Difference between revisions of "Testis"

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Image:Seminiferous_tubule_and_sperm_low_mag.jpg | Seminiferous tubule and sperm - low mag. (WC/Nephron)
Image:Seminiferous_tubule_and_sperm_low_mag.jpg | Seminiferous tubule and sperm - low mag. (WC/Nephron)
Image:Seminiferous_tubule_and_sperm.jpg | Seminiferous tubule and sperm - high mag. (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 ITGCN. (WC/Nephron)
Image:Intratubular_germ_cell_neoplasia_-_2_-_very_high_mag.jpg | Benign seminiferous tubules and GCNIS (ITGCN). (WC/Nephron)
</gallery>
</gallery>
====Interstitial====
====Interstitial====
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! 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
| [[Image:Intratubular_germ_cell_neoplasia_high_mag_cropped.jpg|thumb|center|150px|ITGCN (WC)]]
| [[Image:Intratubular_germ_cell_neoplasia_high_mag_cropped.jpg|thumb|center|150px|GCNIS (WC)]]
|-  
|-  
| [[Seminoma]]
| [[Seminoma]]
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| [[Image:Teratoma_2_low_mag.jpg|thumb|center|150px|Teratoma (WC)]]
| [[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)
| [[Image:Spermatocytic_seminoma_high_mag.jpg|thumb|center|150px|Spermatocytic seminoma (WC)]]
| [[Image:Spermatocytic_seminoma_high_mag.jpg|thumb|center|150px|Spermatocytic tumour (WC)]]
|-  
|-  
| [[Mixed germ cell tumour]]
| [[Mixed germ cell tumour]]
Line 226: Line 226:
==Hydrocele testis==
==Hydrocele testis==
*[[AKA]] ''hydrocele''.
*[[AKA]] ''hydrocele''.
===General===
{{Main|Hydrocele testis}}
*Benign.
**May be seen in association with a testicular neoplasm.<ref name=pmid9490992>{{Cite journal  | last1 = Junnila | first1 = J. | last2 = Lassen | first2 = P. | title = Testicular masses. | journal = Am Fam Physician | volume = 57 | issue = 4 | pages = 685-92 | month = Feb | year = 1998 | doi =  | PMID = 9490992 }}</ref>
*Common.<ref name=pmid20705202>{{Cite journal  | last1 = Wampler | first1 = SM. | last2 = Llanes | first2 = M. | title = Common scrotal and testicular problems. | journal = Prim Care | volume = 37 | issue = 3 | pages = 613-26, x | month = Sep | year = 2010 | doi = 10.1016/j.pop.2010.04.009 | PMID = 20705202 }}</ref>
 
Clinical:
*Scrotal mass.
 
===Microscopic===
Features:
*Cyst lined by a simple ciliated epithelium.
*Does '''not''' contain sperm.
 
DDx:
*[[Spermatocele]] - contains sperm.
 
===Sign out===
<pre>
HYDROCELE SAC, LEFT, EXCISION:
- CONSISTENT WITH HYDROCELE SAC.
</pre>
 
<pre>
SOFT TISSUE ("HYDROCELE SAC"),LEFT, EXCISION:
- FIBROADIPOSE TISSUE COVERED BY MESOTHELIUM WITH REACTIVE CHANGES -- CONSISTENT
  WITH HYDROCELE SAC.
- EPIDIDYMIS WITH SPERM (INCIDENTAL FINDING).
</pre>
 
====Micro====
The sections shows fragments of tissue compatible with a benign cyst, that had a fibrous wall and was lined by a simple epithelium. No spermatocytes are identified.
 
Benign connective tissue (including skeletal muscle, nerves and blood vessels) is also present.


