|
|
(59 intermediate revisions by the same user not shown) |
Line 1: |
Line 1: |
| | [[Image:Seminoma_of_the_Testis.jpg|thumb|150px|Orchiectomy specimen showing testis replaced by tumour (proven to be [[seminoma]]). (WC/Ed Uthman)]] |
| The '''testis''', plural '''testes''', are important for survival of the species. Tumours occasionally arise in 'em. They generally are not biopsied. | | The '''testis''', plural '''testes''', are important for survival of the species. Tumours occasionally arise in 'em. They generally are not biopsied. |
|
| |
|
| If the testis is biopsied, it is usually for fertility -- to understand whether the man is really azoospermic. | | If the testis is biopsied, it is usually for [[male infertility|fertility]]. The [[cut-up]] of orchiectomy specimens is dealt with in ''[[orchiectomy grossing]]''. |
|
| |
|
| =Gross= | | =Normal testis= |
| | ===Gross=== |
| Anatomy - deep to superficial: | | Anatomy - deep to superficial: |
| *Tunica albuginea - fibrous layer. | | *Tunica albuginea - fibrous layer. |
| *Tunica vaginalis - thin mesothelial layer. | | *Tunica vaginalis - thin mesothelial layer. |
| | **This layer is important in the [[cancer staging|staging]] of testicular tumours. |
|
| |
|
| =Normal histology= | | ===Microscopic=== |
| ===Seminiferous tubules=== | | ====Seminiferous tubules==== |
| *Sertoli cells ([[AKA]] sustentacular cell [[AKA]] nurse cell). | | *Sertoli cells ([[AKA]] sustentacular cell [[AKA]] nurse cell). |
| **Large cells with oval nucleus. | | **Large cells with oval nucleus. |
Line 22: |
Line 25: |
| **You don't see the tail on light microscopy. | | **You don't see the tail on light microscopy. |
|
| |
|
| Images: | | =====Images===== |
| *[http://commons.wikimedia.org/wiki/File:Seminiferous_tubule_and_sperm_low_mag.jpg Seminiferous tubule and sperm - low mag. (WC/Nephron)].
| | <gallery> |
| *[http://commons.wikimedia.org/wiki/File:Seminiferous_tubule_and_sperm.jpg Seminiferous tubule and sperm - high mag. (WC/Nephron)].
| | Image:Seminiferous_tubule_and_sperm_low_mag.jpg | Seminiferous tubule and sperm - low mag. (WC/Nephron) |
| *[http://commons.wikimedia.org/wiki/File:Intratubular_germ_cell_neoplasia_-_2_-_very_high_mag.jpg Benign seminiferous tubules and ITGCN (WC/Nephron)].
| | Image:Seminiferous_tubule_and_sperm.jpg | Seminiferous tubule and sperm - high mag. (WC/Nephron) |
| | | Image:Intratubular_germ_cell_neoplasia_-_2_-_very_high_mag.jpg | Benign seminiferous tubules and GCNIS (ITGCN). (WC/Nephron) |
| ===Interstitium=== | | </gallery> |
| | ====Interstitial==== |
| *Leydig cell ([[AKA]] interstitial cell). | | *Leydig cell ([[AKA]] interstitial cell). |
| **Large eosinophilic cell. | | **Large eosinophilic cell. |
| *Blood vessels. | | *[[Blood vessel]]s. |
|
| |
|
| ===Associated structures=== | | =====Image===== |
| *Epididymis - stores the sperm. | | <gallery> |
| | Image:Leydig_cells_-_very_high_mag.jpg | Leydig cells - very high mag. (WC/Nephron) |
| | </gallery> |
| | ====Associated structures==== |
| | *[[Epididymis]] - stores the sperm. |
| **Pseudostratified epithelium with cilia. | | **Pseudostratified epithelium with cilia. |
|
| |
|
Line 39: |
Line 47: |
| *[http://www.webpathology.com/image.asp?n=3&Case=27 Epididymis (webpathology.com)]. | | *[http://www.webpathology.com/image.asp?n=3&Case=27 Epididymis (webpathology.com)]. |
|
| |
|
| ===Rete testis=== | | ====Rete testis==== |
| *Receives stuff from the tubules. | | *Receives stuff from the tubules. |
| | *Occasionally afflicted by ''[[adenomatous hyperplasia of the rete testis]]''. |
| *Very rarely give rise to an ''[[adenocarcinoma of the rete testis]]''. | | *Very rarely give rise to an ''[[adenocarcinoma of the rete testis]]''. |
| *May be involved by [[seminoma]] - increases risk of relapse in a univariate analysis.<Ref>{{Cite journal | last1 = Soper | first1 = MS. | last2 = Hastings | first2 = JR. | last3 = Cosmatos | first3 = HA. | last4 = Slezak | first4 = JM. | last5 = Wang | first5 = R. | last6 = Lodin | first6 = K. | title = Observation Versus Adjuvant Radiation or Chemotherapy in the Management of Stage I Seminoma: Clinical Outcomes and Prognostic Factors for Relapse in a Large US Cohort. | journal = Am J Clin Oncol | volume = | issue = | pages = | month = Dec | year = 2012 | doi = 10.1097/COC.0b013e318277d839 | PMID = 23275274 }}</ref> | | *May be involved by [[seminoma]]. |
| | **Increases risk of relapse in a univariate analysis.<Ref>{{Cite journal | last1 = Soper | first1 = MS. | last2 = Hastings | first2 = JR. | last3 = Cosmatos | first3 = HA. | last4 = Slezak | first4 = JM. | last5 = Wang | first5 = R. | last6 = Lodin | first6 = K. | title = Observation Versus Adjuvant Radiation or Chemotherapy in the Management of Stage I Seminoma: Clinical Outcomes and Prognostic Factors for Relapse in a Large US Cohort. | journal = Am J Clin Oncol | volume = | issue = | pages = | month = Dec | year = 2012 | doi = 10.1097/COC.0b013e318277d839 | PMID = 23275274 }}</ref> |
| | **More common with (sometimes subtle) intertubular pattern of seminoma.<ref name=pmid16021570>{{Cite journal | last1 = Browne | first1 = TJ. | last2 = Richie | first2 = JP. | last3 = Gilligan | first3 = TD. | last4 = Rubin | first4 = MA. | title = Intertubular growth in pure seminomas: associations with poor prognostic parameters. | journal = Hum Pathol | volume = 36 | issue = 6 | pages = 640-5 | month = Jun | year = 2005 | doi = 10.1016/j.humpath.2005.03.011 | PMID = 16021570 }}</ref> |
|
| |
|
| Microscopic: | | Microscopic: |
| *Delicate anastomosing channels lined by cuboid epithelium. | | *Delicate anastomosing channels lined by cuboid epithelium. |
|
| |
|
| Images: | | =====Images===== |
| *[http://commons.wikimedia.org/wiki/File:Rete_testis_high_mag.jpg Rete testis (WC/Nephron)].
