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Testis (view source)

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[[Image:Seminoma_of_the_Testis.jpg|thumb|150px|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.   
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.
If the testis is biopsied, it is usually for [[male infertility|fertility]].  The [[cut-up]] of orchiectomy specimens is dealt with in ''[[orchiectomy grossing]]''.


=Normal testis=
=Normal testis=
==Gross==
===Gross===
Anatomy - deep to superficial:
Anatomy - deep to superficial:
*Tunica albuginea - fibrous layer.
*Tunica albuginea - fibrous layer.
*Tunica vaginalis - thin mesothelial layer.
*Tunica vaginalis - thin mesothelial layer.
**This layer is important in the [[cancer staging|staging]] of testicular tumours.


==Microscopic==
===Microscopic===
===Seminiferous tubules===
====Seminiferous tubules====
*Sertoli cells ([[AKA]] sustentacular cell [[AKA]] nurse cell).  
*Sertoli cells ([[AKA]] sustentacular cell [[AKA]] nurse cell).  
**Large cells with oval nucleus.  
**Large cells with oval nucleus.  
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**You don't see the tail on light microscopy.
**You don't see the tail on light microscopy.


====Images====
=====Images=====
<gallery>
<gallery>
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====
*Leydig cell ([[AKA]] interstitial cell).
*Leydig cell ([[AKA]] interstitial cell).
**Large eosinophilic cell.
**Large eosinophilic cell.
*[[Blood vessel]]s.
*[[Blood vessel]]s.


====Image====
=====Image=====
<gallery>
<gallery>
Image:Leydig_cells_-_very_high_mag.jpg | Leydig cells - very high mag. (WC/Nephron)
Image:Leydig_cells_-_very_high_mag.jpg | Leydig cells - very high mag. (WC/Nephron)
</gallery>
</gallery>
===Associated structures===
====Associated structures====
*Epididymis - stores the sperm.
*[[Epididymis]] - stores the sperm.
**Pseudostratified epithelium with cilia.
**Pseudostratified epithelium with cilia.


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*[http://www.webpathology.com/image.asp?n=3&Case=27 Epididymis (webpathology.com)].
*[http://www.webpathology.com/image.asp?n=3&Case=27 Epididymis (webpathology.com)].


===Rete testis===
====Rete testis====
*Receives stuff from the tubules.
*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]]''.
*Very rarely give rise to an ''[[adenocarcinoma of the rete testis]]''.
*May be involved by [[seminoma]] - increases risk of relapse in a univariate analysis.<Ref>{{Cite journal  | last1 = Soper | first1 = MS. | last2 = Hastings | first2 = JR. | last3 = Cosmatos | first3 = HA. | last4 = Slezak | first4 = JM. | last5 = Wang | first5 = R. | last6 = Lodin | first6 = K. | title = 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. | journal = Am J Clin Oncol | volume =  | issue =  | pages =  | month = Dec | year = 2012 | doi = 10.1097/COC.0b013e318277d839 | PMID = 23275274 }}</ref>
*May be involved by [[seminoma]].
**Increases risk of relapse in a univariate analysis.<Ref>{{Cite journal  | last1 = Soper | first1 = MS. | last2 = Hastings | first2 = JR. | last3 = Cosmatos | first3 = HA. | last4 = Slezak | first4 = JM. | last5 = Wang | first5 = R. | last6 = Lodin | first6 = K. | title = 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. | journal = Am J Clin Oncol | volume =  | issue =  | pages =  | month = Dec | year = 2012 | doi = 10.1097/COC.0b013e318277d839 | PMID = 23275274 }}</ref>
**More common with (sometimes subtle) intertubular pattern of seminoma.<ref name=pmid16021570>{{Cite journal  | last1 = Browne | first1 = TJ. | last2 = Richie | first2 = JP. | last3 = Gilligan | first3 = TD. | last4 = Rubin | first4 = MA. | title = Intertubular growth in pure seminomas: associations with poor prognostic parameters. | journal = Hum Pathol | volume = 36 | issue = 6 | pages = 640-5 | month = Jun | year = 2005 | doi = 10.1016/j.humpath.2005.03.011 | PMID = 16021570 }}</ref>


Microscopic:
Microscopic:
*Delicate anastomosing channels lined by cuboid epithelium.
*Delicate anastomosing channels lined by cuboid epithelium.


====Images====
=====Images=====
<gallery>
<gallery>
Image:Rete_testis_high_mag.jpg | Rete testis (WC/Nephron)
Image:Rete_testis_high_mag.jpg | Rete testis (WC/Nephron)
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*[http://www.webpathology.com/image.asp?case=27&n=5 Rete testis (webpathology.com)].
*[http://www.webpathology.com/image.asp?case=27&n=5 Rete testis (webpathology.com)].


===Appendix of testis===
====Appendix of testis====
Muellerian duct remnant.
*Muellerian duct remnant.


Microscopic:
Microscopic:
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*[http://www.webpathology.com/image.asp?case=27&n=7 Appendix of testis (webpathology.com)].
*[http://www.webpathology.com/image.asp?case=27&n=7 Appendix of testis (webpathology.com)].