==Idiopathic granulomatous orchitis==
==Idiopathic granulomatous orchitis==
Line 273: 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 280: 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===
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==Adenomatous hyperplasia of the rete testis==
==Adenomatous hyperplasia of the rete testis==
{{Main|Adenomatous hyperplasia of the rete testis}}
{{Main|Adenomatous hyperplasia of the rete testis}}
==Epidermoid cyst of the testis==
{{Main|Epidermoid cyst of the testis}}
==Testicular trauma==
===General===
*May lead to orchitectomy.
===Gross===
*Hemorrhagic.
===Microscopic===
Features:
*Necrotic seminiferous tubules.
*Intratubular blood in keeping with hemorrhage.
Note:
*Normal spermatogenesis in background - if viable tissue present.
===Sign out===
<pre>
Right Testicle Tissue, Debridement:
    - 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>


=Premalignant=
=Premalignant=
==Intratubular germ cell neoplasia==
==Germ cell neoplasia in situ==
*Abbreviated ''ITGCN''.
*Previously ''intratubular germ cell neoplasia'' (abbreviated ''ITGCN'').
{{Main|Intratubular germ cell neoplasia}}
{{Main|Germ cell neoplasia in situ}}


=Germ cell tumours=
=Germ cell tumours=
Line 307: Line 306:
{{Main|Seminoma}}
{{Main|Seminoma}}


==Spermatocytic seminoma==
==Spermatocytic tumour==
{{Main|Spermatocytic seminoma}}
*Previously ''spermatocytic seminoma''.
{{Main|Spermatocytic tumour}}


==Yolk sac tumour==
==Yolk sac tumour==
Line 360: Line 360:
==Fibrous pseudotumour of the paratesticular region==
==Fibrous pseudotumour of the paratesticular region==
{{Main|Fibrous pseudotumour of the paratesticular region}}
{{Main|Fibrous pseudotumour of the paratesticular region}}
==Testicular metastasis==
{{Main|Testicular metastasis}}


=See also=
=See also=

Latest revision as of 19:26, 9 September 2021

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.

If the testis is biopsied, it is usually for fertility. The cut-up of orchiectomy specimens is dealt with in orchiectomy grossing.

Normal testis

Gross

Anatomy - deep to superficial:

  • Tunica albuginea - fibrous layer.
  • Tunica vaginalis - thin mesothelial layer.
    • This layer is important in the staging of testicular tumours.

Microscopic

Seminiferous tubules

  • Sertoli cells (AKA sustentacular cell AKA nurse cell).
    • Large cells with oval nucleus.
  • Primary spermatocyte.
    • Small cells with dark nucleus on basement membrane.
  • Secondary spermatocyte.
    • Rarely seen on light microscopy.
  • Spermatids.
    • Round small.
    • Usually close to the centre of the lumen.
  • Spermatozoa.
    • You don't see the tail on light microscopy.
Images

  • Seminiferous tubule and sperm - low mag. (WC/Nephron)

  • Seminiferous tubule and sperm - high mag. (WC/Nephron)

  • Benign seminiferous tubules and GCNIS (ITGCN). (WC/Nephron)

Interstitial

Image

  • Leydig cells - very high mag. (WC/Nephron)

Associated structures

  • Epididymis - stores the sperm.
    • Pseudostratified epithelium with cilia.

Image:

Rete testis

Microscopic:

  • Delicate anastomosing channels lined by cuboid epithelium.
Images

  • Rete testis (WC/Nephron)

www:

Appendix of testis

  • Muellerian duct remnant.

Microscopic:

  • Polypoid structure.

Images:

Sign out

TESTICLE, RIGHT, ORCHIECTOMY:
- TESTICLE WITHOUT APPARENT PATHOLOGY.
- NEGATIVE FOR INTRATUBULAR GERM CELL NEOPLASIA.
- NEGATIVE FOR MALIGNANCY.

Alternate

RIGHT TESTICLE, ORCHIDECTOMY:
- BENIGN TESTIS WITH SPERMATOGENESIS.
- NEGATIVE FOR INTRATUBULAR GERM CELL NEOPLASIA.
- NEGATIVE FOR MALIGNANCY.

Diagnoses (overview)

IHC for GCTs

ABCDs of GCTs:

  • AFP - yolk sac tumour.
  • Beta-hCG - choriocarcinoma.
  • CD30 - embryonal carcinoma.
  • D2-40 - seminoma.