| | <gallery> |
| *[http://commons.wikimedia.org/wiki/File:Rete_testis_with_seminoma.jpg Seminoma in the rete testis (WC/Nephron)]. | | Image:Rete_testis_high_mag.jpg | Rete testis (WC/Nephron) |
| | *[Image:Rete_testis_with_seminoma.jpg | Seminoma in the rete testis (WC/Nephron) |
| | </gallery> |
| | www: |
| *[http://www.webpathology.com/image.asp?case=27&n=5 Rete testis (webpathology.com)]. | | *[http://www.webpathology.com/image.asp?case=27&n=5 Rete testis (webpathology.com)]. |
|
| |
|
| ===Appendix of testis=== | | ====Appendix of testis==== |
| Muellerian duct remnant. | | *Muellerian duct remnant. |
|
| |
|
| Microscopic: | | Microscopic: |
Line 61: |
Line 75: |
| *[http://www.webpathology.com/image.asp?case=27&n=8 Appendix of testis (webpathology.com)]. | | *[http://www.webpathology.com/image.asp?case=27&n=8 Appendix of testis (webpathology.com)]. |
| *[http://www.webpathology.com/image.asp?case=27&n=7 Appendix of testis (webpathology.com)]. | | *[http://www.webpathology.com/image.asp?case=27&n=7 Appendix of testis (webpathology.com)]. |
| | |
| | ===Sign out=== |
| | <pre> |
| | TESTICLE, RIGHT, ORCHIECTOMY: |
| | - TESTICLE WITHOUT APPARENT PATHOLOGY. |
| | - NEGATIVE FOR INTRATUBULAR GERM CELL NEOPLASIA. |
| | - NEGATIVE FOR MALIGNANCY. |
| | </pre> |
| | |
| | ====Alternate==== |
| | <pre> |
| | RIGHT TESTICLE, ORCHIDECTOMY: |
| | - BENIGN TESTIS WITH SPERMATOGENESIS. |
| | - NEGATIVE FOR INTRATUBULAR GERM CELL NEOPLASIA. |
| | - NEGATIVE FOR MALIGNANCY. |
| | </pre> |
|
| |
|
| =Diagnoses (overview)= | | =Diagnoses (overview)= |
Line 67: |
Line 97: |
| *Infertility - azoospermic. | | *Infertility - azoospermic. |
| **No sperm present. | | **No sperm present. |
| *Germ cell tumours (GCTs). | | *[[Germ cell tumours]] (GCTs). |
| **Intratubular germ cell neoplasia. | | **[[Intratubular germ cell neoplasia]]. |
| **Seminoma. | | **[[Seminoma]]. |
| **Spermatocytic seminoma. | | **[[Spermatocytic seminoma]]. |
| **Yolk sac tumour (endodermal sinus tumour). | | **[[Yolk sac tumour]] (endodermal sinus tumour). |
| **Embryonal carcinoma. | | **[[Embryonal carcinoma]]. |
| **Choriocarcinoma. | | **[[Choriocarcinoma]]. |
| **Teratoma. | | **[[Teratoma]]. |
| **Mixed GCT - 60% of GCTs are mixed. | | **[[Mixed GCT]] - 60% of GCTs are mixed. |
| ***Common combinations: | | ***Common combinations: |
| ***# teratoma + embryonal carcinoma + endodermal sinus tumour (yolk sac tumour) (TEE). | | ***# teratoma + embryonal carcinoma + endodermal sinus tumour (yolk sac tumour) (TEE). |
Line 81: |
Line 111: |
| ***# embryonal + teratoma (TE). | | ***# embryonal + teratoma (TE). |
| *Sex-cord stromal tumour. | | *Sex-cord stromal tumour. |
| **Leydig cell tumour. | | **[[Leydig cell tumour]]. |
| **Sertoli cell tumour. | | **[[Sertoli cell tumour]]. |
|
| |
|
| ===IHC for GCTs=== | | ===IHC for GCTs=== |
Line 89: |
Line 119: |
| *Beta-hCG - choriocarcinoma. | | *Beta-hCG - choriocarcinoma. |
| *CD30 - embryonal carcinoma. | | *CD30 - embryonal carcinoma. |
| *D2-40 - seminoma. | | *[[D2-40]] - seminoma. |
|
| |
|
| ===Tabular summary of GCTs=== | | ===Tabular summary of GCTs=== |
Line 100: |
Line 130: |
| ! Image | | ! Image |
| |- | | |- |
| | [[Intratubular germ cell neoplasia]] (ITGCN) | | | [[Germ cell neoplasia in situ]] (GCNIS) |
| | nests of small fried egg cells | | | nests of small fried egg cells |
| | large central nucleus, clear <br>cytoplasm, round ''or'' polygonal nuclear membrane, [[nucleoli]]<ref name=Ref_GUP538>{{Ref GUP|538}}</ref> | | | large central nucleus, clear <br>cytoplasm, round ''or'' polygonal nuclear membrane, [[nucleoli]]<ref name=Ref_GUP538>{{Ref GUP|538}}</ref> |
| | CD117 | | | CD117 |
| | appearance similar to seminoma | | | appearance similar to seminoma |
| | [http://commons.wikimedia.org/wiki/File:Intratubular_germ_cell_neoplasia_high_mag.jpg], [http://commons.wikimedia.org/wiki/File:Intratubular_germ_cell_neoplasia_high_mag_cropped.jpg] | | | [[Image:Intratubular_germ_cell_neoplasia_high_mag_cropped.jpg|thumb|center|150px|GCNIS (WC)]] |
| |- | | |- |
| | [[Seminoma]] | | | [[Seminoma]] |
Line 112: |
Line 142: |
| | D2-40 | | | D2-40 |
| | Dysgerminoma = female version of this tumour | | | Dysgerminoma = female version of this tumour |
| | [http://commons.wikimedia.org/wiki/File:Seminoma_high_mag.jpg], [http://commons.wikimedia.org/wiki/File:Seminoma_intermed_mag.jpg] | | | [[Image:Seminoma_high_mag.jpg|thumb|center|150px|Seminoma (WC)]] |
| |- | | |- |
| | [[Yolk sac tumour]] (endodermal sinus tumour) | | | [[Yolk sac tumour]] (endodermal sinus tumour) |
Line 119: |
Line 149: |
| | AFP | | | AFP |
| | patterns: microcystic, solid, hepatoid | | | patterns: microcystic, solid, hepatoid |
| | [http://webpathology.com/image.asp?case=34&n=6 hepatoid YST] | | | [[Image:Mixed_germ_cell_tumour_-_very_high_mag.jpg|thumb|center|150px|Yolk sac tumour (WC)]] |
| |- | | |- |
| | [[Embryonal carcinoma]] | | | [[Embryonal carcinoma]] |
Line 126: |
Line 156: |
| | CD30 | | | CD30 |
| | usu. part of a mixed GCT | | | usu. part of a mixed GCT |
| | [http://commons.wikimedia.org/wiki/File:Embryonal_carcinoma_intermed_mag.jpg], [http://www.webpathology.com/image.asp?case=33&n=1], [http://www.webpathology.com/image.asp?n=4&Case=37] | | | [[Image:Embryonal_carcinoma_high_mag.jpg|thumb|center|150px|Embryonal carcinoma (WC)]] |
| |- | | |- |
| | [[Choriocarcinoma]] | | | [[Choriocarcinoma]] |
Line 132: |
Line 162: |
| | cells with clear cytoplasm (cytotrophoblast), multinucleated cells (syncytiotrophoblast) | | | cells with clear cytoplasm (cytotrophoblast), multinucleated cells (syncytiotrophoblast) |
| | beta-hCG | | | beta-hCG |
| | other | | | not commonly pure, usu. a component of a mixed GCT |
| | [http://www.webpathology.com/image.asp?case=36&n=1] | | | [[Image:Choriocarcinoma_-2-_very_high_mag.jpg|thumb|center|150px|Choriocarcinoma (WC)]] |
| |- | | |- |
| | [[Teratoma]], immature | | | [[Teratoma]] |
| | primitive neuroepithelium | | | skin, GI tract-like epithelium |
| | pseudostratified epithelium in rosettes (gland-like arrangement)
| | | skin (epidermis, adnexal structures - sebaceous glands, hair follicles), GI tract-like glands (simple tall columnar epithelium), fat +/-primitive neuroepithelium (pseudostratified epithelium in [[rosettes]]) |
| | None | | | None |
| | teratoma are always malignant in males | | | testicular teratomas in post-pubertal males are all considered malignant<ref>{{Cite journal | last1 = Carver | first1 = BS. | last2 = Al-Ahmadie | first2 = H. | last3 = Sheinfeld | first3 = J. | title = Adult and pediatric testicular teratoma. | journal = Urol Clin North Am | volume = 34 | issue = 2 | pages = 245-51; abstract x | month = May | year = 2007 | doi = 10.1016/j.ucl.2007.02.013 | PMID = 17484929 }}</ref> |
