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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=
=Normal testis=
===Seminiferous tubules===
===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.  
Line 17: Line 25:
**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)].


===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]]''.
*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.


Image:
=====Images=====
*[http://commons.wikimedia.org/wiki/File:Rete_testis_high_mag.jpg Rete testis (WC)].
<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)].
*[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=8 Appendix of testis (webpathology.com)].
*[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)].
*[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)=
=Diagnoses (overview)=
Line 54: Line 97:
*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===
{| class="wikitable"
{| class="wikitable sortable"
!| Tumour
! Tumour
!| Key feature
! Key feature
!| Microscopic
! Microscopic
!| IHC
! IHC
!| Other
! Other
!| 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, squared-off 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
| [http://commons.wikimedia.org/wiki/File:Intratubular_germ_cell_neoplasia_high_mag.jpg], [http://commons.wikimedia.org/wiki/File:Intratubular_germ_cell_neoplasia_high_mag_cropped.jpg]
| [[Image:Intratubular_germ_cell_neoplasia_high_mag_cropped.jpg|thumb|center|150px|GCNIS (WC)]]
|-  
|-  
| [[Seminoma]]
| [[Seminoma]]
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| D2-40
| D2-40
| Dysgerminoma = female version of this tumour
| Dysgerminoma = female version of this tumour
| [http://commons.wikimedia.org/wiki/File:Seminoma_high_mag.jpg], [http://commons.wikimedia.org/wiki/File:Seminoma_intermed_mag.jpg]
| [[Image:Seminoma_high_mag.jpg|thumb|center|150px|Seminoma (WC)]]
|-  
|-  
| [[Yolk sac tumour]] (endodermal sinus tumour)
| [[Yolk sac tumour]] (endodermal sinus tumour)
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| 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]]
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| CD30
| CD30
| usu. part of a mixed GCT  
| usu. part of a mixed GCT  
| [http://commons.wikimedia.org/wiki/File:Embryonal_carcinoma_intermed_mag.jpg], [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]]
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| cells with clear cytoplasm (cytotrophoblast), multinucleated cells (syncytiotrophoblast)
| cells with clear cytoplasm (cytotrophoblast), multinucleated cells (syncytiotrophoblast)
| beta-hCG
| beta-hCG
| other
| not commonly pure, usu. a component of a mixed GCT
| [http://www.webpathology.com/image.asp?case=36&n=1]
| [[Image:Choriocarcinoma_-2-_very_high_mag.jpg|thumb|center|150px|Choriocarcinoma (WC)]]
|-  
|-  
| [[Teratoma]], immature
| [[Teratoma]]
| primitive neuroepithelium  
| skin, GI tract-like epithelium
| pseudostratified epithelium in rosettes (gland-like arrangement)
| 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
| teratoma are always malignant in males
| 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>
| [http://commons.wikimedia.org/wiki/File:Primitive_neuroepithelium_intermed_mag.jpg]
| [[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)
| [http://commons.wikimedia.org/wiki/File:Spermatocytic_seminoma_high_mag.jpg]
| [[Image:Spermatocytic_seminoma_high_mag.jpg|thumb|center|150px|Spermatocytic tumour (WC)]]
|-  
|-  
| [[Mixed germ cell tumour]]
| [[Mixed germ cell tumour]]
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| NA
| NA
| -
| -
| -
| [[Image:Mixed_germ_cell_tumour_-_intermed_mag.jpg|thumb|center|150px|Mixed GCT (WC)]]
|}
|}


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| MART-1, calretinin, 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]]
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| ?
| ?
| 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)]]
|}
|}


=Premalignant=
=Benign=
==Intratubular germ cell neoplasia==
==Testicular atrophy==
*Abbreviated ''ITGCN''.
*[[AKA]] ''atrophic testis''.
===General===
*[[AKA]] ''atrophy of the testis''.
*Considered the precursor lesion for germ cell tumours.
{{Main|Testicular atrophy}}
*Not all germ cell tumours (GCTs) arise from ''intratubular germ cell neoplasia''.  


The following testicular GCTs do not arise from ITCGN:
==Male infertility==
*[[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>
*This is a [[clinical diagnosis]].
*[[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>
{{Main|Male infertility}}
*Teratoma. (???)


===Microscopic===
==Spermatocele==
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>
{{Main|Spermatocele}}
*Enlarged nuclei, vesicular.
*Clear cytoplasm.
*Nucleoli, prominent.


Image(s):
==Hydrocele testis==
*[http://commons.wikimedia.org/wiki/File:Intratubular_germ_cell_neoplasia_high_mag_cropped.jpg ITGCN - cropped (WC)].
*[[AKA]] ''hydrocele''.
*[http://commons.wikimedia.org/wiki/File:Intratubular_germ_cell_neoplasia_high_mag.jpg ITGCN (WC)].
{{Main|Hydrocele testis}}
*[http://www.webpathology.com/image.asp?case=30&n=1 ITGCN (webpathology.com)].


=Germ cell tumours=
==Idiopathic granulomatous orchitis==
{{Main|Germ cell tumours}}
:''Granulomatous orchitis'' redirects here.
==Seminoma==
===General===
===General===
*Male counterpart of the [[dysgerminoma]], which arise in the [[ovary]].
*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===
Features:<ref name=pmid21458170/>
*[[Granuloma]]s +/- [[necrosis]].
*+/-Destruction of seminiferous tubules.
*Prominent collagen fibrosis.
 
