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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.
[[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.   


==Normal==
If the testis is biopsied, it is usually for [[male infertility|fertility]].  The [[cut-up]] of orchiectomy specimens is dealt with in ''[[orchiectomy grossing]]''.
===Seminiferous tubules===
 
=Normal testis=
===Gross===
Anatomy - deep to superficial:
*Tunica albuginea - fibrous layer.
*Tunica vaginalis - thin mesothelial layer.
**This layer is important in the [[cancer staging|staging]] of testicular tumours.
 
===Microscopic===
====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.


===Interstitium===
=====Images=====
<gallery>
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:Intratubular_germ_cell_neoplasia_-_2_-_very_high_mag.jpg | Benign seminiferous tubules and GCNIS (ITGCN). (WC/Nephron)
</gallery>
====Interstitial====
*Leydig cell ([[AKA]] interstitial cell).
*Leydig cell ([[AKA]] interstitial cell).
**Large eosinophilic cell.
**Large eosinophilic cell.
*Blood vessels.
*[[Blood vessel]]s.


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


==Diagnoses==
====Rete testis====
*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]]''.
*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:
*Delicate anastomosing channels lined by cuboid epithelium.
 
=====Images=====
<gallery>
Image:Rete_testis_high_mag.jpg | Rete testis (WC/Nephron)
*[Image:Rete_testis_with_seminoma.jpg | Seminoma in the rete testis (WC/Nephron)
</gallery>
www:
*[http://www.webpathology.com/image.asp?case=27&n=5 Rete testis (webpathology.com)].
 
====Appendix of testis====
*Muellerian duct remnant.
 
Microscopic:
*Polypoid structure.
 
Images:
*[http://www.webpathology.com/image.asp?case=27&n=8 Appendix of testis (webpathology.com)].
*[http://www.webpathology.com/image.asp?case=27&n=7 Appendix of testis (webpathology.com)].
 
===Sign out===
<pre>
TESTICLE, RIGHT, ORCHIECTOMY:
- 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 MALIGNANCY.
</pre>
 