| | [http://commons.wikimedia.org/wiki/File:Primitive_neuroepithelium_intermed_mag.jpg] | | | [[Image:Teratoma_2_low_mag.jpg|thumb|center|150px|Teratoma (WC)]] |
| |- | | |- |
| | [[Spermatocytic seminoma]] | | | [[Spermatocytic tumour]] (previously ''spermatocytic seminoma'') |
| | population of 3 cells | | | population of 3 cells |
| | pop.: (1) small cell with high [[NC ratio]] (mature lymphocyte-like), (2) medium with nucleoli, (3) large cells with filamentous chromatin - few present | | | pop.: (1) small cell with high [[NC ratio]] (mature lymphocyte-like), (2) medium with nucleoli, (3) large cells with filamentous chromatin - few present |
| | ? | | | ? |
| | does not arise from ITGCN, no lymphocytic infiltrate (like in seminoma) | | | does not arise from GCNIS, no lymphocytic infiltrate (like in seminoma) |
| | [http://commons.wikimedia.org/wiki/File:Spermatocytic_seminoma_high_mag.jpg] | | | [[Image:Spermatocytic_seminoma_high_mag.jpg|thumb|center|150px|Spermatocytic tumour (WC)]] |
| |- | | |- |
| | [[Mixed germ cell tumour]] | | | [[Mixed germ cell tumour]] |
Line 154: |
Line 184: |
| | NA | | | NA |
| | - | | | - |
| | - | | | [[Image:Mixed_germ_cell_tumour_-_intermed_mag.jpg|thumb|center|150px|Mixed GCT (WC)]] |
| |} | | |} |
|
| |
|
Line 171: |
Line 201: |
| | MART-1, calretinin, inhibin | | | MART-1, calretinin, inhibin |
| | +/-Reinke crystals (cylindrical crystalloid eosinophilic cytoplasmic bodies) | | | +/-Reinke crystals (cylindrical crystalloid eosinophilic cytoplasmic bodies) |
| | [http://commons.wikimedia.org/wiki/File:Leydig_cell_tumour2.jpg] | | | [[Image:Leydig_cell_tumour3.jpg|thumb|center|150px|Leydig cell tumour (WC)]] |
| |- | | |- |
| | [[Sertoli cell tumour]] | | | [[Sertoli cell tumour]] |
Line 178: |
Line 208: |
| | ? | | | ? |
| | usu. no significant nuclear atypia, no mitoses | | | usu. no significant nuclear atypia, no mitoses |
| | [http://commons.wikimedia.org/wiki/File:Sertoli_cell_tumour_low_mag.jpg] | | | [[Image:Sertoli_cell_tumour_high_mag.jpg|thumb|center|150px|Sertoli cell tumour (WC)]] |
| |} | | |} |
|
| |
|
| =Benign= | | =Benign= |
| ==Testicular atrophy== | | ==Testicular atrophy== |
| :''Cryptorchidism'' redirects here.
| |
| *[[AKA]] ''atrophic testis''. | | *[[AKA]] ''atrophic testis''. |
| *[[AKA]] ''atrophy of the testis''. | | *[[AKA]] ''atrophy of the testis''. |
| ===General===
| | {{Main|Testicular atrophy}} |
| *Microscopic appearance identical to ''cryptorchidism'' (undescended testis).<ref name=Ref_PCPBoD8_506-7>{{Ref PCPBoD8|506-7}}</ref>
| |
| | |
| ===Gross===
| |
| *Decreased size.
| |
| | |
| ===Microscopic===
| |
| Features:<ref name=Ref_PCPBoD8_506-7>{{Ref PCPBoD8|506-7}}</ref>
| |
| *Thickening of seminiferous tubule basement membrane.
| |
| *Intertubular fibrosis.
| |
| *Decreased sperm/no sperm present.
| |
| | |
| Note:
| |
| *End-stage testicle - only has Sertoli cell within the seminiferous tubules.
| |
| | |
| Image:
| |
| *[http://www.surgicalpathologyatlas.com/glfusion/mediagallery/media.php?f=0&sort=0&s=20080802171227609 Testicular atrophy (surgicalpathologyatlas.com)].
| |
| | |
| ===Sign out===
| |
| <pre>
| |
| TESTICLE, RIGHT, ORCHIECTOMY:
| |
| - ATROPHIC TESTICLE.
| |
| - NEGATIVE FOR INTRATUBULAR GERM CELL NEOPLASIA.
| |
| - NEGATIVE FOR MALIGNANCY.
| |
| </pre>
| |
| | |
| ====Micro====
| |
| The sections show seminiferous tubules surrounded by thick hyaline sleeves. In a large number of sections only Sertoli cells are found in the tubules.
| |
| | |
| In some sections poorly defined paucicellular tubular structures reminiscent of seminiferous tubules composed of hyaline material are present; these probably represent obsolete seminiferous tubules. Focally, fibrosis is seen without definite tumour outlines. There is no significant inflammation. The rete testis is identified.
| |
| | |
| Rare seminiferous tubules have spermatid within. The germ cells seen do not have appreciable nuclear atypia.
| |
|
| |
|
| Numerous small Leydig cell clusters are seen in some sections.
| | ==Male infertility== |
| | *This is a [[clinical diagnosis]]. |
| | {{Main|Male infertility}} |
|
| |
|
| ==Spermatocele== | | ==Spermatocele== |
| ===General===
| | {{Main|Spermatocele}} |
| *Benign.
| |
| *Cyst of the epididymis (classic).
| |
| **May arise in the rete testis or [[vas deferens]].<ref>URL: [http://emedicine.medscape.com/article/443432-overview http://emedicine.medscape.com/article/443432-overview]. Accessed on: 5 March 2012.</ref>
| |
| | |
| Clinical:
| |
| *Often asymptomatic.
| |
| *Excised due to pain or mass effect.<ref name=pmid18357964>{{Cite journal | last1 = Walsh | first1 = TJ. | last2 = Seeger | first2 = KT. | last3 = Turek | first3 = PJ. | title = Spermatoceles in adults: when does size matter? | journal = Arch Androl | volume = 53 | issue = 6 | pages = 345-8 | month = | year = | doi = | PMID = 18357964 }}</ref>
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| *Cyst lined by a simple ciliated epithelium.
| |
| *Contain sperm.
| |
| **Head: ~1/2 the size of a [[RBC]], black.
| |
| **Tail: infrequently seen.
| |
| | |
| Note:
| |
| *Small cellular clusters may be present.
| |
| **May mimic [[small cell carcinoma]].<ref name=pmid19740515>{{Cite journal | last1 = Lane | first1 = Z. | last2 = Epstein | first2 = JI. | title = Small blue cells mimicking small cell carcinoma in spermatocele and hydrocele specimens: a report of 5 cases. | journal = Hum Pathol | volume = 41 | issue = 1 | pages = 88-93 | month = Jan | year = 2010 | doi = 10.1016/j.humpath.2009.06.018 | PMID = 19740515 }}</ref>
| |
| | |
| DDx:
| |
| *[[Hydrocele testis]] - do not contain sperm.
| |
| | |
| Images:
| |
| *www:
| |
| **[http://www.webpathology.com/image.asp?n=4&Case=40 Spermatocele - low mag. (webpathology.com)].
| |
| **[http://www.webpathology.com/image.asp?n=5&Case=40 Spermatocele - high mag. (webpathology.com)].
| |
| *[[WC]]:
| |
| **[http://commons.wikimedia.org/wiki/File:Spermatocele_-_intermed_mag.jpg Spermatocele - intermed. mag. (WC)].
| |
| **[http://commons.wikimedia.org/wiki/File:Spermatocele_-_very_high_mag.jpg Spermatocele - very high mag. (WC)].
| |
|
| |
|
| ==Hydrocele testis== | | ==Hydrocele testis== |
| *[[AKA]] ''hydrocele''. | | *[[AKA]] ''hydrocele''. |
| ===General===
| | {{Main|Hydrocele testis}} |
| *Benign.
| |
| | |
| Clinical:
| |
| *Scrotal mass.
