Difference between revisions of "Testis"

Jump to navigation Jump to search

Testis (view source)

Revision as of 15:36, 17 June 2017

12,944 bytes removed ,  15:36, 17 June 2017
→‎Hydrocele testis: split out
(36 intermediate revisions by the same user not shown)
Line 1: Line 1:
[[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.  
Line 23: Line 25:
**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.


Line 45: Line 47:
*[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)
Line 61: Line 66:
*[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:
Line 71: Line 76:
*[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.
Line 117: Line 130:
! 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]]
Line 159: Line 172:
| [[Image:Teratoma_2_low_mag.jpg|thumb|center|150px|Teratoma (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.
==Male infertility==
 
*This is a [[clinical diagnosis]].
Numerous small Leydig cell clusters are seen in some sections.
{{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.
**May be seen in association with a testicular neoplasm.<ref name=pmid9490992>{{Cite journal  | last1 = Junnila | first1 = J. | last2 = Lassen | first2 = P. | title = Testicular masses. | journal = Am Fam Physician | volume = 57 | issue = 4 | pages = 685-92 | month = Feb | year = 1998 | doi =  | PMID = 9490992 }}</ref>
*Common.<ref name=pmid20705202>{{Cite journal  | last1 = Wampler | first1 = SM. | last2 = Llanes | first2 = M. | title = Common scrotal and testicular problems. | journal = Prim Care | volume = 37 | issue = 3 | pages = 613-26, x | month = Sep | year = 2010 | doi = 10.1016/j.pop.2010.04.009 | PMID = 20705202 }}</ref>
 
Clinical:
*Scrotal mass.
 
===Microscopic===
Features:
*Cyst lined by a simple ciliated epithelium.
*Does '''not''' contain sperm.
 
DDx:
*[[Spermatocele]] - contains sperm.
 
===Sign out===
<pre>
HYDROCELE SAC, LEFT, EXCISION:
- CONSISTENT WITH HYDROCELE SAC.
</pre>
 
<pre>
SOFT TISSUE ("HYDROCELE SAC"),LEFT, EXCISION:
- FIBROADIPOSE TISSUE COVERED BY MESOTHELIUM WITH REACTIVE CHANGES -- CONSISTENT
  WITH HYDROCELE SAC.
- EPIDIDYMIS WITH SPERM (INCIDENTAL FINDING).
</pre>
 
====Micro====
The sections shows fragments of tissue compatible with a benign cyst, that had a fibrous wall and was lined by a simple epithelium. No spermatocytes are identified.
 
Benign connective tissue (including skeletal muscle, nerves and blood vessels) is also present.


==Idiopathic granulomatous orchitis==
==Idiopathic granulomatous orchitis==
Line 319: Line 241:


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 326: 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 331: 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:
==Testicular abscess==
*[[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>
{{Main|Testicular abscess}}
*[[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/>
==Testicular torsion==
*Undifferentiated ITGCN.
{{Main|Testicular torsion}}
*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===
==Adenomatous hyperplasia of the rete testis==
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|Adenomatous hyperplasia of the rete testis}}
*"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:
==Epidermoid cyst of the testis==
*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|Epidermoid cyst of the testis}}


====Images====
=Premalignant=
<gallery>
==Germ cell neoplasia in situ==
Image:Intratubular_germ_cell_neoplasia_-_2_-_very_high_mag.jpg | Benign seminiferous tubules and ITGCN. (WC/Nephron)
*Previously ''intratubular germ cell neoplasia'' (abbreviated ''ITGCN'').
Image:Intratubular_germ_cell_neoplasia_high_mag_cropped.jpg | ITGCN - cropped. (WC/Nephron)
{{Main|Germ cell neoplasia in situ}}
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===
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>
*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:
*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 tumours=
=Germ cell tumours=
Line 387: Line 279:
{{Main|Seminoma}}
{{Main|Seminoma}}


==Spermatocytic seminoma==
==Spermatocytic tumour==
{{Main|Spermatocytic seminoma}}
*Previously ''spermatocytic seminoma''.
{{Main|Spermatocytic tumour}}


==Yolk sac tumour==
==Yolk sac tumour==
Line 404: 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 453: Line 312:


==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 525: 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 546: Line 343:
*[[Vas deferens]].
*[[Vas deferens]].
*[[Spermatic cord]].
*[[Spermatic cord]].
*[[Paratesticular region]].


=References=
=References=
Line 554: Line 352:


[[Category: Genitourinary pathology]]
[[Category: Genitourinary pathology]]
[[Category: Testis]]
Michael
48,448

edits

Retrieved from "https://librepathology.org/wiki/Special:MobileDiff/25903...47519"

Navigation menu