==Sign out==
===Sign out===
<pre>
<pre>
TESTICLE, RIGHT, ORCHIECTOMY:
TESTICLE, RIGHT, ORCHIECTOMY:
- TESTICLE WITHOUT APPARENT PATHOLOGY.
- TESTICLE WITHOUT APPARENT PATHOLOGY.
- NEGATIVE FOR INTRATUBULAR GERM CELL NEOPLASIA.
- NEGATIVE FOR MALIGNANCY.
</pre>
====Alternate====
<pre>
RIGHT TESTICLE, ORCHIDECTOMY:
- BENIGN TESTIS WITH SPERMATOGENESIS.
- NEGATIVE FOR INTRATUBULAR GERM CELL NEOPLASIA.
- NEGATIVE FOR INTRATUBULAR GERM CELL NEOPLASIA.
- NEGATIVE FOR MALIGNANCY.
- NEGATIVE FOR MALIGNANCY.
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*Infertility - azoospermic.
*Infertility - azoospermic.
**No sperm present.
**No sperm present.
*Germ cell tumours (GCTs).
*[[Germ cell tumours]] (GCTs).
**Intratubular germ cell neoplasia.
**[[Intratubular germ cell neoplasia]].
**Seminoma.
**[[Seminoma]].
**Spermatocytic seminoma.
**[[Spermatocytic seminoma]].
**Yolk sac tumour (endodermal sinus tumour).
**[[Yolk sac tumour]] (endodermal sinus tumour).
**Embryonal carcinoma.
**[[Embryonal carcinoma]].
**Choriocarcinoma.
**[[Choriocarcinoma]].
**Teratoma.
**[[Teratoma]].
**Mixed GCT - 60% of GCTs are mixed.
**[[Mixed GCT]] - 60% of GCTs are mixed.
***Common combinations:  
***Common combinations:  
***# teratoma + embryonal carcinoma + endodermal sinus tumour (yolk sac tumour) (TEE).
***# teratoma + embryonal carcinoma + endodermal sinus tumour (yolk sac tumour) (TEE).
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***# embryonal + teratoma (TE).
***# embryonal + teratoma (TE).
*Sex-cord stromal tumour.
*Sex-cord stromal tumour.
**Leydig cell tumour.
**[[Leydig cell tumour]].
**Sertoli cell tumour.
**[[Sertoli cell tumour]].


===IHC for GCTs===
===IHC for GCTs===
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*Beta-hCG - choriocarcinoma.
*Beta-hCG - choriocarcinoma.
*CD30 - embryonal carcinoma.
*CD30 - embryonal carcinoma.
*D2-40 - seminoma.
*[[D2-40]] - seminoma.


===Tabular summary of GCTs===
===Tabular summary of GCTs===
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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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| None
| None
| testicular teratomas in post-pubertal males are all considered malignant<ref>{{Cite journal  | last1 = Carver | first1 = BS. | last2 = Al-Ahmadie | first2 = H. | last3 = Sheinfeld | first3 = J. | title = Adult and pediatric testicular teratoma. | journal = Urol Clin North Am | volume = 34 | issue = 2 | pages = 245-51; abstract x | month = May | year = 2007 | doi = 10.1016/j.ucl.2007.02.013 | PMID = 17484929 }}</ref>
| testicular teratomas in post-pubertal males are all considered malignant<ref>{{Cite journal  | last1 = Carver | first1 = BS. | last2 = Al-Ahmadie | first2 = H. | last3 = Sheinfeld | first3 = J. | title = Adult and pediatric testicular teratoma. | journal = Urol Clin North Am | volume = 34 | issue = 2 | pages = 245-51; abstract x | month = May | year = 2007 | doi = 10.1016/j.ucl.2007.02.013 | PMID = 17484929 }}</ref>
| [[Image:Primitive_neuroepithelium_intermed_mag.jpg|thumb|center|150px|Primitive neuroepithelium (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 200: Line 213:
=Benign=
=Benign=
==Testicular atrophy==
==Testicular atrophy==
:''Cryptorchidism'' redirects here.
*[[AKA]] ''atrophic testis''.
*[[AKA]] ''atrophic testis''.
*[[AKA]] ''atrophy of the testis''.
*[[AKA]] ''atrophy of the testis''.
===General===
{{Main|Testicular atrophy}}
*Microscopic appearance identical to ''cryptorchidism'' (undescended testis).<ref name=Ref_PCPBoD8_506-7>{{Ref PCPBoD8|506-7}}</ref>
 
===Gross===
*Decreased size.
 
===Microscopic===
Features:<ref name=Ref_PCPBoD8_506-7>{{Ref PCPBoD8|506-7}}</ref>
*Thickening of seminiferous tubule basement membrane.
*Intertubular fibrosis.
*Decreased sperm/no sperm present.
 
Note:
*End-stage testicle - only has Sertoli cell within the seminiferous tubules.
 
Image:
*[http://www.surgicalpathologyatlas.com/glfusion/mediagallery/media.php?f=0&sort=0&s=20080802171227609 Testicular atrophy (surgicalpathologyatlas.com)].
 
===Sign out===
<pre>
TESTICLE, RIGHT, ORCHIECTOMY:
- ATROPHIC TESTICLE.
- NEGATIVE FOR INTRATUBULAR GERM CELL NEOPLASIA.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
====Micro====
The sections show seminiferous tubules surrounded by thick hyaline sleeves.  In a large number of sections only Sertoli cells are found in the tubules. 
 