Tabular summary of GCTs

Tumour Key feature Microscopic IHC Other Image
Germ cell neoplasia in situ (GCNIS) nests of small fried egg cells large central nucleus, clear
cytoplasm, round or polygonal nuclear membrane, nucleoli[3] 		CD117 appearance similar to seminoma
GCNIS (WC)
Seminoma fried egg cells fried egg-like cells (central nucleus, clear
cytoplasm) with squared-off nuclear
membrane, nucleoli, lymphocytic infiltrate, granulomata,
syncytiotrophoblastic giant cells[4] 		D2-40 Dysgerminoma = female version of this tumour
Seminoma (WC)
Yolk sac tumour (endodermal sinus tumour) Schiller-Duval bodies Schiller-Duval b. = central blood vessel surrounded by epithelial-like cells a space and more epithelial-like cells, variable arch. AFP patterns: microcystic, solid, hepatoid
Yolk sac tumour (WC)
Embryonal carcinoma prominent nucleoli, vescicular nuclei var. arch.: tubulopapillary, glandular, solid, embryoid bodies (ball of cells in surrounded by empty space on three sides), +/-nuclear overlap, mitoses common CD30 usu. part of a mixed GCT
Embryonal carcinoma (WC)
Choriocarcinoma marked nuclear atypia cells with clear cytoplasm (cytotrophoblast), multinucleated cells (syncytiotrophoblast) beta-hCG not commonly pure, usu. a component of a mixed GCT
Choriocarcinoma (WC)
Teratoma skin, GI tract-like epithelium skin (epidermis, adnexal structures - sebaceous glands, hair follicles), GI tract-like glands (simple tall columnar epithelium), fat +/-primitive neuroepithelium (pseudostratified epithelium in rosettes) None testicular teratomas in post-pubertal males are all considered malignant[5]
Teratoma (WC)
Spermatocytic tumour (previously spermatocytic seminoma) 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 ? does not arise from GCNIS, no lymphocytic infiltrate (like in seminoma)
Spermatocytic tumour (WC)
Mixed germ cell tumour NA common combinations: teratoma + embryonal carcinoma + endodermal sinus tumour (yolk sac tumour) (TEE); seminoma + embryonal (SE); embryonal + teratoma (TE) NA -
Mixed GCT (WC)

Tabular summary of (male) SCSTs

Tumour Key feature Microscopic IHC Other Image
Leydig cell tumour intersitial cell cluster with eosinophilic cytoplasm cytoplasmic vacuolization, uniform nuclei with nucleoli MART-1, calretinin, inhibin +/-Reinke crystals (cylindrical crystalloid eosinophilic cytoplasmic bodies)
Leydig cell tumour (WC)
Sertoli cell tumour cells in cords or trabeculae light staining bubbly cytoplasm +/- large cytoplasmic vacuoles, granular chromatin ? usu. no significant nuclear atypia, no mitoses
Sertoli cell tumour (WC)

Benign

Testicular atrophy

  • AKA atrophic testis.
  • AKA atrophy of the testis.
Main article: Testicular atrophy

Male infertility

Main article: Male infertility

Spermatocele

Main article: Spermatocele

Hydrocele testis

Main article: Hydrocele testis

Idiopathic granulomatous orchitis

Granulomatous orchitis redirects here.

General

  • Rare.
  • Unknown etiology -- possibly trauma + immune reaction to sperm.[6]

Microscopic

Features:[6]

  • Granulomas +/- necrosis.
  • +/-Destruction of seminiferous tubules.
  • Prominent collagen fibrosis.

DDx:

Stains

Testicular scar

Main article: Testicular scar

Testicular abscess

Main article: Testicular abscess

Testicular torsion

Main article: Testicular torsion

Adenomatous hyperplasia of the rete testis

Main article: Adenomatous hyperplasia of the rete testis

Epidermoid cyst of the testis

Main article: Epidermoid cyst of the testis

Testicular trauma

General

  • May lead to orchitectomy.

Gross

  • Hemorrhagic.

Microscopic

Features:

  • Necrotic seminiferous tubules.
  • Intratubular blood in keeping with hemorrhage.

Note:

  • Normal spermatogenesis in background - if viable tissue present.

Sign out

Right Testicle Tissue, Debridement:
     - 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.

Premalignant

Germ cell neoplasia in situ

  • Previously intratubular germ cell neoplasia (abbreviated ITGCN).
Main article: Germ cell neoplasia in situ

Germ cell tumours

Main article: Germ cell tumours

Seminoma

Main article: Seminoma

Spermatocytic tumour

  • Previously spermatocytic seminoma.
Main article: Spermatocytic tumour

Yolk sac tumour

Main article: Yolk sac tumour
  • Most common GCT in infants and young boys.