=Diagnoses (overview)=
*Benign.
*Benign.
**Spermatid present/not present.
**Spermatid present/not present.
*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).
Line 46: Line 111:
***# 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===
{| class="wikitable"
{| class="wikitable sortable"
!| Tumour
! Tumour
!| Key feature
! Key feature
!| Microscopic
! Microscopic
!| IHC
! IHC
!| Other
! Other
!| Image
! Image
|-  
|-  
| Intratubular germ cell neoplasia (IGCN)
| [[Germ cell neoplasia in situ]] (GCNIS)
| nests of small fried egg cells
| nests of small fried egg cells
| large central nucleus, clear <br>cytoplasm, squared-off nuclear membrane, nucleoli<ref>GUP P.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
| [[Image:Intratubular_germ_cell_neoplasia_high_mag_cropped.jpg|thumb|center|150px|GCNIS (WC)]]
|-  
|-  
| Seminoma
| [[Seminoma]]
| fried egg cells
| fried egg cells
| fried egg-like cells (central nucleus, clear <br>cytoplasm) with squared-off nuclear <br>membrane, nucleoli, lymphocytic infiltrate, granulomata,<br>syncytiotrophoblastic giant cells<ref>GUP P.542.</ref>
| fried egg-like cells (central nucleus, clear <br>cytoplasm) with squared-off nuclear <br>membrane, nucleoli, lymphocytic infiltrate, granulomata,<br>syncytiotrophoblastic giant cells<ref name=Ref_GUP542>{{Ref GUP|542}}</ref>
| D2-40
| D2-40
| Dysgerminoma
| Dysgerminoma = female version of this tumour
| Image
| [[Image:Seminoma_high_mag.jpg|thumb|center|150px|Seminoma (WC)]]
|-  
|-  
| Yolk sac tumour (endodermal sinus tumour)
| [[Yolk sac tumour]] (endodermal sinus tumour)
| Schiller-Duval bodies
| Schiller-Duval bodies
| Schiller-Duval b. = central blood vessel surrounded by epithelial-like cells a space and more epithelial-like cells, variable arch.  
| Schiller-Duval b. = central blood vessel surrounded by epithelial-like cells a space and more epithelial-like cells, variable arch.  
| AFP
| AFP
| patterns: microcystic, solid, hepatoid
| patterns: microcystic, solid, hepatoid
| [http://webpathology.com/image.asp?case=34&n=6 hepatoid YST]
| [[Image:Mixed_germ_cell_tumour_-_very_high_mag.jpg|thumb|center|150px|Yolk sac tumour (WC)]]
|-  
|-  
| Embryonal carcinoma
| [[Embryonal carcinoma]]
| prominent nucleoli, vescicular nuclei
| 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
| var. arch.: tubulopapillary, glandular, solid, embryoid bodies (ball of cells in surrounded by empty space on three sides), +/-nuclear overlap, mitoses common
| CD30
| CD30
| usu. part of a mixed GCT  
| usu. part of a mixed GCT  
| [http://www.webpathology.com/image.asp?case=33&n=1], [http://www.webpathology.com/image.asp?n=4&Case=37]
| [[Image:Embryonal_carcinoma_high_mag.jpg|thumb|center|150px|Embryonal carcinoma (WC)]]
|-  
|-  
| Choriocarcinoma
| [[Choriocarcinoma]]
| key feature
| marked nuclear atypia
| detailed micro
| cells with clear cytoplasm (cytotrophoblast), multinucleated cells (syncytiotrophoblast)
| beta-hCG
| beta-hCG
| other
| not commonly pure, usu. a component of a mixed GCT
| image
| [[Image:Choriocarcinoma_-2-_very_high_mag.jpg|thumb|center|150px|Choriocarcinoma (WC)]]
|-  
|-  
| Teratoma
| [[Teratoma]]
| key feature
| skin, GI tract-like epithelium
| detailed micro
| skin (epidermis, adnexal structures - sebaceous glands, hair follicles), GI tract-like glands (simple tall columnar epithelium), fat +/-primitive neuroepithelium (pseudostratified epithelium in [[rosettes]])
| None
| None
| other
| 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
| [[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 scant cytoplasm, (2) medium with nucleoli, (3) large - rare
| pop.: (1) small cell with high [[NC ratio]] (mature lymphocyte-like), (2) medium with nucleoli, (3) large cells with filamentous chromatin - few present
| nuclei round, no nucleoli rare/none
| does not arise 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 tumour (WC)]]
|-  
|-  
| Mixed germ cell tumour
| [[Mixed germ cell tumour]]
| NA
| NA
| common combinations: teratoma + embryonal carcinoma + endodermal sinus tumour (yolk sac tumour) (TEE); seminoma + embryonal (SE); embryonal + teratoma (TE)  
| common combinations: teratoma + embryonal carcinoma + endodermal sinus tumour (yolk sac tumour) (TEE); seminoma + embryonal (SE); embryonal + teratoma (TE)  
| NA
| NA
| -
| -
| -
| [[Image:Mixed_germ_cell_tumour_-_intermed_mag.jpg|thumb|center|150px|Mixed GCT (WC)]]
|}
|}


Line 131: Line 196:
!| Image
!| Image
|-  
|-  
| Leydig cell tumour
| [[Leydig cell tumour]]
| intersitial cell cluster with eosinophilic cytoplasm
| intersitial cell cluster with eosinophilic cytoplasm
| cytoplasmic vacuolization, uniform nuclei with nucleoli
| cytoplasmic vacuolization, uniform nuclei with nucleoli
| MART-1, calretin, inhibin
| MART-1, calretinin, inhibin
| +/-Reinke crystals (cylindrical crystalloid eosinophilic cytoplasmic bodies)
| +/-Reinke crystals (cylindrical crystalloid eosinophilic cytoplasmic bodies)
| [http://commons.wikimedia.org/wiki/File:Leydig_cell_tumour2.jpg]
| [[Image:Leydig_cell_tumour3.jpg|thumb|center|150px|Leydig cell tumour (WC)]]
|-  
|-  
| Sertoli cell tumour
| [[Sertoli cell tumour]]
| cells in cords or trabeculae
| cells in cords or [[trabeculae]]
| light staining bubbly cytoplasm +/- large cytoplasmic vacuoles, granular chromatin
| light staining bubbly cytoplasm +/- large cytoplasmic vacuoles, granular chromatin
| ?
| ?
| usu. no significant nuclear atypia, no mitoses  
| usu. no significant nuclear atypia, no mitoses  
| [http://commons.wikimedia.org/wiki/File:Sertoli_cell_tumour_low_mag.jpg]
| [[Image:Sertoli_cell_tumour_high_mag.jpg|thumb|center|150px|Sertoli cell tumour (WC)]]
|}
|}


