CA

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Gleason score is primary and secondary grade added
Primary is predominant pattern, escondary is any additional pattern of lesser amt.

Prostate CA behaves like avg of the best and worst grades.

Gleason has correlation with px.

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Prostate specific antigen

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high degree of specificity

(there is an immunostain for it - you stain structures OUTSIDE of the prostate!!!)

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High-grade prostatic intraepithelial neoplasia (PIN)

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a premalignant lesion

Cytologic features of malignancy but with a benign architecture.

Isolated finding - repeat the biopsy because there is often a carcinoma elsewhere in the prostate gland.