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The ''' | [[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. | |||
== | 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. | ||
Line 15: | Line 25: | ||
**You don't see the tail on light microscopy. | **You don't see the tail on light microscopy. | ||
=== | =====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 | *[[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. | ||
Line 27: | 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)]. | ||
==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=== | ||
Line 54: | Line 119: | ||
*Beta-hCG - choriocarcinoma. | *Beta-hCG - choriocarcinoma. | ||
*CD30 - embryonal carcinoma. | *CD30 - embryonal carcinoma. | ||
*D2-40 - seminoma. | *[[D2-40]] - seminoma. | ||
== | ===Tabular summary of GCTs=== | ||
{| class="wikitable sortable" | |||
! Tumour | |||
! Key feature | |||
! Microscopic | |||
! IHC | |||
! Other | |||
! Image | |||
|- | |||
| [[Germ cell neoplasia in situ]] (GCNIS) | |||
| 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> | |||
| CD117 | |||
| appearance similar to seminoma | |||
| [[Image:Intratubular_germ_cell_neoplasia_high_mag_cropped.jpg|thumb|center|150px|GCNIS (WC)]] | |||
|- | |||
| [[Seminoma]] | |||
| 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 name=Ref_GUP542>{{Ref GUP|542}}</ref> | |||
| D2-40 | |||
| Dysgerminoma = female version of this tumour | |||
| [[Image:Seminoma_high_mag.jpg|thumb|center|150px|Seminoma (WC)]] | |||
|- | |||
| [[Yolk sac tumour]] (endodermal sinus tumour) | |||
| Schiller-Duval bodies | |||
| Schiller-Duval b. = central blood vessel surrounded by epithelial-like cells a space and more epithelial-like cells, variable arch. | |||
| AFP | |||
| patterns: microcystic, solid, hepatoid | |||
| [[Image:Mixed_germ_cell_tumour_-_very_high_mag.jpg|thumb|center|150px|Yolk sac tumour (WC)]] | |||
|- | |||
| [[Embryonal carcinoma]] | |||
| 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 | |||
| CD30 | |||
| usu. part of a mixed GCT | |||
| [[Image:Embryonal_carcinoma_high_mag.jpg|thumb|center|150px|Embryonal carcinoma (WC)]] | |||
|- | |||
| [[Choriocarcinoma]] | |||
| marked nuclear atypia | |||
| cells with clear cytoplasm (cytotrophoblast), multinucleated cells (syncytiotrophoblast) | |||
| beta-hCG | |||
| not commonly pure, usu. a component of a mixed GCT | |||
| [[Image:Choriocarcinoma_-2-_very_high_mag.jpg|thumb|center|150px|Choriocarcinoma (WC)]] | |||
|- | |||
| [[Teratoma]] | |||
| skin, GI tract-like epithelium | |||
| skin (epidermis, adnexal structures - sebaceous glands, hair follicles), GI tract-like glands (simple tall columnar epithelium), fat +/-primitive neuroepithelium (pseudostratified epithelium in [[rosettes]]) | |||
| 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> | |||
| [[Image:Teratoma_2_low_mag.jpg|thumb|center|150px|Teratoma (WC)]] | |||
|- | |||
| [[Spermatocytic tumour]] (previously ''spermatocytic seminoma'') | |||
| 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 | |||
| ? | |||
| 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]] | |||
| NA | |||
| common combinations: teratoma + embryonal carcinoma + endodermal sinus tumour (yolk sac tumour) (TEE); seminoma + embryonal (SE); embryonal + teratoma (TE) | |||
| NA | |||
| - | |||
| [[Image:Mixed_germ_cell_tumour_-_intermed_mag.jpg|thumb|center|150px|Mixed GCT (WC)]] | |||
|} | |||
===Tabular summary of (male) SCSTs=== | |||
{| class="wikitable" | |||
!| Tumour | |||
!| Key feature | |||
!| Microscopic | |||
!| IHC | |||
!| Other | |||
!| Image | |||
|- | |||
| [[Leydig cell tumour]] | |||
| intersitial cell cluster with eosinophilic cytoplasm | |||
| cytoplasmic vacuolization, uniform nuclei with nucleoli | |||
| MART-1, calretinin, inhibin | |||
| +/-Reinke crystals (cylindrical crystalloid eosinophilic cytoplasmic bodies) | |||
