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53 Cards in this Set
- Front
- Back
List the types of seminoma
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1. Classic
2. Spermatocytic |
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List the types of non-seminoma germ cell tumors
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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. |
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Testicular tumors: age
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In young men from 15-45 (except for spermatocytic seminoma)
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Testicular tumors: incidence
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Increased progressively in the 20th century.
5-6 white males per 100,000 |
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Testicular tumors: racial factors
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White males have a higher rate of testicular tumors.
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Testicular tumors: socioeconomic factors
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Occur more commonly in those of higher economic status.
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Testicular tumors: risk factors
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- Cryptorchidism (10-15x risk of cancer, also increased risk of bilateral cancer in unilateral cryptorchidism)
- Prior hx of GCT - FH - Hx of gonadal dysgenesis |
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ITGCN: what does it stand for?
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Intratubular Germ Cell Neoplasia
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ITGCN: microscopic
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Cells have clear or retracted cytoplasm and enlarged hyperchromic nuclei with one or more nuclei. Spermatogenesis is absent and the tubular BM is thickened.
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What is the most common type of germ cell tumor?
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Seminoma
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Classic seminoma: what percentage of seminomas are classic?
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93%
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Classic seminoma: average age of onset?
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40
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Classic seminoma: histology
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Lobules and nests of tumor cells with typical fibrous septa and lymphocytes.
Clear cytoplasm and centrally located hyperchromatic nuclei. |
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Classic seminoma: tumor marker
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PLAP (placental alkaline phosphatase) is elevated in 40% of cases.
AFP is usually negative HCG is usually negative |
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Spermatocytic seminoma: age
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Older, > 65
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Spermatocytic seminoma: location?
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More frequently bilateral and sometimes multifocal
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Spermatocytic seminoma: prognosis
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Excellent! Slow growing tumor that rarely produces metastises.
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Spermatocytic seminoma: only found where? Seen with other tumors?
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Only found in the testes, never seen in combination with other germ cell tumors.
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Spermatocytic seminoma: histology
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Sheets suppoted by fibrous trabeculae
A mixture of 3 types of cells: medium sized, giant cells, and small cells. |
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c/c Classical seminoma and spermatocytic seminoma: lymphocytic infiltration
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With spermatocytic seminoma there is NO lymphocytic infiltrate
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Embryonal carcinoma: age
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20-30
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Embryonal carcinoma vs. seminomas: personalities
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Embryonal carcinoma is more aggressive.
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Embryonal carcinoma: histology
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Anaplastic with numerous mitoses and exhibit prominent variation in size and shape. Angry-looking hyperchromatic nuclei.
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Embryonal carcinoma vs. seminoma: can you see cell borders?
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Not with embryonal carcinoma - cell borders are usually indistinct.
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Choriocarcinoma: personality
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Highly malignant with aggressive behavior
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Choriocarcinoma: prevalence
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extremely rare (less than 1% of all GCT)
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Choriocarcinoma: age
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20-30s
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Choriocarcinoma: tumor marker?
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HCG is elevated.
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Choriocarcinoma: presentation
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Ususally symptomatic because of metastises of because of gynecomastia (due to production of HCG).
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Choriocarcinoma: histology
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See syncytiotrophoblastic and cytotrophoblastic cells.
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Choriocarcinoma: gross
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Primary tumors are very small. See hemorrhage.
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Yolk sac (Endodermal sinus) tumor: prevalence
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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. |
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Yolk sac (Endodermal sinus) tumor: clinical presentation
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Usually presents as a testicular mass. Can be large.
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Yolk sac (Endodermal sinus) tumor: histology
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Most characteristic: Schiller-Duval Body.
Also see intracytoplasmic hyaline droplets (AFP) and alpha-1-antitrypsin in neoplastic cells. |
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Yolk sac (Endodermal sinus) tumor: tumor marker
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AFP!
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Teratoma: definition
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Tumors of three histologically identifiable germ layers
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Teratoma: age
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Any age. Common in infants, rare in adults.
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Teratoma: clinical
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Painless/painful enlargement of the testes.
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Teratoma: what do you NOT see on gross appearance?
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No hemorrhage or necrosis
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Teratoma: types
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- Mature teratoma
- Immature teratoma - Teratoma with malignant transformation |
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Teratoma in children vs. adults: malignant?
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In prepubertal males, teratomas are usually mature and benign.
In adult males, teratomas ALL are potentially malignant. |
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Teratocarcinoma: what are they?
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Mixed GCTs composed of embryonal carcinoma and teratoma.
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What percentage of GCTs are mixed?
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About 60% (usually a non-seminoma pattern)
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Teratocarcinoma: spread
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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. |
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Which testicular tumors metastisize early?
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Choriocarcinoma and embryonal carcinoma.
Choriocarcinoma is usually metastisized at diagnosis. |
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Testicular tumors: AFP elevation indicates what?
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Yolk sac (endodermal sinus) tumor
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Testicular tumors: PLAP elevation indicates what?
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(Classical seminoma) But not very specific.
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Testicular tumors: HCG elevation indicates what?
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Chorinocarcinoma
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Testicular tumor: staging
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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 |
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Germ cell tumors: chromosome
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Chromosome isochromosome (12p) is usually abnormal.
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How does the treatment of a seminoma and a non-seminoma GCT differ?
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Seminoma: orchiectomy + radiation therapy
Non-seminoma GCT: chemotherapy + retroperitoneal LN dissection. |
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ITGCN: most often progresses to what?
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Seminoma
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ITGCN: NOT associated with what?
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Spermatocytic seminoma
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