Difference between revisions of "Testis"
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m (→Sertoli cell nodule: re-arr.) |
(→Intratubular germ cell neoplasia: +abbrev.) |
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=Premalignant= | =Premalignant= | ||
==Intratubular germ cell neoplasia== | ==Intratubular germ cell neoplasia== | ||
*Abbreviated ''ITGCN''. | |||
===General=== | ===General=== | ||
*Considered the precursor lesion for germ cell tumours. | *Considered the precursor lesion for germ cell tumours. | ||
Revision as of 19:18, 22 October 2011
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.
Normal
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.
Interstitium
- Leydig cell (AKA interstitial cell).
- Large eosinophilic cell.
- Blood vessels.
Associated structures
- Epididymis - stores the sperm.
- Pseudostratified epithelium with cilia.
Image:
Rete testis
- Receives stuff from the tubules.
Microscopic:
- Delicate anastomosing channels lined by cuboid epithelium.
Image:
Appendix of testis
Muellerian duct remnant.
Microscopic:
- Polypoid structure.
Images:
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.
- 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.
Tabular summary of GCTs
| Tumour | Key feature | Microscopic | IHC | Other | Image |
|---|---|---|---|---|---|
| Intratubular germ cell neoplasia (ITGCN) | nests of small fried egg cells | large central nucleus, clear cytoplasm, squared-off nuclear membrane, nucleoli[1] |
CD117 | appearance similar to seminoma | [1], [2] |
| Seminoma | fried egg cells | fried egg-like cells (central nucleus, clear cytoplasm) with squared-off nuclear membrane, nucleoli, lymphocytic infiltrate, granulomata, syncytiotrophoblastic giant cells[2] |
D2-40 | Dysgerminoma = female version of this tumour | [3], [4] |
| 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 | hepatoid YST |
| 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 | [5], [6], [7] |
| Choriocarcinoma | marked nuclear atypia | cells with clear cytoplasm (cytotrophoblast), multinucleated cells (syncytiotrophoblast) | beta-hCG | other | [8] |
| Teratoma, immature | primitive neuroepithelium | pseudostratified epithelium in rosettes (gland-like arrangement) | None | teratoma are always malignant in males | [9] |
| 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 ITGCN, no lymphocytic infiltrate (like in seminoma) | [10] |
| Mixed germ cell tumour | NA | common combinations: teratoma + embryonal carcinoma + endodermal sinus tumour (yolk sac tumour) (TEE); seminoma + embryonal (SE); embryonal + teratoma (TE) | NA | - | - |
![[1]](http://commons.wikimedia.org/wiki/File:Intratubular_germ_cell_neoplasia_high_mag.jpg){kind=link}
![[2]](http://commons.wikimedia.org/wiki/File:Intratubular_germ_cell_neoplasia_high_mag_cropped.jpg){kind=link}
![[3]](http://commons.wikimedia.org/wiki/File:Seminoma_high_mag.jpg){kind=link}
![[4]](http://commons.wikimedia.org/wiki/File:Seminoma_intermed_mag.jpg){kind=link}
![[5]](http://commons.wikimedia.org/wiki/File:Embryonal_carcinoma_intermed_mag.jpg){kind=link}
![[9]](http://commons.wikimedia.org/wiki/File:Primitive_neuroepithelium_intermed_mag.jpg){kind=link}
![[10]](http://commons.wikimedia.org/wiki/File:Spermatocytic_seminoma_high_mag.jpg){kind=link}
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) | [11] |
| Sertoli cell tumour | cells in cords or trabeculae | light staining bubbly cytoplasm +/- large cytoplasmic vacuoles, granular chromatin | ? | usu. no significant nuclear atypia, no mitoses | [12] |
![[11]](http://commons.wikimedia.org/wiki/File:Leydig_cell_tumour2.jpg){kind=link}
![[12]](http://commons.wikimedia.org/wiki/File:Sertoli_cell_tumour_low_mag.jpg){kind=link}
Premalignant
Intratubular germ cell neoplasia
- 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 ITCGN:
- Spermatocytic seminoma.[3]
- Yolk sac tumours (endodermal sinus tumour).[4]
- Teratoma. (???)
Microscopic
Features:[5]
- Enlarged nuclei, vesicular.
- Clear cytoplasm.
- Nucleoli, prominent.
Image(s):
Germ cell tumours
Main article: Germ cell tumours
Seminoma
General
- Male counterpart of the dysgerminoma, which arise in the ovary.
Epidemiology & etiology
- Arises from intratubular germ cell neoplasia (ITGCN).
Microsopy
Features:
- Cells with fried egg appearance.
- Clear cytoplasm.
- Central nucleus, with prominent nucleolus.
- Nucleus has "corners", i.e. it is not round.
- Lymphoctyes common, not essential.
- May see syncytiotrophoblasts, AKA syncytiotrophoblastic giant cells (STGCs).[2]
- Large + irregular, vesicular nuclei.
- Eosinophilic vacuolated cytoplasm (contains hCG).
- Syncytiotrophoblasts = closest to mom in normal chorionic villi - covers cytotrophoblast.[6]
- May see florid granulomatous reaction.
Memory device: 3 Cs - clear cytoplasm, central nucleus, corners on the nuclear membrane.
Images:
DDx:
- Mixed germ cell tumour.
- Solid variant of yolk sac tumour.
- Lacks fibrous septae and lymphocytes.[7]
IHC
- D2-40 +ve.
- CD117 +ve (ckit).
- CD30 -ve.[8]
- Done to r/o embryonal carcinoma.