| [[Image:Leydig_cell_tumour3.jpg|thumb|center|150px|Leydig cell tumour (WC)]] | |||
|- | |||
| [[Sertoli cell tumour]] | |||
| cells in cords or [[trabeculae]] | |||
| light staining bubbly cytoplasm +/- large cytoplasmic vacuoles, granular chromatin | |||
| ? | |||
| usu. no significant nuclear atypia, no mitoses | |||
| [[Image:Sertoli_cell_tumour_high_mag.jpg|thumb|center|150px|Sertoli cell tumour (WC)]] | |||
|} | |||
=== | =Benign= | ||
==Testicular atrophy== | |||
* | *[[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}} | |||
== | ==Idiopathic granulomatous orchitis== | ||
:''Granulomatous orchitis'' redirects here. | |||
===General=== | |||
*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: | 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> | |||
=== | ===Stains=== | ||
* | *AFB -ve -- for tuberculosis. | ||
* | *[[Dieterle stain]] -ve -- for syphilis. | ||
== | ==Testicular scar== | ||
{{Main|Testicular scar}} | |||
== | ==Testicular abscess== | ||
{{Main|Testicular abscess}} | |||
== | ==Testicular torsion== | ||
{{Main|Testicular torsion}} | |||
=== | ==Adenomatous hyperplasia of the rete testis== | ||
{{Main|Adenomatous hyperplasia of the rete testis}} | |||
==Epidermoid cyst of the testis== | |||
{{Main|Epidermoid cyst of the testis}} | |||
==Testicular trauma== | |||
===General=== | |||
*May lead to orchitectomy. | |||
* | |||
===Gross=== | |||
* | *Hemorrhagic. | ||
=== | ===Microscopic=== | ||
* | Features: | ||
*Necrotic seminiferous tubules. | |||
*Intratubular blood in keeping with hemorrhage. | |||
Note: | |||
* | *Normal spermatogenesis in background - if viable tissue present. | ||
=== | ===Sign out=== | ||
<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. | |||
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== | ||
{{Main|Yolk sac tumour}} | |||
* | *Most common GCT in infants and young boys. | ||
== | ===Microscopic=== | ||
=== | Classic feature: | ||
*Schiller-Duval bodies. | |||
**Look like glomerulus - central blood vessel surrounded by epithelial-like cells a space and more epithelial-like cells | |||
*Architecure - variable. | |||
**Most common ''microcystic pattern''.<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> | |||
== | ==Embryonal carcinoma== | ||
{{Main|Embryonal carcinoma}} | |||
These often look like a poorly differentiated carcinoma. | |||
==Choriocarcinoma== | |||
{{Main|Choriocarcinoma}} | |||
These are aggressive tumours. | |||
=== | |||
== | ==Teratoma of the testis== | ||
{{Main|Teratoma}} | |||
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= | |||
==Leydig cell tumour== | ==Leydig cell tumour== | ||
*[[AKA]] ''interstitial cell tumour''. | *[[AKA]] ''interstitial cell tumour''. | ||
{{Main|Leydig cell tumour}} | |||
=== | ==Sertoli cell nodule== | ||
*Abbreviated ''SCN''. | |||
* | *[[AKA]] ''Pick's adenoma''. | ||
* | *AKA ''testicular tubular adenoma''. | ||
* | *AKA ''tubular adenoma of the testis''. | ||
*'' | {{Main|Sertoli cell nodule}} | ||
==Sertoli cell tumour== | |||
{{Main|Sertoli cell tumour}} | |||
== | =Other= | ||
These tumours are rare. | |||
== | ==Adenocarcinoma of the rete testis== | ||
{{Main|Adenocarcinoma of the rete testis}} | |||
== | ==Testicular adrenal rest tumour== | ||
:Abbreviated ''TART''. | |||
{{Main|Testicular adrenal rest tumour}} | |||
==Fibrous pseudotumour of the paratesticular region== | |||
{{Main|Fibrous pseudotumour of the paratesticular region}} | |||
==Testicular metastasis== | |||
{{Main|Testicular metastasis}} | |||
=See also= | |||
*[[Genitourinary pathology]]. | |||
*[[Ovary]]. | *[[Ovary]]. | ||
*[[Ovarian tumours]]. | *[[Ovarian tumours]]. | ||
*[[Vas deferens]]. | |||
*[[Spermatic cord]]. | |||
*[[Paratesticular region]]. | |||
=References= | |||
{{reflist|2}} | {{reflist|2}} | ||
=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]] |
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