Difference between revisions of "Testis"
Jump to navigation
Jump to search
m (→IHC: more) |
m (→IHC: AKA) |
||
Line 213: | Line 213: | ||
*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>PMID 15950053.</ref> | *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>PMID 15950053.</ref> | ||
*Melan A.<ref name=pmid12966351>PMID 12966351.</ref> | *Melan A.<ref name=pmid12966351>PMID 12966351.</ref> | ||
**AKA ''MART-1''. | |||
**Expressed in melanoma, adrenal tissue, steroid-secreting tumours. | **Expressed in melanoma, adrenal tissue, steroid-secreting tumours. | ||
Revision as of 14:50, 18 May 2010
The Testes are important for survival of the species. Tumours occasionally arise in 'em. They generally are not biopsied. If they are biopsied, it is usually for fertility -- to understand whether they are really azoospermic.
Normal
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.
Interstitium
- Leydig cell.
- Large eosinophilic cell.
Diagnoses
- 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.
- Leydig cell tumour.
- Sertoli cell tumour.
IHC for GCTs
ABCDs of GCTs:
- AFP - yolk sac tumour.
- Beta-hCG - choriocarcinoma.
- CD30 - embryonal carcinoma.
- D2-40 - seminoma.
Seminoma
Male counterpart of the dysgerminoma, which arise in the ovary.
Microsopy
Features:
- Cells with fried egg appearance.
- Clear cytoplasm.
- Central nucleus.
- Nucleus has "corners", i.e. it is not round.
- Lymphoctyes common, not essential.
- May see syncytiotrophoblasts.
- Large + many irregular or lobular hyperchromatic nuclei.
- Eosinophilic vacuolated cytoplasm (contains hCG).
- Closest to mom in normal chorionic villi - covers cytotrophoblast.[1]
- May see florid granulomatous reaction.
Memory device: 3 Cs - clear cytoplasm, central nucleus, corners on the nuclear membrane.
DDx:
- Mixed germ cell tumour.
- Solid variant of yolk sac tumour.
- Lacks fibrous septae and lymphocytes.[2]
Epi. & etiology
- Arises from intratubular germ cell neoplasia (ITGCN).
IHC
- D2-40+
- CD117+ (ckit)
- CD30+ (??? check ???)
- Cytokeratins - (weak focal positivity)
Intratubular germ cell neoplasia
- 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 ITCGN:
- Spermatocytic seminoma.[3]
- Yolk sac tumours (endodermal sinus tumour).[4]
- Teratoma. (???)
Spermatocytic seminoma
Microscopy[5]
- Population of three cells.
- Small cells - look like secondary spermatocytes.
- Medium cells with nucleoli.
- Large cells.
Epidemiology
- Does NOT arise from intratubular germ cell neoplasia (ITGCN)[6] - not considered a subtype of seminoma.
Yolk sac tumour
Tumour also known as endodermal sinus tumour.
Microscopy
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.[7]
Image:
Variants:
- Hepatoid pattern.[8]
- Vaguely resembles liver.
- Hyaline globules (light red well-circumscribed globs).
- Bile canaculi.
- Vaguely resembles liver.
- Solid pattern.[9]
- Vaguely resembles seminoma.
Image:
Epidemiology
- Most common GCT in infants and young boys.
IHC
- AFP+
- a1-AT+
- cytokeratin+ ???
DDx
- Embryonal carcinoma.
Embryonal carcinoma
General
- Affects young adults.
- May be seen in women.
Microscopy
Features:[10]
- Cell border indistinct.
- Mitoses common.
- Variable architecture:
- Tubulopapillary,
- Glandular,
- Solid,
- Embryoid bodies - ball of cells in surrounded by empty space on three sides.
- Nuclei overlap.
Notes:
- Cytoplasmic staining variable (eosinophilic to basophilic).
DDx
- Yolk sac tumour.
IHC
- Cytokeratin+ ???[11]
- CD30+ ???
Choriocarcinoma
- Syncytiotrophoblasts (eosinophilic cytoplasm with vacuoles (contain hCG), multiple hyperchromatic nuclei)
- Large + many irreg. or lobular hyperchromatic nuclei
- Eosinophilic vacuolated cytoplasm (contains hCG)
- Cytotrophoblasts (polygonal shape, borders, clear cytoplasm, in cords, single nucleus)
- Polygonal shaped cells in cords/masses
- Distinct cell borders
- Clear cytoplasm
- Single uniform nucleus
- +/-Hemorrhage
- +/-Necrosis
Clinical:
- Aggressive clinical course.
IHC
- beta-hCG+.
Also see: Chorionic villi.
Teratoma
- Consists of all three germ layers.
- Endoderm.
- Mesoderm.
- Ectoderm.
Leydig cell tumour
- Arises from interstitial cell.
- AKA interstitial cell tumour.
Microscopic
Features:[12]
- Vacuolization - key feature.
- Cytoplasm - clear to eosinophilic.
- Nucleoli common.
- Reinke crystals, cylindrical crystalloid eosinophilic cytoplasmic bodies (not always present).
Images:
- Leydig cell tumour - low mag. (WC).
- Leydig cell tumour - intermed. mag. (WC).
- Leydig cell tumour - high mag. (WC).
IHC
- Alpha-inhibin.
- Calretinin.[13][14]
- Melan A.[15]
- AKA MART-1.
- Expressed in melanoma, adrenal tissue, steroid-secreting tumours.
See also
References
- ↑ [1]
- ↑ URL: http://webpathology.com/image.asp?case=34&n=8. Accessed on: March 8, 2010.
- ↑ Müller J, Skakkebaek NE, Parkinson MC (February 1987). "The spermatocytic seminoma: views on pathogenesis". Int. J. Androl. 10 (1): 147–56. PMID 3583416.
- ↑ Manivel JC, Simonton S, Wold LE, Dehner LP (June 1988). "Absence of intratubular germ cell neoplasia in testicular yolk sac tumors in children. A histochemical and immunohistochemical study". Arch. Pathol. Lab. Med. 112 (6): 641–5. PMID 2837162.
- ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. ISBN 0-7216-0187-1.
- ↑ Müller J, Skakkebaek NE, Parkinson MC (February 1987). "The spermatocytic seminoma: views on pathogenesis". Int. J. Androl. 10 (1): 147–56. doi:10.1111/j.1365-2605.1987.tb00176.x. PMID 3583416.
- ↑ URL: http://webpathology.com/image.asp?case=34&n=1. Accessed on: March 8, 2010.
- ↑ URL: http://webpathology.com/image.asp?case=34&n=6. Accessed on: March 8, 2010.
- ↑ URL: http://webpathology.com/image.asp?case=34&n=8. Accessed on: March 8, 2010.
- ↑ GUP P.549
- ↑ NEED REF.
- ↑ GUP P.581.
- ↑ URL: http://www.antibodybeyond.com/reviews/cell-markers/leydig-cell-marker.htm. Accessed on: 18 May 2010.
- ↑ PMID 15950053.
- ↑ PMID 12966351.