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 | ||
|- | |- | ||
| [[ | | [[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| | | [[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 | | [[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 | | does not arise from GCNIS, no lymphocytic infiltrate (like in seminoma) | ||
| [[Image:Spermatocytic_seminoma_high_mag.jpg|thumb|center|150px|Spermatocytic | | [[Image:Spermatocytic_seminoma_high_mag.jpg|thumb|center|150px|Spermatocytic tumour (WC)]] | ||
|- | |- | ||
| [[Mixed germ cell tumour]] | | [[Mixed germ cell tumour]] | ||
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==Hydrocele testis== | ==Hydrocele testis== | ||
*[[AKA]] ''hydrocele''. | *[[AKA]] ''hydrocele''. | ||
{{Main|Hydrocele testis}} | |||
==Idiopathic granulomatous orchitis== | ==Idiopathic granulomatous orchitis== | ||
Line 273: | Line 241: | ||
DDx: | DDx: | ||
*[[ | *[[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> | *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= | ||
== | ==Germ cell neoplasia in situ== | ||
* | *Previously ''intratubular germ cell neoplasia'' (abbreviated ''ITGCN''). | ||
{{Main| | {{Main|Germ cell neoplasia in situ}} | ||
=Germ cell tumours= | =Germ cell tumours= | ||
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{{Main|Seminoma}} | {{Main|Seminoma}} | ||
==Spermatocytic | ==Spermatocytic tumour== | ||
{{Main|Spermatocytic | *Previously ''spermatocytic seminoma''. | ||
{{Main|Spermatocytic tumour}} | |||
==Yolk sac tumour== | ==Yolk sac tumour== | ||
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==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
The testis, plural testes, are important for survival of the species. Tumours occasionally arise in 'em. They generally are not biopsied.
![](/w/images/thumb/8/82/Seminoma_of_the_Testis.jpg/150px-Seminoma_of_the_Testis.jpg)
Orchiectomy specimen showing testis replaced by tumour (proven to be seminoma). (WC/Ed Uthman)
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
Interstitial
- Leydig cell (AKA interstitial cell).
- Large eosinophilic cell.
- Blood vessels.
Image
Associated structures
- Epididymis - stores the sperm.
- Pseudostratified epithelium with cilia.
Image:
Rete testis
- 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.
- May be involved by seminoma.
Microscopic:
- Delicate anastomosing channels lined by cuboid epithelium.
Images
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)
- Benign.
- Spermatid present/not present.
- Infertility - azoospermic.
- No sperm present.
- Germ cell tumours (GCTs).
- Intratubular germ cell neoplasia.
- Seminoma.
- Spermatocytic seminoma.
- Yolk sac tumour (endodermal sinus tumour).
- Embryonal carcinoma.
- Choriocarcinoma.
- Teratoma.
- Mixed GCT - 60% of GCTs are mixed.
- Common combinations:
- teratoma + embryonal carcinoma + endodermal sinus tumour (yolk sac tumour) (TEE).
- seminoma + embryonal (SE).
- embryonal + teratoma (TE).
- Common combinations:
- Sex-cord stromal tumour.
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 | |
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 | |
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 | |
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 | |
Choriocarcinoma | marked nuclear atypia | cells with clear cytoplasm (cytotrophoblast), multinucleated cells (syncytiotrophoblast) | beta-hCG | not commonly pure, usu. a component of a mixed GCT | |
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] | |
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) | |
Mixed germ cell tumour | NA | common combinations: teratoma + embryonal carcinoma + endodermal sinus tumour (yolk sac tumour) (TEE); seminoma + embryonal (SE); embryonal + teratoma (TE) | NA | - |
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) | |
Sertoli cell tumour | cells in cords or trabeculae | light staining bubbly cytoplasm +/- large cytoplasmic vacuoles, granular chromatin | ? | usu. no significant nuclear atypia, no mitoses |
Benign
Testicular atrophy
Main article: Testicular atrophy
Male infertility
- This is a clinical diagnosis.
Main article: Male infertility
Spermatocele
Main article: Spermatocele
Hydrocele testis
- AKA hydrocele.
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:
- GCNIS (ITGCN).
- Seminoma.
- Tertiary syphilis - classically, plasma cell rich.[7]
- Syphilis, unlike other infections of the GU tract, is said to affect the testis before the epididymis.[8]
- Tuberculosis.
- Lymphoma.[6]
- Malakoplakia.[6]
- BCG-associated orchitis.[9][10]
Stains
- AFB -ve -- for tuberculosis.
- Dieterle stain -ve -- for syphilis.
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
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 6.0 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ URL: http://webpathology.com/image.asp?case=34&n=1. Accessed on: March 8, 2010.
- ↑ Moore, Keith L.; Persaud, T.V.N. (2002). The Developing Human: Clinically Oriented Embryology (7th ed.). Saunders. pp. 83. ISBN 978-0721694122.