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| *Cyst lined by a simple ciliated epithelium.
| |
| *Does '''not''' contain sperm.
| |
| | |
| DDx:
| |
| *[[Spermatocele]] - contains sperm.
| |
|
| |
|
| ==Idiopathic granulomatous orchitis== | | ==Idiopathic granulomatous orchitis== |
Line 282: |
Line 241: |
|
| |
|
| DDx: | | DDx: |
| *[[ITGCN]]. | | *[[GCNIS]] (ITGCN). |
| *[[Seminoma]]. | | *[[Seminoma]]. |
| *Tertiary [[syphilis]] - classically, plasma cell rich.<ref name=pmid22343746>{{Cite journal | last1 = Sekita | first1 = N. | last2 = Nishikawa | first2 = R. | last3 = Fujimura | first3 = M. | last4 = Sugano | first4 = I. | last5 = Mikami | first5 = K. | title = [Syphilitic orchitis: a case report]. | journal = Hinyokika Kiyo | volume = 58 | issue = 1 | pages = 53-5 | month = Jan | year = 2012 | doi = | PMID = 22343746 }}</ref> | | *Tertiary [[syphilis]] - classically, plasma cell rich.<ref name=pmid22343746>{{Cite journal | last1 = Sekita | first1 = N. | last2 = Nishikawa | first2 = R. | last3 = Fujimura | first3 = M. | last4 = Sugano | first4 = I. | last5 = Mikami | first5 = K. | title = [Syphilitic orchitis: a case report]. | journal = Hinyokika Kiyo | volume = 58 | issue = 1 | pages = 53-5 | month = Jan | year = 2012 | doi = | PMID = 22343746 }}</ref> |
Line 289: |
Line 248: |
| *[[Lymphoma]].<ref name=pmid21458170/> | | *[[Lymphoma]].<ref name=pmid21458170/> |
| *[[Malakoplakia]].<ref name=pmid21458170/> | | *[[Malakoplakia]].<ref name=pmid21458170/> |
| | *BCG-associated orchitis.<ref name=pmid23856256>{{Cite journal | last1 = Parker | first1 = SG. | last2 = Kommu | first2 = SS. | title = Post-intravesical BCG epididymo-orchitis: Case report and a review of the literature. | journal = Int J Surg Case Rep | volume = 4 | issue = 9 | pages = 768-70 | month = | year = 2013 | doi = 10.1016/j.ijscr.2013.05.017 | PMID = 23856256 }}</ref><ref name=pmid12841318>{{Cite journal | last1 = Bulbul | first1 = MA. | last2 = Hijaz | first2 = A. | last3 = Beaini | first3 = M. | last4 = Araj | first4 = GF. | last5 = Tawil | first5 = A. | title = Tuberculous epididymo-orchitis following intravesical BCG for superficial bladder cancer. | journal = J Med Liban | volume = 50 | issue = 1-2 | pages = 67-9 | month = | year = | doi = | PMID = 12841318 }}</ref> |
|
| |
|
| ===Stains=== | | ===Stains=== |
Line 294: |
Line 254: |
| *[[Dieterle stain]] -ve -- for syphilis. | | *[[Dieterle stain]] -ve -- for syphilis. |
|
| |
|
| =Premalignant= | | ==Testicular scar== |
| ==Intratubular germ cell neoplasia==
| | {{Main|Testicular scar}} |
| *Abbreviated ''ITGCN''.
| |
| ===General===
| |
| *Considered the precursor lesion for germ cell tumours.
| |
| *Not all germ cell tumours (GCTs) arise from ''intratubular germ cell neoplasia''.
| |
|
| |
|
| The following testicular GCTs do not arise from ITGCN:
| | ==Testicular abscess== |
| *[[Spermatocytic seminoma]].<ref>{{cite journal |author=Müller J, Skakkebaek NE, Parkinson MC |title=The spermatocytic seminoma: views on pathogenesis |journal=Int. J. Androl. |volume=10 |issue=1 |pages=147–56 |year=1987 |month=February |pmid=3583416 |doi= |url=}}</ref>
| | {{Main|Testicular abscess}} |
| *[[Yolk sac tumour]]s (endodermal sinus tumour).<ref>{{cite journal |author=Manivel JC, Simonton S, Wold LE, Dehner LP |title=Absence of intratubular germ cell neoplasia in testicular yolk sac tumors in children. A histochemical and immunohistochemical study |journal=Arch. Pathol. Lab. Med. |volume=112 |issue=6 |pages=641–5 |year=1988 |month=June |pmid=2837162 |doi= |url=}}</ref>
| |
| *Teratoma.{{Fact}}
| |
|
| |
|
| Classification:<ref name=pmid11900581/>
| | ==Testicular torsion== |
| *Undifferentiated ITGCN.
| | {{Main|Testicular torsion}} |
| *Differentiated ITGCN.<ref name=pmid17592271>{{Cite journal | last1 = Lau | first1 = SK. | last2 = Weiss | first2 = LM. | last3 = Chu | first3 = PG. | title = Association of intratubular seminoma and intratubular embryonal carcinoma with invasive testicular germ cell tumors. | journal = Am J Surg Pathol | volume = 31 | issue = 7 | pages = 1045-9 | month = Jul | year = 2007 | doi = 10.1097/PAS.0b013e31802b8712 | PMID = 17592271 }}</ref>
| |
| **''Intratubular embryonal carcinoma''.
| |
| **''Intratubular seminoma.''
| |
|
| |
|
| ===Microscopic=== | | ==Adenomatous hyperplasia of the rete testis== |
| Features:<ref>URL: [http://www.webpathology.com/image.asp?case=30&n=1 http://www.webpathology.com/image.asp?case=30&n=1]. Accessed on: 18 May 2010.</ref><ref name=pmid3328244>{{Cite journal | last1 = Gondos | first1 = B. | last2 = Migliozzi | first2 = JA. | title = Intratubular germ cell neoplasia. | journal = Semin Diagn Pathol | volume = 4 | issue = 4 | pages = 292-303 | month = Nov | year = 1987 | doi = | PMID = 3328244 }}</ref>
| | {{Main|Adenomatous hyperplasia of the rete testis}} |
| *"Large" round ''or'' polygonal nuclei.
| |
| **Size in relation to normal often not defined.
| |
| ***Rakheja ''et al.'' say >= 5x a lymphocyte for intratubular embryonal carcinoma.<ref name=pmid11900581>{{Cite journal | last1 = Rakheja | first1 = D. | last2 = Hoang | first2 = MP. | last3 = Sharma | first3 = S. | last4 = Albores-Saavedra | first4 = J. | title = Intratubular embryonal carcinoma. | journal = Arch Pathol Lab Med | volume = 126 | issue = 4 | pages = 487-90 | month = Apr | year = 2002 | doi = 10.1043/0003-9985(2002)1260487:IEC2.0.CO;2 | PMID = 11900581 | url = http://www.archivesofpathology.org/doi/full/10.1043/0003-9985(2002)126%3C0487:IEC%3E2.0.CO;2 }}</ref>
| |
| **Polygonal nuclei = squared-off nuclear membrane.