- Cytokeratins usu. -ve, may have weak focal positivity.[8]
- OCT3/4 +ve.[9]
Spermatocytic seminoma
General
- Rare tumour.
- Only one case of metastases in 200 cases.[10]
- Orchiectomy is curative.
- Not reported/found in females.[10]
- Typically older - mean age 50s.[10]
Epidemiology
- Does NOT arise from intratubular germ cell neoplasia (ITGCN)[11] - not considered a subtype of seminoma.
Microscopic
Features:[12]
- Population of three cells.
- Mucoid lakes.
- Intratubular spread.
Notes:
- Spireme = the tangle of filaments in prophase portion of mitosis.[13]
- May have eosinophilic cytoplasm (dependent on lab).
- Usually larger than Leydig cell tumour.
Images:
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.[14]
Embryonal carcinoma
Main article: Embryonal carcinoma
These often look like a poorly differentiated carcinoma.
General
- Affects young adults.
- May be seen in women.
Microscopic
Features:[15]
- 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
Main article: Choriocarcinoma
These are aggressive tumours.
Microscopic
Features:
- Syncytiotrophoblasts:
- Large + many irreg. or lobular hyperchromatic nuclei.
- Eosinophilic vacuolated cytoplasm (contains hCG).
- Cytotrophoblasts:
- Clear cytoplasm.
- Polygonal shaped cells in cords/masses.
- Distinct cell borders.
- Single uniform nucleus.
- +/-Hemorrhage.
- +/-Necrosis.
Teratoma
Main article: Teratoma
In males these tumours are always malignant. They consist of all three germ layers.[16]
Sex cord stromal tumours
Leydig cell tumour
- Arises from interstitial cell.
- AKA interstitial cell tumour.
Microscopic
Features:[17]
- Vacuolization - key feature.
- Cytoplasm - clear to eosinophilic.
- Nucleoli common.
- Reinke crystals, cylindrical crystalloid eosinophilic cytoplasmic bodies (not always present).
DDx:
- Spermatocytic seminoma - may have eosinophilic cytoplasm.
Images:
- Leydig cell tumour - low mag. (WC).
- Leydig cell tumour - intermed. mag. (WC).
- Leydig cell tumour - high mag. (WC).
IHC
- Inhibin-alpha.
- Calretinin.[18][19]
- Melan A.[20]
- AKA MART-1.
- Expressed in melanoma, adrenal tissue, steroid-secreting tumours.
Sertoli cell nodule
- AKA Pick's adenoma, AKA testicular tubular adenoma, AKA tubular adenoma of the testis.
General
- 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.[21]
Microscopic
- 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.
Images:
Sertoli cell tumour
General
- Arises from Sertoli cells (AKA nurse cells).
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.
Image(s):
IHC
- Alpha-inhibin +ve. (???)
See also
References
- ↑ 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.
- ↑ 2.0 2.1 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.
- ↑ 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.
- ↑ URL: http://www.webpathology.com/image.asp?case=30&n=1. Accessed on: 18 May 2010.
- ↑ URL: http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png. Accessed on: 31 May 2010.
- ↑ URL: http://webpathology.com/image.asp?case=34&n=8. Accessed on: March 8, 2010.
- ↑ 8.0 8.1 PMID 16867864.
- ↑ Emerson, RE.; Ulbright, TM. (Jun 2010). "Intratubular germ cell neoplasia of the testis and its associated cancers: the use of novel biomarkers.". Pathology 42 (4): 344-55. doi:10.3109/00313021003767355. PMID 20438407.
- ↑ 10.0 10.1 10.2 10.3 Eble JN (October 1994). "Spermatocytic seminoma". Hum. Pathol. 25 (10): 1035–42. PMID 7927308.
- ↑ 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.
- ↑ 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.
- ↑ URL: http://www.thefreedictionary.com/spireme. Accessed on: 4 June 2010.
- ↑ URL: http://webpathology.com/image.asp?case=34&n=1. Accessed on: March 8, 2010.
- ↑ Zhou, Ming; Magi-Galluzzi, Cristina (2006). Genitourinary Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 549. ISBN 978-0443066771.
- ↑ Moore, Keith L.; Persaud, T.V.N. (2002). The Developing Human: Clinically Oriented Embryology (7th ed.). Saunders. pp. 83. ISBN 978-0721694122.
- ↑ Zhou, Ming; Magi-Galluzzi, Cristina (2006). Genitourinary Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 581. ISBN 978-0443066771.
- ↑ URL: http://www.antibodybeyond.com/reviews/cell-markers/leydig-cell-marker.htm. Accessed on: 18 May 2010.
- ↑ Bar-Shira Maymon B, Yavetz H, Yogev L, et al. (2005). "Detection of calretinin expression in abnormal immature Sertoli cells in non-obstructive azoospermia". Acta Histochem. 107 (2): 105–12. doi:10.1016/j.acthis.2005.02.002. PMID 15950053.
- ↑ Yao DX, Soslow RA, Hedvat CV, Leitao M, Baergen RN (September 2003). "Melan-A (A103) and inhibin expression in ovarian neoplasms". Appl. Immunohistochem. Mol. Morphol. 11 (3): 244–9. PMID 12966351.
- ↑ 21.0 21.1 Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 227. ISBN 978-0470519035.
- ↑ Ricco R, Bufo P (October 1980). "[Histologic study of 3 cases of so-called tubular adenoma of the testis]" (in Italian). Boll. Soc. Ital. Biol. Sper. 56 (20): 2110–5. PMID 6109541.