DDx:
*[[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>


===Epidemiology & etiology===
===Stains===
*Arises from ''intratubular germ cell neoplasia'' (ITGCN).
*AFB -ve -- for tuberculosis.
*[[Dieterle stain]] -ve -- for syphilis.


===Microsopy===
==Testicular scar==
Features:
{{Main|Testicular scar}}
*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 name=Ref_GUP542>{{Ref GUP|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 abscess==
{{Main|Testicular abscess}}


Images:
==Testicular torsion==
*[http://commons.wikimedia.org/wiki/File:Seminoma_high_mag.jpg Seminoma - high mag. (WC)].
{{Main|Testicular torsion}}
*[http://commons.wikimedia.org/wiki/File:Seminoma_intermed_mag.jpg Seminoma - intermed. mag. (WC)].


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/>
*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>


==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.
*Not reported/found in females.<ref name=pmid7927308/>
*Typically older - mean age 50s.<ref name=pmid7927308/>


====Epidemiology====
===Gross===
*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.
*Hemorrhagic.


===Microscopic===
===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>
Features:
*Population of three cells.
*Necrotic seminiferous tubules.
*#Small cells (6-8 µm) - with a large NC [[ratio]].
*Intratubular blood in keeping with hemorrhage.
*#*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:
Note:
*''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>
*Normal spermatogenesis in background - if viable tissue present.
*May have eosinophilic cytoplasm (dependent on lab).
**Usually larger than [[Leydig cell tumour]].


Images:
===Sign out===
*[http://commons.wikimedia.org/wiki/File:Spermatocytic_seminoma_high_mag.jpg Spermatocytic seminoma - high mag. (WC)].
<pre>
*[http://commons.wikimedia.org/wiki/File:Spermatocytic_seminoma_intermed_mag.jpg Spermatocytic seminoma - intermed. mag. (WC)].
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.
 
Comment:
The clinical history of trauma is noted.
</pre>
 
=Premalignant=
==Germ cell neoplasia in situ==
*Previously ''intratubular germ cell neoplasia'' (abbreviated ''ITGCN'').
{{Main|Germ cell neoplasia in situ}}
 
=Germ cell tumours=
{{Main|Germ cell tumours}}
==Seminoma==
{{Main|Seminoma}}
 
==Spermatocytic tumour==
*Previously ''spermatocytic seminoma''.
{{Main|Spermatocytic tumour}}


==Yolk sac tumour==
==Yolk sac tumour==
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{{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==
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These are aggressive tumours.
These are aggressive tumours.


===Microscopic===
==Teratoma of the testis==
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==
{{Main|Teratoma}}
{{Main|Teratoma}}
In males these tumours are always malignant.  They 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>  
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>


=Sex cord stromal tumours=
=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===
Features:<ref name=Ref_GUP581>{{Ref GUP|581}}</ref>
*Vacuolization - ''key feature''.
*Cytoplasm - clear to eosinophilic.
*Nucleoli common.
*''Reinke crystals'', cylindrical crystalloid eosinophilic cytoplasmic bodies (not always present).
 
DDx:
*[[Spermatocytic seminoma]] - may have eosinophilic cytoplasm.
 
Images:
*[http://commons.wikimedia.org/wiki/File:Leydig_cell_tumour1.jpg Leydig cell tumour - low mag. (WC)].
*[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===
*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==
*[[AKA]] Pick's adenoma, AKA testicular tubular adenoma, AKA tubular adenoma of the testis.
*Abbreviated ''SCN''.
===General===
*[[AKA]] ''Pick's adenoma''.
*Benign proliferation of Sertoli cells - associated with cryptorchidism (undescended testis).
*AKA ''testicular tubular adenoma''.
*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>
*AKA ''tubular adenoma of the testis''.
 
{{Main|Sertoli cell nodule}}
===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.
 
Images:
*[http://commons.wikimedia.org/wiki/File:Sertoli_cell_nodule_high_mag.jpg Sertoli cell nodule - high mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Sertoli_cell_nodule_low_mag.jpg Sertoli cell nodule - low mag. (WC)].


==Sertoli cell tumour==
==Sertoli cell tumour==
{{Main|Sertoli cell tumour}}


===General===
=Other=
*Arises from ''Sertoli cells'' ([[AKA]] nurse cells).
These tumours are rare.


===Microscopic===
==Adenocarcinoma of the rete testis==
Features:
{{Main|Adenocarcinoma of the rete testis}}
*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:
==Testicular adrenal rest tumour==
*Mitoses are rare.
:Abbreviated ''TART''.
*No significant nuclear atypia.
{{Main|Testicular adrenal rest tumour}}
 
DDx:
*[[Granulosa cell tumour]] - may be very similar.  Often has nuclear grooves.
*Epithelioid [[adenomatoid tumour]].


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


===IHC===
==Testicular metastasis==
*Alpha-inhibin +ve. (???)
{{Main|Testicular metastasis}}


=See also=
=See also=
Line 399: Line 369:
*[[Ovarian tumours]].
*[[Ovarian tumours]].
*[[Vas deferens]].
*[[Vas deferens]].
*[[Spermatic cord]].
*[[Paratesticular region]].


=References=
=References=
Line 407: Line 379:


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