==Intratubular germ cell neoplasia==
=Benign=
*Considered the precursor lesion for germ cell tumours.
==Testicular atrophy==
*Not all germ cell tumours (GCTs) arise from ''intratubular germ cell neoplasia''.  
*[[AKA]] ''atrophic testis''.
*[[AKA]] ''atrophy of the testis''.
{{Main|Testicular atrophy}}
 
==Male infertility==
*This is a [[clinical diagnosis]].
{{Main|Male infertility}}
 
==Spermatocele==
{{Main|Spermatocele}}
 
==Hydrocele testis==
*[[AKA]] ''hydrocele''.
{{Main|Hydrocele testis}}


The following testicular GCTs do not arise from ITCGN:
==Idiopathic granulomatous orchitis==
*[[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>
:''Granulomatous orchitis'' redirects here.
*[[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>
===General===
*Teratoma. (???)
*Rare.
*Unknown etiology -- possibly trauma + immune reaction to sperm.<ref name=pmid21458170>{{Cite journal | last1 = Roy | first1 = S. | last2 = Hooda | first2 = S. | last3 = Parwani | first3 = AV. | title = Idiopathic granulomatous orchitis. | journal = Pathol Res Pract | volume = 207 | issue = 5 | pages = 275-8 | month = May | year = 2011 | doi = 10.1016/j.prp.2011.02.005 | PMID = 21458170 }}</ref>


===Microscopic===
===Microscopic===
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>
Features:<ref name=pmid21458170/>
*Enlarged nuclei, vesicular.
*[[Granuloma]]s +/- [[necrosis]].
*Clear cytoplasm.
*+/-Destruction of seminiferous tubules.
*Nucleoli, prominent.
*Prominent collagen fibrosis.


Image(s):
DDx:
*[http://www.webpathology.com/image.asp?case=30&n=1 ITGCN (webpathology.com)].
*[[GCNIS]] (ITGCN).
*[[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>
**Syphilis, unlike other infections of the GU tract, is said to affect the testis before the epididymis.<ref name=Ref_WMSP364>{{Ref WMSP|364}}</ref>
*[[Tuberculosis]].
*[[Lymphoma]].<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>


==Seminoma==
===Stains===
===General===
*AFB -ve -- for tuberculosis.
*Male counterpart of the [[dysgerminoma]], which arise in the [[ovary]].
*[[Dieterle stain]] -ve -- for syphilis.


===Epidemiology & etiology===
==Testicular scar==
*Arises from ''intratubular germ cell neoplasia'' (ITGCN).
{{Main|Testicular scar}}


===Microsopy===
==Testicular abscess==
Features:
{{Main|Testicular abscess}}
*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 [[syncytiotrophoblast]]s, AKA ''syncytiotrophoblastic giant cells'' (STGCs).<ref>GUP P.542.</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>
*May see florid granulomatous reaction.


Memory device: 3 Cs - clear cytoplasm, central nucleus, corners on the nuclear membrane.
==Testicular torsion==
{{Main|Testicular torsion}}


DDx:
==Adenomatous hyperplasia of the rete testis==
*Mixed germ cell tumour.
{{Main|Adenomatous hyperplasia of the rete testis}}
*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>


===IHC===
==Epidermoid cyst of the testis==
*D2-40 +ve.
{{Main|Epidermoid cyst of the testis}}
*CD117 +ve (ckit).
*CD30 -ve.<ref name=pmid16867864>PMID 16867864.</ref>
**Done to r/o embryonal carcinoma.
*Cytokeratins usu. -ve, may have weak focal positivity.<ref name=pmid16867864/>


==Spermatocytic seminoma==
==Testicular trauma==
===General===
===General===
*Rare tumour.
*May lead to orchitectomy.
*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.
===Gross===
*Not reported/found in females.<ref name=pmid7927308/>
*Hemorrhagic.
 
===Microscopic===
Features:
*Necrotic seminiferous tubules.
*Intratubular blood in keeping with hemorrhage.
 