In some sections poorly defined paucicellular tubular structures reminiscent of seminiferous tubules composed of hyaline material are present; these probably represent obsolete seminiferous tubules.  Focally, fibrosis is seen without definite tumour outlines.  There is no significant inflammation.  The rete testis is identified.
 
Rare seminiferous tubules have spermatid within. The germ cells seen do not have appreciable nuclear atypia.


Numerous small Leydig cell clusters are seen in some sections.
==Male infertility==
*This is a [[clinical diagnosis]].
{{Main|Male infertility}}


==Spermatocele==
==Spermatocele==
===General===
{{Main|Spermatocele}}
*Benign.
*Cyst of the epididymis (classic).
**May arise in the rete testis or [[vas deferens]].<ref>URL: [http://emedicine.medscape.com/article/443432-overview http://emedicine.medscape.com/article/443432-overview]. Accessed on: 5 March 2012.</ref>
 
Clinical:
*Often asymptomatic.
*Excised due to pain or mass effect.<ref name=pmid18357964>{{Cite journal  | last1 = Walsh | first1 = TJ. | last2 = Seeger | first2 = KT. | last3 = Turek | first3 = PJ. | title = Spermatoceles in adults: when does size matter? | journal = Arch Androl | volume = 53 | issue = 6 | pages = 345-8 | month =  | year =  | doi =  | PMID = 18357964 }}</ref>
 
===Microscopic===
Features:
*Cyst lined by a simple ciliated epithelium.
*Contain sperm.
**Head: ~1/2 the size of a [[RBC]], black.
**Tail: infrequently seen. 
 
Note:
*Small cellular clusters may be present.
**May mimic [[small cell carcinoma]].<ref name=pmid19740515>{{Cite journal  | last1 = Lane | first1 = Z. | last2 = Epstein | first2 = JI. | title = Small blue cells mimicking small cell carcinoma in spermatocele and hydrocele specimens: a report of 5 cases. | journal = Hum Pathol | volume = 41 | issue = 1 | pages = 88-93 | month = Jan | year = 2010 | doi = 10.1016/j.humpath.2009.06.018 | PMID = 19740515 }}</ref>
 
DDx:
*[[Hydrocele testis]] - do not contain sperm.


====Images====
<gallery>
Image:Spermatocele_-_intermed_mag.jpg | Spermatocele - intermed. mag. (WC)
Image:Spermatocele_-_very_high_mag.jpg | Spermatocele - very high mag. (WC)
</gallery>
www:
*[http://www.webpathology.com/image.asp?n=4&Case=40 Spermatocele - low mag. (webpathology.com)].
*[http://www.webpathology.com/image.asp?n=5&Case=40 Spermatocele - high mag. (webpathology.com)].
==Hydrocele testis==
==Hydrocele testis==
*[[AKA]] ''hydrocele''.
*[[AKA]] ''hydrocele''.
===General===
{{Main|Hydrocele testis}}
*Benign.
 
Clinical:
*Scrotal mass.
 
===Microscopic===
Features:
*Cyst lined by a simple ciliated epithelium.
*Does '''not''' contain sperm.
 
DDx:
*[[Spermatocele]] - contains sperm.


==Idiopathic granulomatous orchitis==
==Idiopathic granulomatous orchitis==
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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 306: 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===
Line 311: Line 254:
*[[Dieterle stain]] -ve -- for syphilis.
*[[Dieterle stain]] -ve -- for syphilis.


=Premalignant=
==Testicular scar==
==Intratubular germ cell neoplasia==
{{Main|Testicular scar}}
*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 ITGCN:
*[[Spermatocytic seminoma]].<ref>{{cite journal |author=Müller J, Skakkebaek NE, Parkinson MC |title=The spermatocytic seminoma: views on pathogenesis |journal=Int. J. Androl. |volume=10 |issue=1 |pages=147–56 |year=1987 |month=February |pmid=3583416 |doi= |url=}}</ref>
*[[Yolk sac tumour]]s (endodermal sinus tumour).<ref>{{cite journal |author=Manivel JC, Simonton S, Wold LE, Dehner LP |title=Absence of intratubular germ cell neoplasia in testicular yolk sac tumors in children. A histochemical and immunohistochemical study |journal=Arch. Pathol. Lab. Med. |volume=112 |issue=6 |pages=641–5 |year=1988 |month=June |pmid=2837162 |doi= |url=}}</ref>
*Teratoma.{{Fact}}
 
Classification:<ref name=pmid11900581/>
*Undifferentiated ITGCN.
*Differentiated ITGCN.<ref name=pmid17592271>{{Cite journal  | last1 = Lau | first1 = SK. | last2 = Weiss | first2 = LM. | last3 = Chu | first3 = PG. | title = Association of intratubular seminoma and intratubular embryonal carcinoma with invasive testicular germ cell tumors. | journal = Am J Surg Pathol | volume = 31 | issue = 7 | pages = 1045-9 | month = Jul | year = 2007 | doi = 10.1097/PAS.0b013e31802b8712 | PMID = 17592271 }}</ref>
**''Intratubular embryonal carcinoma''.
**''Intratubular seminoma.''