| |
| *Prominent nucleoli - '''key feature'''.
| |
| *Clear cytoplasm.
| |
| *+/-Cells fill the tubule.
| |
| | |
| DDx:
| |
| *Sertoli cell-only syndrome - Sertoli cells also have nucleoli, wind swept appearance.<ref>URL: [http://www.webpathology.com/image.asp?n=3&Case=28 http://www.webpathology.com/image.asp?n=3&Case=28]. Accessed on: 25 March 2013.</ref>
| |
|
| |
|
| Images:
| | ==Epidermoid cyst of the testis== |
| *[[WC]]:
| | {{Main|Epidermoid cyst of the testis}} |
| **[http://commons.wikimedia.org/wiki/File:Intratubular_germ_cell_neoplasia_high_mag_cropped.jpg ITGCN - cropped (WC)].
| |
| **[http://commons.wikimedia.org/wiki/File:Intratubular_germ_cell_neoplasia_high_mag.jpg ITGCN (WC)].
| |
| *www:
| |
| **[http://www.webpathology.com/image.asp?case=30&n=1 ITGCN (webpathology.com)].
| |
| **[http://www.archivesofpathology.org/na101/home/literatum/publisher/pinnacle/journals/content/arpa/2002/15432165-126.4/0003-9985%282002%29126%3C0487%3Aiec%3E2.0.co%3B2/production/images/large/i1543-2165-126-4-487-f01.jpeg Intratubular embryonal carcinoma (archivesofpathology.org)].<ref name=pmid11900581/>
| |
|
| |
|
| ===IHC=== | | ==Testicular trauma== |
| Features:<ref name=pmid15221945>{{Cite journal | last1 = Honecker | first1 = F. | last2 = Stoop | first2 = H. | last3 = de Krijger | first3 = RR. | last4 = Chris Lau | first4 = YF. | last5 = Bokemeyer | first5 = C. | last6 = Looijenga | first6 = LH. | title = Pathobiological implications of the expression of markers of testicular carcinoma in situ by fetal germ cells. | journal = J Pathol | volume = 203 | issue = 3 | pages = 849-57 | month = Jul | year = 2004 | doi = 10.1002/path.1587 | PMID = 15221945 }}</ref>
| |
| *PLAP +ve.<ref>{{Cite journal | last1 = Schreiber | first1 = L. | last2 = Lifschitz-Mercer | first2 = B. | last3 = Paz | first3 = G. | last4 = Yavetz | first4 = H. | last5 = Elliott | first5 = DJ. | last6 = Kula | first6 = K. | last7 = Slowikowska-Hilczer | first7 = J. | last8 = Maymon | first8 = BB. | title = Double immunolabeling by the RBM and the PLAP markers for identifying intratubular (in situ) germ cell neoplasia of the testis. | journal = Int J Surg Pathol | volume = 11 | issue = 1 | pages = 17-20 | month = Jan | year = 2003 | doi = | PMID = 12598912 }}</ref>
| |
| *CD117 +ve.
| |
| **Disputed: doesn't differentiate neoplastic from non-neoplastic according to Biermann ''et al''.<ref name=pmid22340755>{{Cite journal | last1 = Biermann | first1 = K. | last2 = Stoop | first2 = H. | last3 = Looijenga | first3 = L. | title = c-KIT protein expression does not discriminate neoplastic from non-neoplastic intratubular germ cells. | journal = Histopathology | volume = 60 | issue = 6 | pages = 1017-9 | month = May | year = 2012 | doi = 10.1111/j.1365-2559.2011.04157.x | PMID = 22340755 }}</ref>
| |
| *OCT3/4 +ve.
| |
| | |
| Note:
| |
| *Normal testis PLAP -ve, CD117 -ve.<ref name=pmid9104938>{{Cite journal | last1 = Hawkins | first1 = E. | last2 = Heifetz | first2 = SA. | last3 = Giller | first3 = R. | last4 = Cushing | first4 = B. | title = The prepubertal testis (prenatal and postnatal): its relationship to intratubular germ cell neoplasia: a combined Pediatric Oncology Group and Children's Cancer Study Group. | journal = Hum Pathol | volume = 28 | issue = 4 | pages = 404-10 | month = Apr | year = 1997 | doi = | PMID = 9104938 }}</ref>
| |
| | |
| =Germ cell tumours=
| |
| {{Main|Germ cell tumours}}
| |
| ==Seminoma==
| |
| :Should ''not'' be confused with the unrelated tumour called ''[[spermatocytic seminoma]]''.
| |
| ===General=== | | ===General=== |
| *Male counterpart of the [[dysgerminoma]], which arise in the [[ovary]]. | | *May lead to orchitectomy. |
| *Most common [[germ cell tumour]] of the testis.
| |
|
| |
|
| Clinical:
| | ===Gross=== |
| *Elevated serum LDH. | | *Hemorrhagic. |
| *Normal serum alpha fetoprotein.
| |
| *Usually normal beta-hCG.
| |
|
| |
|
| Note:
| | ===Microscopic=== |
| *Rarely, it may present a retroperitoneal mass.<ref name=pmid21424055>{{Cite journal | last1 = Preda | first1 = O. | last2 = Nicolae | first2 = A. | last3 = Loghin | first3 = A. | last4 = Borda | first4 = A. | last5 = Nogales | first5 = FF. | title = Retroperitoneal seminoma as a first manifestation of a partially regressed (burnt-out) testicular germ cell tumor. | journal = Rom J Morphol Embryol | volume = 52 | issue = 1 | pages = 193-6 | month = | year = 2011 | doi = | PMID = 21424055 }}</ref>
| |
| | |
| ====Epidemiology & etiology====
| |
| *Arises from ''[[intratubular germ cell neoplasia]]'' (ITGCN).
| |
| | |
| ===Microsopic===
| |
| Features: | | Features: |
| *Cells with fried egg appearance - '''key feature''': | | *Necrotic seminiferous tubules. |
| **Clear cytoplasm.
| | *Intratubular blood in keeping with hemorrhage. |
| **Central nucleus, with prominent nucleolus. | |
| ***Nucleus may have "corners", i.e. it is ''not'' round.
| |
| *+/-Lymphoctyes - interspersed (very common).
| |
| *+/-[[Syncytiotrophoblast]]s, [[AKA]] ''syncytiotrophoblastic giant cells'' (STGCs),<ref name=Ref_GUP542>{{Ref GUP|542}}</ref> present in ~10-20% of seminoma.<ref>URL: [http://www.webpathology.com/image.asp?case=31&n=10 http://www.webpathology.com/image.asp?case=31&n=10]. Accessed on: 22 May 2012.</ref>
| |
| **Large + irregular, vesicular nuclei.
| |
| **Eosinophilic vacuolated cytoplasm (contains hCG).
| |
| ***Syncytiotrophoblasts = closest to mom in normal [[chorionic villi]] - covers cytotrophoblast.<ref>URL: [http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png]. Accessed on: 31 May 2010.</ref>
| |
| *+/-Florid granulomatous reaction.
| |
|
| |
|
| Memory device: 3 Cs - clear cytoplasm, central nucleus, corners on the nuclear membrane.
| | Note: |
| | | *Normal spermatogenesis in background - if viable tissue present. |
| DDx:
| |
| *[[Embryonal carcinoma]]. | |
| *Solid variant of [[yolk sac tumour]].