Note:
*Normal spermatogenesis in background - if viable tissue present.


===Epidemiology===
===Sign out===
*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.
<pre>
Right Testicle Tissue, Debridement:
    - Hemorrhagic testicular tissue and necrotic seminiferous tubules.
    - Small amount of viable seminiferous tubules with spermatogenesis.
    - NEGATIVE for germ cell neoplasia in situ.
    - NEGATIVE for malignancy.


===Microscopy===
Comment:
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>
The clinical history of trauma is noted.
*Population of three cells.
</pre>
*#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:
=Premalignant=
*''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>
==Germ cell neoplasia in situ==
*Previously ''intratubular germ cell neoplasia'' (abbreviated ''ITGCN'').
{{Main|Germ cell neoplasia in situ}}


Images:
=Germ cell tumours=
*[http://commons.wikimedia.org/wiki/File:Spermatocytic_seminoma_high_mag.jpg Spermatocytic seminoma - high mag. (WC)].
{{Main|Germ cell tumours}}
*[http://commons.wikimedia.org/wiki/File:Spermatocytic_seminoma_intermed_mag.jpg Spermatocytic seminoma - intermed. mag. (WC)].
==Seminoma==
{{Main|Seminoma}}
 
==Spermatocytic tumour==
*Previously ''spermatocytic seminoma''.
{{Main|Spermatocytic tumour}}


==Yolk sac tumour==
==Yolk sac tumour==
Tumour also known as ''endodermal sinus tumour''.
{{Main|Yolk sac tumour}}
*Most common GCT in infants and young boys.


===Microscopy===
===Microscopic===
Classic feature:
Classic feature:
*Schiller-Duval bodies.
*Schiller-Duval bodies.
Line 237: Line 320:
*Architecure - variable.
*Architecure - variable.
**Most common ''microcystic pattern''.<ref>URL: [http://webpathology.com/image.asp?case=34&n=1 http://webpathology.com/image.asp?case=34&n=1]. Accessed on: March 8, 2010.</ref>
**Most common ''microcystic pattern''.<ref>URL: [http://webpathology.com/image.asp?case=34&n=1 http://webpathology.com/image.asp?case=34&n=1]. Accessed on: March 8, 2010.</ref>
Image:
*[http://www.webpathology.com/image.asp?case=34&n=5 Schiller-Duval body (webpathology.com)].
Variants:
*Hepatoid pattern.<ref>URL: [http://webpathology.com/image.asp?case=34&n=6 http://webpathology.com/image.asp?case=34&n=6]. Accessed on: March 8, 2010.</ref>
**Vaguely resembles liver.
***Hyaline globules (light red well-circumscribed globs).
***Bile canaculi.
*Solid pattern.<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>
**Vaguely resembles ''seminoma''.
Image:
*[http://webpathology.com/image.asp?case=34&n=6 Hepatoid Pattern].
===Epidemiology===
*Most common GCT in infants and young boys.
===IHC===
*AFP+
*a1-AT+
*cytokeratin+ ???
===DDx===
*Embryonal carcinoma.


==Embryonal carcinoma==
==Embryonal carcinoma==
===General===
{{Main|Embryonal carcinoma}}
*Affects young adults.
These often look like a poorly differentiated carcinoma.
**May be seen in women.
 
===Microscopy===
Features:<ref>GUP P.549</ref>
*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+ ???<ref>NEED REF.</ref>
*CD30 +ve.  


==Choriocarcinoma==
==Choriocarcinoma==
===Clinical===
{{Main|Choriocarcinoma}}
*Aggressive clinical course.
These are aggressive tumours.
 
===Microscopy===
*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.
 
Image(s):
*[http://www.webpathology.com/image.asp?case=36&n=1 Choriocarcinoma (webpathology.com)]
 
Notes:
*See: ''[[Chorionic villi]]''.
 
===IHC===
*beta-hCG +ve.
 
==[[Teratoma]]==
*Consists of all three germ layers.
**Endoderm.
**Mesoderm.
**Ectoderm.
 
===Classification===
*Divided into:
**Mature.
**Immature.
 
===Immature===
*Immature if neural tissue is present:<ref>RS. 2 May 2010.</ref>
**Vaguely resembles pseudostratified respiratory epithelium.
*Islands of small hyperchromatic cells - "blastema".
*+/-Cartilage.