===Microscopic===
==Testicular abscess==
Features:<ref>URL: [http://www.webpathology.com/image.asp?case=30&n=1 http://www.webpathology.com/image.asp?case=30&n=1]. Accessed on: 18 May 2010.</ref><ref name=pmid3328244>{{Cite journal  | last1 = Gondos | first1 = B. | last2 = Migliozzi | first2 = JA. | title = Intratubular germ cell neoplasia. | journal = Semin Diagn Pathol | volume = 4 | issue = 4 | pages = 292-303 | month = Nov | year = 1987 | doi =  | PMID = 3328244 }}</ref>
{{Main|Testicular abscess}}
*"Large" round ''or'' polygonal nuclei.
**Size in relation to normal often not defined.
***Rakheja ''et al.'' say >= 5x a lymphocyte for intratubular embryonal carcinoma.<ref name=pmid11900581>{{Cite journal  | last1 = Rakheja | first1 = D. | last2 = Hoang | first2 = MP. | last3 = Sharma | first3 = S. | last4 = Albores-Saavedra | first4 = J. | title = Intratubular embryonal carcinoma. | journal = Arch Pathol Lab Med | volume = 126 | issue = 4 | pages = 487-90 | month = Apr | year = 2002 | doi = 10.1043/0003-9985(2002)1260487:IEC2.0.CO;2 | PMID = 11900581 | url = http://www.archivesofpathology.org/doi/full/10.1043/0003-9985(2002)126%3C0487:IEC%3E2.0.CO;2 }}</ref>
**Polygonal nuclei = squared-off nuclear membrane.
*Prominent nucleoli - '''key feature'''.
*Clear cytoplasm.
*+/-Cells fill the tubule.


DDx:
==Testicular torsion==
*Sertoli cell-only syndrome - Sertoli cells also have nucleoli, wind swept appearance.<ref>URL: [http://www.webpathology.com/image.asp?n=3&Case=28 http://www.webpathology.com/image.asp?n=3&Case=28]. Accessed on: 25 March 2013.</ref>
{{Main|Testicular torsion}}


====Images====
==Adenomatous hyperplasia of the rete testis==
<gallery>
{{Main|Adenomatous hyperplasia of the rete testis}}
Image:Intratubular_germ_cell_neoplasia_-_2_-_very_high_mag.jpg | Benign seminiferous tubules and ITGCN. (WC/Nephron)
Image:Intratubular_germ_cell_neoplasia_high_mag_cropped.jpg | ITGCN - cropped. (WC/Nephron)
Image:Intratubular_germ_cell_neoplasia_high_mag.jpg | ITGCN. (WC/Nephron)
</gallery>
www:
*[http://www.webpathology.com/image.asp?case=30&n=1 ITGCN (webpathology.com)].
*[http://www.archivesofpathology.org/na101/home/literatum/publisher/pinnacle/journals/content/arpa/2002/15432165-126.4/0003-9985%282002%29126%3C0487%3Aiec%3E2.0.co%3B2/production/images/large/i1543-2165-126-4-487-f01.jpeg Intratubular embryonal carcinoma (archivesofpathology.org)].<ref name=pmid11900581/>


===IHC===
==Epidermoid cyst of the testis==
Features:<ref name=pmid15221945>{{Cite journal  | last1 = Honecker | first1 = F. | last2 = Stoop | first2 = H. | last3 = de Krijger | first3 = RR. | last4 = Chris Lau | first4 = YF. | last5 = Bokemeyer | first5 = C. | last6 = Looijenga | first6 = LH. | title = Pathobiological implications of the expression of markers of testicular carcinoma in situ by fetal germ cells. | journal = J Pathol | volume = 203 | issue = 3 | pages = 849-57 | month = Jul | year = 2004 | doi = 10.1002/path.1587 | PMID = 15221945 }}</ref>
{{Main|Epidermoid cyst of the testis}}
*PLAP +ve.<ref>{{Cite journal  | last1 = Schreiber | first1 = L. | last2 = Lifschitz-Mercer | first2 = B. | last3 = Paz | first3 = G. | last4 = Yavetz | first4 = H. | last5 = Elliott | first5 = DJ. | last6 = Kula | first6 = K. | last7 = Slowikowska-Hilczer | first7 = J. | last8 = Maymon | first8 = BB. | title = Double immunolabeling by the RBM and the PLAP markers for identifying intratubular (in situ) germ cell neoplasia of the testis. | journal = Int J Surg Pathol | volume = 11 | issue = 1 | pages = 17-20 | month = Jan | year = 2003 | doi =  | PMID = 12598912 }}</ref>
*CD117 +ve.
**Disputed: doesn't differentiate neoplastic from non-neoplastic according to Biermann ''et al''.<ref name=pmid22340755>{{Cite journal  | last1 = Biermann | first1 = K. | last2 = Stoop | first2 = H. | last3 = Looijenga | first3 = L. | title = c-KIT protein expression does not discriminate neoplastic from non-neoplastic intratubular germ cells. | journal = Histopathology | volume = 60 | issue = 6 | pages = 1017-9 | month = May | year = 2012 | doi = 10.1111/j.1365-2559.2011.04157.x | PMID = 22340755 }}</ref>
*OCT3/4 +ve.