| |
| **Lacks fibrous septae and lymphocytes.<ref>URL: [http://webpathology.com/image.asp?case=34&n=8 http://webpathology.com/image.asp?case=34&n=8]. Accessed on: March 8, 2010.</ref>
| |
| *[[Mixed germ cell tumour]].
| |
| *[[Choriocarcinoma]] - esp. if (multinucleated) syncytiotrophoblasts are present.<ref name=pmid157614>{{Cite journal | last1 = Hedinger | first1 = C. | last2 = von Hochstetter | first2 = AR. | last3 = Egloff | first3 = B. | title = Seminoma with syncytiotrophoblastic giant cells. A special form of seminoma. | journal = Virchows Arch A Pathol Anat Histol | volume = 383 | issue = 1 | pages = 59-67 | month = Jul | year = 1979 | doi = | PMID = 157614 }}</ref>
| |
| *Granulomatous orchitis - if [[granuloma]]s are present.
| |
| | |
| Images:
| |
| *[http://commons.wikimedia.org/wiki/File:Seminoma_high_mag.jpg Seminoma - high mag. (WC/Nephron)].
| |
| *[http://commons.wikimedia.org/wiki/File:Seminoma_intermed_mag.jpg Seminoma - intermed. mag. (WC/Nephron)].
| |
| *[http://commons.wikimedia.org/wiki/File:Rete_testis_with_seminoma.jpg Seminoma in the rete testis (WC/Nephron)].
| |
| *[http://commons.wikimedia.org/wiki/File:Seminoma_with_syncytiotrophoblasts_-_intermed_mag.jpg Seminoma with syncytiotrophoblasts - intermed. mag. (WC/Nephron)].
| |
| *[http://commons.wikimedia.org/wiki/File:Seminoma_with_syncytiotrophoblasts_-_very_high_mag.jpg Seminoma with syncytiotrophoblasts - very high mag. (WC/Nephron)].
| |
| | |
| ===IHC===
| |
| *D2-40 +ve ~100% of cases.<ref name=pmid17277761>{{Cite journal | last1 = Lau | first1 = SK. | last2 = Weiss | first2 = LM. | last3 = Chu | first3 = PG. | title = D2-40 immunohistochemistry in the differential diagnosis of seminoma and embryonal carcinoma: a comparative immunohistochemical study with KIT (CD117) and CD30. | journal = Mod Pathol | volume = 20 | issue = 3 | pages = 320-5 | month = Mar | year = 2007 | doi = 10.1038/modpathol.3800749 | PMID = 17277761 }}</ref>
| |
| *CD117 +ve (ckit) ~92% of cases.<ref name=pmid17277761/>
| |
| *CD30 -ve.<ref name=pmid16867864>{{Cite journal | last1 = Cossu-Rocca | first1 = P. | last2 = Jones | first2 = TD. | last3 = Roth | first3 = LM. | last4 = Eble | first4 = JN. | last5 = Zheng | first5 = W. | last6 = Karim | first6 = FW. | last7 = Cheng | first7 = L. | title = Cytokeratin and CD30 expression in dysgerminoma. | journal = Hum Pathol | volume = 37 | issue = 8 | pages = 1015-21 | month = Aug | year = 2006 | doi = 10.1016/j.humpath.2006.02.018 | PMID = 16867864 }}</ref>
| |
| **Done to r/o [[embryonal carcinoma]].
| |
| *Cytokeratins usu. -ve, may have weak focal positivity.<ref name=pmid16867864/>
| |
| *OCT3/4 +ve.<ref name=pmid20438407>{{Cite journal | last1 = Emerson | first1 = RE. | last2 = Ulbright | first2 = TM. | title = Intratubular germ cell neoplasia of the testis and its associated cancers: the use of novel biomarkers. | journal = Pathology | volume = 42 | issue = 4 | pages = 344-55 | month = Jun | year = 2010 | doi = 10.3109/00313021003767355 | PMID = 20438407 }}</ref>
| |
|
| |
|
| ===Sign out=== | | ===Sign out=== |
| <pre> | | <pre> |
| RETROPERITONEAL SOFT TISSUE, RIGHT, CORE BIOPSY:
| | Right Testicle Tissue, Debridement: |
| - SEMINOMA. | | - Hemorrhagic testicular tissue and necrotic seminiferous tubules. |
| | - Small amount of viable seminiferous tubules with spermatogenesis. |
| | - NEGATIVE for germ cell neoplasia in situ. |
| | - NEGATIVE for malignancy. |
| | |
| | Comment: |
| | The clinical history of trauma is noted. |
| </pre> | | </pre> |
| ====Micro====
| |
| The sections show large atypical, discohesive cells with prominent nucleoli, central
| |
| nuclei and moderate clear cytoplasm, intermixed with mature lymphocytes. Mitotic
| |
| activity is present.
| |
|
| |
|
| ====Small biopsy==== | | =Premalignant= |
| A mixed germ cell tumour cannot be excluded; given the small quantity of tumour, this
| | ==Germ cell neoplasia in situ== |
| biopsy is at a high risk for having undersampled other tumour components should they be
| | *Previously ''intratubular germ cell neoplasia'' (abbreviated ''ITGCN''). |
| present. Correlation with serology and consideration of re-biopsy is suggested.
| | {{Main|Germ cell neoplasia in situ}} |
|
| |
|
| ==Spermatocytic seminoma== | | =Germ cell tumours= |
| ===General===
| | {{Main|Germ cell tumours}} |
| *Rare tumour.
| | ==Seminoma== |
| *Only one case of metastases in 200 cases.<ref name=pmid7927308>{{cite journal |author=Eble JN |title=Spermatocytic seminoma |journal=Hum. Pathol. |volume=25 |issue=10 |pages=1035–42 |year=1994 |month=October |pmid=7927308 |doi= |url=}}</ref>
| | {{Main|Seminoma}} |
| *Orchiectomy is curative.
| |
| *Not reported/found in females.<ref name=pmid7927308/>
| |
| *Typically older - mean age 50s.<ref name=pmid7927308/>
| |
| | |
| ====Epidemiology====
| |
| *Does NOT arise from ''[[intratubular germ cell neoplasia]]'' (ITGCN)<ref>{{cite journal |author=Müller J, Skakkebaek NE, Parkinson MC |title=The spermatocytic seminoma: views on pathogenesis |journal=Int. J. Androl. |volume=10 |issue=1 |pages=147–56 |year=1987 |month=February |pmid=3583416 |doi= 10.1111/j.1365-2605.1987.tb00176.x|url=}}</ref> - '''not''' considered a subtype of [[seminoma]].
| |
| | |
| ===Microscopic=== | |
| Features:<ref>{{cite book |author=Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. |title=Robbins and Cotran pathologic basis of disease |publisher=Elsevier Saunders |location=St. Louis, Mo |year=2005 |pages= |edition=7th |isbn=0-7216-0187-1 |oclc= |doi= |accessdate=}}</ref>
| |
| *Population of three cells.
| |
| *#Small cells (6-8 µm) - with a large NC [[ratio]].
| |
| *#*Look like secondary spermatocytes.
| |
| *#*May be confused with (mature) lymphocytes.
| |
| *#Medium cells (15-18 µm) with prominent nucleoli.
| |
| *#*Filamentous chromatin (AKA ''spireme chromatin'').<ref name=pmid7927308>{{cite journal |author=Eble JN |title=Spermatocytic seminoma |journal=Hum. Pathol. |volume=25 |issue=10 |pages=1035–42 |year=1994 |month=October |pmid=7927308 |doi= |url=}}</ref>
| |
| *#Large cells (50-100 µm).
| |
| *#*Filamentous chromatin.
| |
| *Mucoid lakes.
| |
| *Intratubular spread.