Microscopic

Classic feature:

  • Schiller-Duval bodies.
    • Look like glomerulus - central blood vessel surrounded by epithelial-like cells a space and more epithelial-like cells
  • Architecure - variable.
    • Most common microcystic pattern.[11]

Embryonal carcinoma

Main article: Embryonal carcinoma

These often look like a poorly differentiated carcinoma.

Choriocarcinoma

Main article: Choriocarcinoma

These are aggressive tumours.

Teratoma of the testis

Main article: Teratoma

In post-pubertal males these (testicular) tumours are considered malignant. They usually consist of all three germ layers.[12]

Sex cord stromal tumours

Leydig cell tumour

  • AKA interstitial cell tumour.
Main article: Leydig cell tumour

Sertoli cell nodule

  • Abbreviated SCN.
  • AKA Pick's adenoma.
  • AKA testicular tubular adenoma.
  • AKA tubular adenoma of the testis.
Main article: Sertoli cell nodule

Sertoli cell tumour

Main article: Sertoli cell tumour

Other

These tumours are rare.

Adenocarcinoma of the rete testis

Main article: Adenocarcinoma of the rete testis

Testicular adrenal rest tumour

Abbreviated TART.
Main article: Testicular adrenal rest tumour

Fibrous pseudotumour of the paratesticular region

Main article: Fibrous pseudotumour of the paratesticular region

Testicular metastasis

Main article: Testicular metastasis

See also

References

  1. ↑ Soper, MS.; Hastings, JR.; Cosmatos, HA.; Slezak, JM.; Wang, R.; Lodin, K. (Dec 2012). "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.". Am J Clin Oncol. doi:10.1097/COC.0b013e318277d839. PMID 23275274.
  2. ↑ Browne, TJ.; Richie, JP.; Gilligan, TD.; Rubin, MA. (Jun 2005). "Intertubular growth in pure seminomas: associations with poor prognostic parameters.". Hum Pathol 36 (6): 640-5. doi:10.1016/j.humpath.2005.03.011. PMID 16021570.
  3. ↑ Zhou, Ming; Magi-Galluzzi, Cristina (2006). Genitourinary Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 538. ISBN 978-0443066771.
  4. ↑ Zhou, Ming; Magi-Galluzzi, Cristina (2006). Genitourinary Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 542. ISBN 978-0443066771.
  5. ↑ Carver, BS.; Al-Ahmadie, H.; Sheinfeld, J. (May 2007). "Adult and pediatric testicular teratoma.". Urol Clin North Am 34 (2): 245-51; abstract x. doi:10.1016/j.ucl.2007.02.013. PMID 17484929.
  6. ↑ 6.0 6.1 6.2 6.3 Roy, S.; Hooda, S.; Parwani, AV. (May 2011). "Idiopathic granulomatous orchitis.". Pathol Res Pract 207 (5): 275-8. doi:10.1016/j.prp.2011.02.005. PMID 21458170.
  7. ↑ Sekita, N.; Nishikawa, R.; Fujimura, M.; Sugano, I.; Mikami, K. (Jan 2012). "[Syphilitic orchitis: a case report].". Hinyokika Kiyo 58 (1): 53-5. PMID 22343746.
  8. ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 364. ISBN 978-0781765275.
  9. ↑ Parker, SG.; Kommu, SS. (2013). "Post-intravesical BCG epididymo-orchitis: Case report and a review of the literature.". Int J Surg Case Rep 4 (9): 768-70. doi:10.1016/j.ijscr.2013.05.017. PMID 23856256.
  10. ↑ Bulbul, MA.; Hijaz, A.; Beaini, M.; Araj, GF.; Tawil, A.. "Tuberculous epididymo-orchitis following intravesical BCG for superficial bladder cancer.". J Med Liban 50 (1-2): 67-9. PMID 12841318.
  11. ↑ URL: http://webpathology.com/image.asp?case=34&n=1. Accessed on: March 8, 2010.
  12. ↑ Moore, Keith L.; Persaud, T.V.N. (2002). The Developing Human: Clinically Oriented Embryology (7th ed.). Saunders. pp. 83. ISBN 978-0721694122.

External links

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