Note:
=Premalignant=
*Normal testis PLAP -ve, CD117 -ve.<ref name=pmid9104938>{{Cite journal  | last1 = Hawkins | first1 = E. | last2 = Heifetz | first2 = SA. | last3 = Giller | first3 = R. | last4 = Cushing | first4 = B. | title = The prepubertal testis (prenatal and postnatal): its relationship to intratubular germ cell neoplasia: a combined Pediatric Oncology Group and Children's Cancer Study Group. | journal = Hum Pathol | volume = 28 | issue = 4 | pages = 404-10 | month = Apr | year = 1997 | doi =  | PMID = 9104938 }}</ref>
==Germ cell neoplasia in situ==
*Previously ''intratubular germ cell neoplasia'' (abbreviated ''ITGCN'').
{{Main|Germ cell neoplasia in situ}}


=Germ cell tumours=
=Germ cell tumours=
{{Main|Germ cell tumours}}
{{Main|Germ cell tumours}}
==Seminoma==
==Seminoma==
:Should ''not'' be confused with the unrelated tumour called ''[[spermatocytic seminoma]]''.
{{Main|Seminoma}}
===General===
*Male counterpart of the [[dysgerminoma]], which arise in the [[ovary]].
*Most common [[germ cell tumour]] of the testis.
 
Clinical:
*Elevated serum LDH.
*Normal serum alpha fetoprotein.
*Usually normal beta-hCG.
 
Note:
*Rarely, it may present a retroperitoneal mass.<ref name=pmid21424055>{{Cite journal  | last1 = Preda | first1 = O. | last2 = Nicolae | first2 = A. | last3 = Loghin | first3 = A. | last4 = Borda | first4 = A. | last5 = Nogales | first5 = FF. | title = Retroperitoneal seminoma as a first manifestation of a partially regressed (burnt-out) testicular germ cell tumor. | journal = Rom J Morphol Embryol | volume = 52 | issue = 1 | pages = 193-6 | month =  | year = 2011 | doi =  | PMID = 21424055 }}</ref>
 
====Epidemiology & etiology====
*Arises from ''[[intratubular germ cell neoplasia]]'' (ITGCN).
 
===Microsopic===
Features:
*Cells with fried egg appearance - '''key feature''':
**Clear cytoplasm.
**Central nucleus, with prominent nucleolus.
***Nucleus may have "corners", i.e. it is ''not'' round.
*+/-Lymphoctyes - interspersed (very common).
*+/-[[Syncytiotrophoblast]]s, [[AKA]] ''syncytiotrophoblastic giant cells'' (STGCs),<ref name=Ref_GUP542>{{Ref GUP|542}}</ref> present in ~10-20% of seminoma.<ref>URL: [http://www.webpathology.com/image.asp?case=31&n=10 http://www.webpathology.com/image.asp?case=31&n=10]. Accessed on: 22 May 2012.</ref>
**Large + irregular, vesicular nuclei.
**Eosinophilic vacuolated cytoplasm (contains hCG).
***Syncytiotrophoblasts = closest to mom in normal [[chorionic villi]] - covers cytotrophoblast.<ref>URL: [http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png http://upload.wikimedia.org/wikipedia/commons/4/45/Gray37.png]. Accessed on: 31 May 2010.</ref>
*+/-Florid granulomatous reaction.
 
Memory device: 3 Cs - clear cytoplasm, central nucleus, corners on the nuclear membrane.
 
DDx:
*[[Embryonal carcinoma]].
*Solid variant of [[yolk sac tumour]].
**Lacks fibrous septae and lymphocytes.<ref>URL: [http://webpathology.com/image.asp?case=34&n=8 http://webpathology.com/image.asp?case=34&n=8]. Accessed on: March 8, 2010.</ref>
*[[Mixed germ cell tumour]].
*[[Choriocarcinoma]] - esp. if (multinucleated) syncytiotrophoblasts are present.<ref name=pmid157614>{{Cite journal  | last1 = Hedinger | first1 = C. | last2 = von Hochstetter | first2 = AR. | last3 = Egloff | first3 = B. | title = Seminoma with syncytiotrophoblastic giant cells. A special form of seminoma. | journal = Virchows Arch A Pathol Anat Histol | volume = 383 | issue = 1 | pages = 59-67 | month = Jul | year = 1979 | doi =  | PMID = 157614 }}</ref>
*Granulomatous orchitis - if [[granuloma]]s are present.
 