| |
|
| |
|
| Notes:
| | ==Spermatocytic tumour== |
| *''Spireme'' = the tangle of filaments in prophase portion of mitosis.<ref>URL: [http://www.thefreedictionary.com/spireme http://www.thefreedictionary.com/spireme]. Accessed on: 4 June 2010.</ref> | | *Previously ''spermatocytic seminoma''. |
| *May have eosinophilic cytoplasm (dependent on lab).
| | {{Main|Spermatocytic tumour}} |
| **Usually larger than [[Leydig cell tumour]].
| |
| | |
| DDx:
| |
| *[[DLBCL]].
| |
| *[[Seminoma]].
| |
| | |
| Images:
| |
| *[http://commons.wikimedia.org/wiki/File:Spermatocytic_seminoma_high_mag.jpg Spermatocytic seminoma - high mag. (WC)].
| |
| *[http://commons.wikimedia.org/wiki/File:Spermatocytic_seminoma_intermed_mag.jpg Spermatocytic seminoma - intermed. mag. (WC)].
| |
| | |
| ===IHC===
| |
| Features:<ref name=pmid10223302>{{Cite journal | last1 = Kraggerud | first1 = SM. | last2 = Berner | first2 = A. | last3 = Bryne | first3 = M. | last4 = Pettersen | first4 = EO. | last5 = Fossa | first5 = SD. | title = Spermatocytic seminoma as compared to classical seminoma: an immunohistochemical and DNA flow cytometric study. | journal = APMIS | volume = 107 | issue = 3 | pages = 297-302 | month = Mar | year = 1999 | doi = | PMID = 10223302 }}</ref>
| |
| *PLAP -ve (0 positive/17).
| |
| *CD117 -ve (7 positive/17).
| |
| *CAM5.2 -ve (1 positive/17).
| |
|
| |
|
| ==Yolk sac tumour== | | ==Yolk sac tumour== |
Line 472: |
Line 324: |
| {{Main|Embryonal carcinoma}} | | {{Main|Embryonal carcinoma}} |
| These often look like a poorly differentiated carcinoma. | | These often look like a poorly differentiated carcinoma. |
| ===General===
| |
| *Affects young adults.
| |
| **May be seen in women.
| |
|
| |
| ===Microscopic===
| |
| Features:<ref name=Ref_GUP549>{{Ref GUP|549}}</ref>
| |
| #Nucleoli - '''key feature'''.
| |
| #Vesicular nuclei (clear, empty appearing nuclei) - '''key feature'''.
| |
| #Nuclei overlap.
| |
| #[[Necrosis]] - common.
| |
| #*Not commonly present in seminoma.
| |
| #Indistinct cell borders
| |
| #Mitoses - common.
| |
| #Variable architecture:
| |
| #*Tubulopapillary.
| |
| #*Glandular.
| |
| #*Solid.
| |
| #*Embryoid bodies - ball of cells in surrounded by empty space on three sides.
| |
|
| |
| Notes:
| |
| *Cytoplasmic staining variable (eosinophilic to basophilic).
| |
|
| |
|
| ==Choriocarcinoma== | | ==Choriocarcinoma== |
| {{Main|Choriocarcinoma}} | | {{Main|Choriocarcinoma}} |
| These are aggressive tumours. | | These are aggressive tumours. |
|
| |
| ===Microscopic===
| |
| Features:
| |
| *Syncytiotrophoblasts:
| |
| **Large + many irreg. or lobular hyperchromatic nuclei.
| |
| **Eosinophilic vacuolated cytoplasm (contains hCG).
| |
| *'''C'''ytotrophoblasts:
| |
| **'''C'''lear cytoplasm.
| |
| **Polygonal shaped cells in cords/masses.
| |
| **Distinct cell borders.
| |
| **Single uniform nucleus.
| |
| *+/-Hemorrhage.
| |
| *+/-Necrosis.
| |
|
| |
|
| ==Teratoma of the testis== | | ==Teratoma of the testis== |
Line 518: |
Line 336: |
| ==Leydig cell tumour== | | ==Leydig cell tumour== |
| *[[AKA]] ''interstitial cell tumour''. | | *[[AKA]] ''interstitial cell tumour''. |
| | | {{Main|Leydig cell tumour}} |
| ===General===
| |
| *Arises from interstitial cell.
| |
| *May be associated with increased testosterone.
| |
| | |
| ===Gross===
| |
| *Solid, lobulated.
| |
| *Red/tan.
| |
| | |
| Image:
| |
| *[http://www.flickr.com/photos/35441329@N05/5056465301/sizes/m/in/photostream/ Leydig cell tumour (flickr.com)].
| |
| | |
| ===Microscopic===
| |
| Features:<ref name=Ref_GUP581>{{Ref GUP|581}}</ref>
| |
| *Vacuolization (cytoplasm) - '''key feature'''.
| |
| *Cytoplasm - clear to eosinophilic - '''important'''.
| |
| *''Reinke crystals'' - classic finding, usually not present.
| |
| **Cylindrical crystalloid eosinophilic cytoplasmic bodies.
| |
| *Nucleoli common.
| |
| *Round nuclei.
| |
| | |
| DDx:
| |
| *[[Spermatocytic seminoma]] - may have eosinophilic cytoplasm.
| |
| *[[Pregnancy luteoma]] - occurs during pregnancy, as the name implies.
| |
| | |
| Images:
| |
| *[[WC]]:
| |
| **[http://commons.wikimedia.org/wiki/File:Leydig_cell_tumour1.jpg Leydig cell tumour - low mag. (WC)].
| |
| **[http://commons.wikimedia.org/wiki/File:Leydig_cell_tumour2.jpg Leydig cell tumour - intermed. mag. (WC)].
| |
| **[http://commons.wikimedia.org/wiki/File:Leydig_cell_tumour3.jpg Leydig cell tumour - high mag. (WC)].
| |
| *www:
| |
| **[http://path.upmc.edu/cases/case404.html Leydig cell tumour - several images (upmc.edu)].
| |
| | |
| ===IHC===
| |
| *Inhibin-alpha.
| |
| *Calretinin.<ref>URL: [http://www.antibodybeyond.com/reviews/cell-markers/leydig-cell-marker.htm http://www.antibodybeyond.com/reviews/cell-markers/leydig-cell-marker.htm]. Accessed on: 18 May 2010.</ref><ref name=pmid15950053>{{cite journal |author=Bar-Shira Maymon B, Yavetz H, Yogev L, ''et al.'' |title=Detection of calretinin expression in abnormal immature Sertoli cells in non-obstructive azoospermia |journal=Acta Histochem. |volume=107 |issue=2 |pages=105–12 |year=2005 |pmid=15950053 |doi=10.1016/j.acthis.2005.02.002 |url=}}</ref>
| |
| *Melan A.<ref name=pmid12966351>{{cite journal |author=Yao DX, Soslow RA, Hedvat CV, Leitao M, Baergen RN |title=Melan-A (A103) and inhibin expression in ovarian neoplasms |journal=Appl. Immunohistochem. Mol. Morphol. |volume=11 |issue=3 |pages=244–9 |year=2003 |month=September |pmid=12966351 |doi= |url=}}</ref>
| |
| **AKA ''MART-1''.
| |
| **Expressed in [[melanoma]], [[adrenal gland|adrenal tissue]], steroid-secreting tumours.
| |
|
| |
|
| ==Sertoli cell nodule== | | ==Sertoli cell nodule== |
| | *Abbreviated ''SCN''. |
| *[[AKA]] ''Pick's adenoma''. | | *[[AKA]] ''Pick's adenoma''. |
| *AKA ''testicular tubular adenoma''. | | *AKA ''testicular tubular adenoma''. |
| *AKA ''tubular adenoma of the testis''. | | *AKA ''tubular adenoma of the testis''. |
| ===General===
| | {{Main|Sertoli cell nodule}} |
| *Benign proliferation of Sertoli cells - associated with cryptorchidism (undescended testis).
