Testis

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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:
        1. teratoma + embryonal carcinoma + endodermal sinus tumour (yolk sac tumour) (TEE).
        2. seminoma + embryonal (SE).
        3. embryonal + teratoma (TE).
  • 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

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.
  • 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.

Microscopic

Features:[12]

  • Vacuolization - key feature.
  • Cytoplasm - clear to eosinophilic.
  • Nucleoli common.


See also

References

  1. ↑ [1]
  2. ↑ URL: http://webpathology.com/image.asp?case=34&n=8. Accessed on: March 8, 2010.
  3. ↑ Müller J, Skakkebaek NE, Parkinson MC (February 1987). "The spermatocytic seminoma: views on pathogenesis". Int. J. Androl. 10 (1): 147–56. PMID 3583416.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ URL: http://webpathology.com/image.asp?case=34&n=1. Accessed on: March 8, 2010.
  8. ↑ URL: http://webpathology.com/image.asp?case=34&n=6. Accessed on: March 8, 2010.
  9. ↑ URL: http://webpathology.com/image.asp?case=34&n=8. Accessed on: March 8, 2010.
  10. ↑ GUP P.549
  11. ↑ NEED REF.
  12. ↑ GUP P.581.

External links

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