====Images====
<gallery>
Image:Seminoma_high_mag.jpg |Seminoma - high mag. (WC/Nephron)
Image:Seminoma_intermed_mag.jpg |Seminoma - intermed. mag. (WC/Nephron)
Image:Rete_testis_with_seminoma.jpg |Seminoma in the rete testis (WC/Nephron)
Image:Seminoma_with_syncytiotrophoblasts_-_intermed_mag.jpg |Seminoma with syncytiotrophoblasts - intermed. mag. (WC/Nephron)
Image:Seminoma_with_syncytiotrophoblasts_-_very_high_mag.jpg |Seminoma with syncytiotrophoblasts - very high mag. (WC/Nephron)
</gallery>
===IHC===
*D2-40 +ve ~100% of cases.<ref name=pmid17277761>{{Cite journal  | last1 = Lau | first1 = SK. | last2 = Weiss | first2 = LM. | last3 = Chu | first3 = PG. | title = D2-40 immunohistochemistry in the differential diagnosis of seminoma and embryonal carcinoma: a comparative immunohistochemical study with KIT (CD117) and CD30. | journal = Mod Pathol | volume = 20 | issue = 3 | pages = 320-5 | month = Mar | year = 2007 | doi = 10.1038/modpathol.3800749 | PMID = 17277761 }}</ref>
*CD117 +ve (ckit) ~92% of cases.<ref name=pmid17277761/>
*CD30 -ve.<ref name=pmid16867864>{{Cite journal  | last1 = Cossu-Rocca | first1 = P. | last2 = Jones | first2 = TD. | last3 = Roth | first3 = LM. | last4 = Eble | first4 = JN. | last5 = Zheng | first5 = W. | last6 = Karim | first6 = FW. | last7 = Cheng | first7 = L. | title = Cytokeratin and CD30 expression in dysgerminoma. | journal = Hum Pathol | volume = 37 | issue = 8 | pages = 1015-21 | month = Aug | year = 2006 | doi = 10.1016/j.humpath.2006.02.018 | PMID = 16867864 }}</ref>
**Done to r/o [[embryonal carcinoma]].
*Cytokeratins usu. -ve, may have weak focal positivity.<ref name=pmid16867864/>
*OCT3/4 +ve.<ref name=pmid20438407>{{Cite journal  | last1 = Emerson | first1 = RE. | last2 = Ulbright | first2 = TM. | title = Intratubular germ cell neoplasia of the testis and its associated cancers: the use of novel biomarkers. | journal = Pathology | volume = 42 | issue = 4 | pages = 344-55 | month = Jun | year = 2010 | doi = 10.3109/00313021003767355 | PMID = 20438407 }}</ref>
 
===Sign out===
<pre>
RETROPERITONEAL SOFT TISSUE, RIGHT, CORE BIOPSY:
- SEMINOMA.
</pre>
====Micro====
The sections show large atypical, discohesive cells with prominent nucleoli, central
nuclei and moderate clear cytoplasm, intermixed with mature lymphocytes. Mitotic
activity is present.
 
====Small biopsy====
A mixed germ cell tumour cannot be excluded; given the small quantity of tumour, this
biopsy is at a high risk for having undersampled other tumour components should they be
present. Correlation with serology and consideration of re-biopsy is suggested.
 
==Spermatocytic seminoma==
===General===
*Rare tumour.
*Only one case of metastases in 200 cases.<ref name=pmid7927308>{{cite journal |author=Eble JN |title=Spermatocytic seminoma |journal=Hum. Pathol. |volume=25 |issue=10 |pages=1035–42 |year=1994 |month=October |pmid=7927308 |doi= |url=}}</ref>
*Orchiectomy is curative.
*Not reported/found in females.<ref name=pmid7927308/>
*Typically older - mean age 50s.<ref name=pmid7927308/>
 
====Epidemiology====
*Does NOT arise from ''[[intratubular germ cell neoplasia]]'' (ITGCN)<ref>{{cite journal |author=Müller J, Skakkebaek NE, Parkinson MC |title=The spermatocytic seminoma: views on pathogenesis |journal=Int. J. Androl. |volume=10 |issue=1 |pages=147–56 |year=1987 |month=February |pmid=3583416 |doi= 10.1111/j.1365-2605.1987.tb00176.x|url=}}</ref> - '''not''' considered a subtype of [[seminoma]].
 
===Microscopic===
Features:<ref>{{cite book |author=Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. |title=Robbins and Cotran pathologic basis of disease |publisher=Elsevier Saunders |location=St. Louis, Mo |year=2005 |pages= |edition=7th |isbn=0-7216-0187-1 |oclc= |doi= |accessdate=}}</ref>
*Population of three cells.
*#Small cells (6-8 µm) - with a large NC [[ratio]].
*#*Look like secondary spermatocytes.
*#*May be confused with (mature) lymphocytes.
*#Medium cells (15-18 µm) with prominent nucleoli.
*#*Filamentous chromatin (AKA ''spireme chromatin'').<ref name=pmid7927308>{{cite journal |author=Eble JN |title=Spermatocytic seminoma |journal=Hum. Pathol. |volume=25 |issue=10 |pages=1035–42 |year=1994 |month=October |pmid=7927308 |doi= |url=}}</ref>
*#Large cells (50-100 µm).
*#*Filamentous chromatin.
*Mucoid lakes.
*Intratubular spread.
 
Notes:
*''Spireme'' = the tangle of filaments in prophase portion of mitosis.<ref>URL: [http://www.thefreedictionary.com/spireme http://www.thefreedictionary.com/spireme]. Accessed on: 4 June 2010.</ref>
*May have eosinophilic cytoplasm (dependent on lab).
**Usually larger than [[Leydig cell tumour]].
 
DDx:
*[[DLBCL]].
*[[Seminoma]].