| |
| *Not composed of a clonal cell population, i.e. ''not'' neoplastic; thus, technically, should not be called an ''adenoma''.<ref name=Ref_DCHH227>{{Ref DCHH|227}}</ref>
| |
| | |
| ===Gross===
| |
| *Usually an incidental finding, rarely presents as a testicular mass.<ref name=pmid21107095>{{Cite journal | last1 = Vallangeon | first1 = BD. | last2 = Eble | first2 = JN. | last3 = Ulbright | first3 = TM. | title = Macroscopic sertoli cell nodule: a study of 6 cases that presented as testicular masses. | journal = Am J Surg Pathol | volume = 34 | issue = 12 | pages = 1874-80 | month = Dec | year = 2010 | doi = 10.1097/PAS.0b013e3181fcab70 | PMID = 21107095 }}</ref>
| |
| | |
| ===Microscopic===
| |
| Features:<ref name=Ref_DCHH227>{{Ref DCHH|227}}</ref><ref>{{cite journal |author=Ricco R, Bufo P |title=[Histologic study of 3 cases of so-called tubular adenoma of the testis] |language=Italian |journal=Boll. Soc. Ital. Biol. Sper. |volume=56 |issue=20 |pages=2110–5 |year=1980 |month=October |pmid=6109541 |doi= |url=}}</ref>
| |
| *Unencapsulated nodules composed of well-formed tubules.
| |
| **May contain eosinophilic (hyaline) blob in lumen (centre).
| |
| *Cells - vaguely resemble immature Sertoli cells:
| |
| **Bland hyperchromatic oval/round nuclei that are stratified.
| |
| | |
| DDx:<ref name=pmid21107095/>
| |
| *[[Sertoli cell tumour]].
| |
| *[[Sex cord tumour with annular tubules]].
| |
| *[[Gonadoblastoma]].
| |
| | |
| Images:
| |
| *[http://commons.wikimedia.org/wiki/File:Sertoli_cell_nodule_high_mag.jpg Sertoli cell nodule - high mag. (WC)].
| |
| *[http://commons.wikimedia.org/wiki/File:Sertoli_cell_nodule_low_mag.jpg Sertoli cell nodule - low mag. (WC)].
| |
| | |
| ===IHC===
| |
| Features:<ref name=pmid21107095/>
| |
| *Alpha-inhibin +ve (5/5 cases).
| |
| *OCT3/4 -ve (5/5 cases).
| |
|
| |
|
| ==Sertoli cell tumour== | | ==Sertoli cell tumour== |
| | | {{Main|Sertoli cell tumour}} |
| ===General===
| |
| *Arises from ''Sertoli cells'' ([[AKA]] nurse cells).
| |
| | |
| May be seen in several syndrome - esp. if there is calcification:
| |
| *[[Carney complex]].<ref name=pmid21047926>{{Cite journal | last1 = Libé | first1 = R. | last2 = Horvath | first2 = A. | last3 = Vezzosi | first3 = D. | last4 = Fratticci | first4 = A. | last5 = Coste | first5 = J. | last6 = Perlemoine | first6 = K. | last7 = Ragazzon | first7 = B. | last8 = Guillaud-Bataille | first8 = M. | last9 = Groussin | first9 = L. | title = Frequent phosphodiesterase 11A gene (PDE11A) defects in patients with Carney complex (CNC) caused by PRKAR1A mutations: PDE11A may contribute to adrenal and testicular tumors in CNC as a modifier of the phenotype. | journal = J Clin Endocrinol Metab | volume = 96 | issue = 1 | pages = E208-14 | month = Jan | year = 2011 | doi = 10.1210/jc.2010-1704 | PMID = 21047926 }}</ref>
| |
| *[[Peutz-Jeghers syndrome]].
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| *Groups of cells in ''cords'' or ''trabeculae'' (beam-like arrangement).
| |
| *Cells have:
| |
| **Light staining bubbly cytoplasm +/- large cytoplasmic vacuoles.
| |
| **Slightly irregular nucleoli.
| |
| **Granular irregular appearing chromatin.
| |
| | |
| Negatives:
| |
| *Mitoses are rare.
| |
| *No significant nuclear atypia.
| |
| | |
| DDx:
| |
| *[[Granulosa cell tumour]] - may be very similar. Often has nuclear grooves.
| |
| *Epithelioid [[adenomatoid tumour]].
| |
| *[[Sertoli cell nodule]].
| |
| | |
| Images:
| |
| *[[WC]]:
| |
| **[http://commons.wikimedia.org/wiki/File:Sertoli_cell_tumour_high_mag.jpg Sertoli cell tumour - high mag. (WC)].
| |
| **[http://commons.wikimedia.org/wiki/File:Sertoli_cell_tumour_low_mag.jpg Sertoli cell tumour - low mag. (WC)].
| |
| *www:
| |
| **[http://path.upmc.edu/cases/case275/micro.html Sertoli cell tumour with calcification in Carney complex - several images (upmc.edu)].
| |
| | |
| ===IHC===
| |
| *Alpha-inhibin +ve. (???)
| |
|
| |
|
| =Other= | | =Other= |
Line 630: |
Line 352: |
|
| |
|
| ==Adenocarcinoma of the rete testis== | | ==Adenocarcinoma of the rete testis== |
| ===General===
| | {{Main|Adenocarcinoma of the rete testis}} |
| *Extremely rare - a few dozen cases in the world literature.<ref name=pmid3799821>{{Cite journal | last1 = Newbold | first1 = RR. | last2 = Bullock | first2 = BC. | last3 = McLachlan | first3 = JA. | title = Adenocarcinoma of the rete testis. Diethylstilbestrol-induced lesions of the mouse rete testis. | journal = Am J Pathol | volume = 125 | issue = 3 | pages = 625-8 | month = Dec | year = 1986 | doi = | PMID = 3799821 | PMC = 1888460 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1888460/?page=1}}</ref>
| | |
| *Possible association of diethylstilbestrol.<ref name=pmid3799821/>
| | ==Testicular adrenal rest tumour== |
| | :Abbreviated ''TART''. |
| | {{Main|Testicular adrenal rest tumour}} |
|
| |
|
| ===Microscopic=== | | ==Fibrous pseudotumour of the paratesticular region== |
| Features:
| | {{Main|Fibrous pseudotumour of the paratesticular region}} |
| *Adenocarcinoma:
| |
| **Tubular or papillary architecture.<ref name=pmid3799821/>
| |
| **Columnar cells with cigar-shaped nuclei.
| |
|
| |
|
| Images:
| | ==Testicular metastasis== |
| *[http://commons.wikimedia.org/wiki/File:Adenocarcinoma_of_the_rete_testis_-_intermed_mag.jpg Adenocarcinoma of the rete testis - intermed. mag. (WC/Nephron)].
| | {{Main|Testicular metastasis}} |
| *[http://commons.wikimedia.org/wiki/File:Adenocarcinoma_of_the_rete_testis_-_extra_-_high_mag.jpg Adenocarcinoma of the rete testis - high mag. (WC/Nephron)].
| |
|
| |
|
| =See also= | | =See also= |
Line 650: |
Line 370: |
| *[[Vas deferens]]. | | *[[Vas deferens]]. |
| *[[Spermatic cord]]. | | *[[Spermatic cord]]. |
| | *[[Paratesticular region]]. |
|
| |
|
| =References= | | =References= |
Line 658: |
Line 379: |
|
| |
|
| [[Category: Genitourinary pathology]] | | [[Category: Genitourinary pathology]] |
| | [[Category: Testis]] |