Images:
==Teratoma of the testis==
*[http://www.webpathology.com/image.asp?n=5&Case=35 Immature teratoma - myxomatous stroma (webpathology.com)].
{{Main|Teratoma}}
*[http://www.webpathology.com/image.asp?n=6&Case=35 Immature teratoma - blastema (webpathology.com)].
In post-pubertal males these (testicular) tumours are considered malignant. They usually consist of all three [[germ layers]].<ref>{{cite book |author=Moore, Keith L.; Persaud, T.V.N.|title=The Developing Human: Clinically Oriented Embryology |publisher=Saunders |location= |year=2002 |pages= 83 |edition=7th |isbn=978-0721694122 |oclc= |doi= |accessdate=}}</ref>
*[http://www.webpathology.com/image.asp?n=7&Case=35 Immature teratoma - primitive neuroepithelium (webpathology.com)].


=Sex cord stromal tumours=
==Leydig cell tumour==
==Leydig cell tumour==
*Arises from interstitial cell.
*[[AKA]] ''interstitial cell tumour''.
*[[AKA]] ''interstitial cell tumour''.
{{Main|Leydig cell tumour}}


===Microscopic===
==Sertoli cell nodule==
Features:<ref>GUP P.581.</ref>
*Abbreviated ''SCN''.
*Vacuolization - ''key feature''.
*[[AKA]] ''Pick's adenoma''.
*Cytoplasm - clear to eosinophilic.
*AKA ''testicular tubular adenoma''.
*Nucleoli common.
*AKA ''tubular adenoma of the testis''.
*''Reinke crystals'', cylindrical crystalloid eosinophilic cytoplasmic bodies (not always present).
{{Main|Sertoli cell nodule}}


Images:
==Sertoli cell tumour==
*[http://commons.wikimedia.org/wiki/File:Leydig_cell_tumour1.jpg Leydig cell tumour - low mag. (WC)].
{{Main|Sertoli cell tumour}}
*[http://commons.wikimedia.org/wiki/File:Leydig_cell_tumour2.jpg Leydig cell tumour - intermed. mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Leydig_cell_tumour3.jpg Leydig cell tumour - high mag. (WC)].


===IHC===
=Other=
*Inhibin-alpha.
These tumours are rare.
*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>PMID 12966351.</ref>
**AKA ''MART-1''.
**Expressed in melanoma, adrenal tissue, steroid-secreting tumours.


==Sertoli cell tumour==
==Adenocarcinoma of the rete testis==
*Arises from ''Sertoli cells'' ([[AKA]] nurse cells).
{{Main|Adenocarcinoma of the rete testis}}


===Microscopic===
==Testicular adrenal rest tumour==
Features:
:Abbreviated ''TART''.
*Groups of cells in ''cords'' or ''trabeculae'' (beam-like arrangement).
{{Main|Testicular adrenal rest tumour}}
*Cells have:
**Light staining bubbly cytoplasm +/- large cytoplasmic vacuoles.
**Slightly irregular nucleoli.
**Granular irregular appearing chromatin.


Negatives:
==Fibrous pseudotumour of the paratesticular region==
*Mitoses are rare.
{{Main|Fibrous pseudotumour of the paratesticular region}}
*No significant nuclear atypia.


Image(s):
==Testicular metastasis==
*[http://commons.wikimedia.org/wiki/File:Sertoli_cell_tumour_high_mag.jpg Sertoli cell tumour - high mag. (WC)].
{{Main|Testicular metastasis}}
*[http://commons.wikimedia.org/wiki/File:Sertoli_cell_tumour_low_mag.jpg Sertoli cell tumour - low mag. (WC)].


==See also==
=See also=
*[[Genitourinary pathology]].
*[[Genitourinary pathology]].
*[[Ovary]].
*[[Ovary]].
*[[Ovarian tumours]].
*[[Ovarian tumours]].
*[[Vas deferens]].
*[[Spermatic cord]].
*[[Paratesticular region]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


==External links==
=External links=
*[http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_is_testicular_cancer_41.asp Testicular cancer (cancer.org)]
*[http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_is_testicular_cancer_41.asp Testicular cancer (cancer.org)]


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