====Images====
==Spermatocytic tumour==
<gallery>
*Previously ''spermatocytic seminoma''.
Image:Spermatocytic_seminoma_high_mag.jpg | Spermatocytic seminoma - high mag. (WC)
{{Main|Spermatocytic tumour}}
Image:Spermatocytic_seminoma_intermed_mag.jpg | Spermatocytic seminoma - intermed. mag. (WC)
</gallery>
===IHC===
Features:<ref name=pmid10223302>{{Cite journal  | last1 = Kraggerud | first1 = SM. | last2 = Berner | first2 = A. | last3 = Bryne | first3 = M. | last4 = Pettersen | first4 = EO. | last5 = Fossa | first5 = SD. | title = Spermatocytic seminoma as compared to classical seminoma: an immunohistochemical and DNA flow cytometric study. | journal = APMIS | volume = 107 | issue = 3 | pages = 297-302 | month = Mar | year = 1999 | doi =  | PMID = 10223302 }}</ref>
*PLAP -ve (0 positive/17).
*CD117 -ve (7 positive/17).
*CAM5.2 -ve (1 positive/17).


==Yolk sac tumour==
==Yolk sac tumour==
Line 493: Line 297:
{{Main|Embryonal carcinoma}}
{{Main|Embryonal carcinoma}}
These often look like a poorly differentiated carcinoma.
These often look like a poorly differentiated carcinoma.
===General===
*Affects young adults.
**May be seen in women.
===Microscopic===
Features:<ref name=Ref_GUP549>{{Ref GUP|549}}</ref>
#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==
==Choriocarcinoma==
{{Main|Choriocarcinoma}}
{{Main|Choriocarcinoma}}
These are aggressive tumours.
These are aggressive tumours.
===Microscopic===
Features:
*Syncytiotrophoblasts:
**Large + many irreg. or lobular hyperchromatic nuclei.
**Eosinophilic vacuolated cytoplasm (contains hCG).
*'''C'''ytotrophoblasts:
**'''C'''lear cytoplasm.
**Polygonal shaped cells in cords/masses.
**Distinct cell borders.
**Single uniform nucleus.
*+/-Hemorrhage.
*+/-Necrosis.


==Teratoma of the testis==
==Teratoma of the testis==
Line 539: Line 309:
==Leydig cell tumour==
==Leydig cell tumour==
*[[AKA]] ''interstitial cell tumour''.
*[[AKA]] ''interstitial cell tumour''.
 
{{Main|Leydig cell tumour}}
===General===
*Arises from interstitial cell.
*May be associated with increased testosterone.
 
===Gross===
*Solid, lobulated.
*Red/tan.
 
Image:
*[http://www.flickr.com/photos/35441329@N05/5056465301/sizes/m/in/photostream/ Leydig cell tumour (flickr.com)].
 
===Microscopic===
Features:<ref name=Ref_GUP581>{{Ref GUP|581}}</ref>
*Vacuolization (cytoplasm) - '''key feature'''.
*Cytoplasm - clear to eosinophilic - '''important'''.
*''Reinke crystals'' - classic finding, usually not present.
**Cylindrical crystalloid eosinophilic cytoplasmic bodies.
*Nucleoli common.
*Round nuclei.
 
DDx:
*[[Spermatocytic seminoma]] - may have eosinophilic cytoplasm.
*[[Pregnancy luteoma]] - occurs during pregnancy, as the name implies.
 
====Images====
<gallery>
Image:Leydig_cell_tumour1.jpg |Leydig cell tumour - low mag. (WC)
Image:Leydig_cell_tumour2.jpg |Leydig cell tumour - intermed. mag. (WC)
Image:Leydig_cell_tumour3.jpg |Leydig cell tumour - high mag. (WC)
</gallery>
www:
*[http://path.upmc.edu/cases/case404.html Leydig cell tumour - several images (upmc.edu)].
 
===IHC===
*Inhibin-alpha.
*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>{{cite journal |author=Bar-Shira Maymon B, Yavetz H, Yogev L, ''et al.'' |title=Detection of calretinin expression in abnormal immature Sertoli cells in non-obstructive azoospermia |journal=Acta Histochem. |volume=107 |issue=2 |pages=105–12 |year=2005 |pmid=15950053 |doi=10.1016/j.acthis.2005.02.002 |url=}}</ref>
*Melan A.<ref name=pmid12966351>{{cite journal |author=Yao DX, Soslow RA, Hedvat CV, Leitao M, Baergen RN |title=Melan-A (A103) and inhibin expression in ovarian neoplasms |journal=Appl. Immunohistochem. Mol. Morphol. |volume=11 |issue=3 |pages=244–9 |year=2003 |month=September |pmid=12966351 |doi= |url=}}</ref>
**AKA ''MART-1''.
**Expressed in [[melanoma]], [[adrenal gland|adrenal tissue]], steroid-secreting tumours.


==Sertoli cell nodule==
==Sertoli cell nodule==
*Abbreviated ''SCN''.
*[[AKA]] ''Pick's adenoma''.
*[[AKA]] ''Pick's adenoma''.
*AKA ''testicular tubular adenoma''.
*AKA ''testicular tubular adenoma''.
*AKA ''tubular adenoma of the testis''.
*AKA ''tubular adenoma of the testis''.
===General===
{{Main|Sertoli cell nodule}}
*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''.<ref name=Ref_DCHH227>{{Ref DCHH|227}}</ref>
 
===Gross===
*Usually an incidental finding, rarely presents as a testicular mass.<ref name=pmid21107095>{{Cite journal  | last1 = Vallangeon | first1 = BD. | last2 = Eble | first2 = JN. | last3 = Ulbright | first3 = TM. | title = Macroscopic sertoli cell nodule: a study of 6 cases that presented as testicular masses. | journal = Am J Surg Pathol | volume = 34 | issue = 12 | pages = 1874-80 | month = Dec | year = 2010 | doi = 10.1097/PAS.0b013e3181fcab70 | PMID = 21107095 }}</ref>
 
===Microscopic===
Features:<ref name=Ref_DCHH227>{{Ref DCHH|227}}</ref><ref>{{cite journal |author=Ricco R, Bufo P |title=[Histologic study of 3 cases of so-called tubular adenoma of the testis] |language=Italian |journal=Boll. Soc. Ital. Biol. Sper. |volume=56 |issue=20 |pages=2110–5 |year=1980 |month=October |pmid=6109541 |doi= |url=}}</ref>
*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.
 
DDx:<ref name=pmid21107095/>
*[[Sertoli cell tumour]].
*[[Sex cord tumour with annular tubules]].
*[[Gonadoblastoma]].
 
====Images====
<gallery>
Image:Sertoli_cell_nodule_high_mag.jpg | Sertoli cell nodule - high mag. (WC)
Image:Sertoli_cell_nodule_low_mag.jpg | Sertoli cell nodule - low mag. (WC)
</gallery>
===IHC===
Features:<ref name=pmid21107095/>
*Alpha-inhibin +ve (5/5 cases).
*OCT3/4 -ve (5/5 cases).


==Sertoli cell tumour==
==Sertoli cell tumour==
===General===
{{Main|Sertoli cell tumour}}
*Arises from ''Sertoli cells'' ([[AKA]] nurse cells).
 
May be seen in several syndrome - esp. if there is calcification:
*[[Carney complex]].<ref name=pmid21047926>{{Cite journal  | last1 = Libé | first1 = R. | last2 = Horvath | first2 = A. | last3 = Vezzosi | first3 = D. | last4 = Fratticci | first4 = A. | last5 = Coste | first5 = J. | last6 = Perlemoine | first6 = K. | last7 = Ragazzon | first7 = B. | last8 = Guillaud-Bataille | first8 = M. | last9 = Groussin | first9 = L. | title = Frequent phosphodiesterase 11A gene (PDE11A) defects in patients with Carney complex (CNC) caused by PRKAR1A mutations: PDE11A may contribute to adrenal and testicular tumors in CNC as a modifier of the phenotype. | journal = J Clin Endocrinol Metab | volume = 96 | issue = 1 | pages = E208-14 | month = Jan | year = 2011 | doi = 10.1210/jc.2010-1704 | PMID = 21047926 }}</ref>
*[[Peutz-Jeghers syndrome]].
 
===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]].
*[[Sertoli cell nodule]].
 
====Images====
<gallery>
Image:Sertoli_cell_tumour_high_mag.jpg | Sertoli cell tumour - high mag. (WC)
Image:Sertoli_cell_tumour_low_mag.jpg | Sertoli cell tumour - low mag. (WC)
</gallery>
www:
*[http://path.upmc.edu/cases/case275/micro.html Sertoli cell tumour with calcification in Carney complex - several images (upmc.edu)].
 
===IHC===
*Alpha-inhibin +ve. (???)


=Other=
=Other=
Line 653: Line 325:


==Adenocarcinoma of the rete testis==
==Adenocarcinoma of the rete testis==
===General===
{{Main|Adenocarcinoma of the rete testis}}
*Extremely rare - a few dozen cases in the world literature.<ref name=pmid3799821>{{Cite journal  | last1 = Newbold | first1 = RR. | last2 = Bullock | first2 = BC. | last3 = McLachlan | first3 = JA. | title = Adenocarcinoma of the rete testis. Diethylstilbestrol-induced lesions of the mouse rete testis. | journal = Am J Pathol | volume = 125 | issue = 3 | pages = 625-8 | month = Dec | year = 1986 | doi =  | PMID = 3799821 | PMC = 1888460 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1888460/?page=1}}</ref>
 
*Possible association of diethylstilbestrol.<ref name=pmid3799821/>
==Testicular adrenal rest tumour==
:Abbreviated ''TART''.
{{Main|Testicular adrenal rest tumour}}
 
==Fibrous pseudotumour of the paratesticular region==
{{Main|Fibrous pseudotumour of the paratesticular region}}


===Microscopic===
==Testicular metastasis==
Features:
{{Main|Testicular metastasis}}
*Adenocarcinoma:
**Tubular or papillary architecture.<ref name=pmid3799821/>
**Columnar cells with cigar-shaped nuclei.


====Images====
<gallery>
Image:Adenocarcinoma_of_the_rete_testis_-_intermed_mag.jpg | Adenocarcinoma of the rete testis - intermed. mag. (WC/Nephron)
Image:Adenocarcinoma_of_the_rete_testis_-_extra_-_high_mag.jpg | Adenocarcinoma of the rete testis - high mag. (WC/Nephron)
</gallery>
=See also=
=See also=
*[[Genitourinary pathology]].
*[[Genitourinary pathology]].
Line 674: Line 343:
*[[Vas deferens]].
*[[Vas deferens]].
*[[Spermatic cord]].
*[[Spermatic cord]].
*[[Paratesticular region]].


=References=
=References=
Line 682: Line 352:


[[Category: Genitourinary pathology]]
[[Category: Genitourinary pathology]]
[[Category: Testis]]
Michael
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