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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 [[male infertility|fertility]]. | 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= | ||
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*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=== | ||
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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==== | ||
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</gallery> | </gallery> | ||
====Associated structures==== | ====Associated structures==== | ||
*Epididymis - stores the sperm. | *[[Epididymis]] - stores the sperm. | ||
**Pseudostratified epithelium with cilia. | **Pseudostratified epithelium with cilia. | ||
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====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]] | *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: | ||
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! Image | ! Image | ||
|- | |- | ||
| [[ | | [[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| | | [[Image:Intratubular_germ_cell_neoplasia_high_mag_cropped.jpg|thumb|center|150px|GCNIS (WC)]] | ||
|- | |- | ||
| [[Seminoma]] | | [[Seminoma]] | ||
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| [[Image:Teratoma_2_low_mag.jpg|thumb|center|150px|Teratoma (WC)]] | | [[Image:Teratoma_2_low_mag.jpg|thumb|center|150px|Teratoma (WC)]] | ||
|- | |- | ||
| [[Spermatocytic | | [[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 | | does not arise from GCNIS, no lymphocytic infiltrate (like in seminoma) | ||
| [[Image:Spermatocytic_seminoma_high_mag.jpg|thumb|center|150px|Spermatocytic | | [[Image:Spermatocytic_seminoma_high_mag.jpg|thumb|center|150px|Spermatocytic tumour (WC)]] | ||
|- | |- | ||
| [[Mixed germ cell tumour]] | | [[Mixed germ cell tumour]] | ||
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*[[AKA]] ''atrophy of the testis''. | *[[AKA]] ''atrophy of the testis''. | ||
{{Main|Testicular atrophy}} | {{Main|Testicular atrophy}} | ||
==Male infertility== | |||
*This is a [[clinical diagnosis]]. | |||
{{Main|Male infertility}} | |||
==Spermatocele== | ==Spermatocele== | ||
{{Main|Spermatocele}} | |||
==Hydrocele testis== | ==Hydrocele testis== | ||
*[[AKA]] ''hydrocele''. | *[[AKA]] ''hydrocele''. | ||
{{Main|Hydrocele testis}} | |||
==Idiopathic granulomatous orchitis== | ==Idiopathic granulomatous orchitis== | ||
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DDx: | DDx: | ||
*[[ | *[[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> | ||
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*[[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=== | ||
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==Testicular abscess== | ==Testicular abscess== | ||
{{Main|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= | =Premalignant= | ||
== | ==Germ cell neoplasia in situ== | ||
* | *Previously ''intratubular germ cell neoplasia'' (abbreviated ''ITGCN''). | ||
{{Main| | {{Main|Germ cell neoplasia in situ}} | ||
=Germ cell tumours= | =Germ cell tumours= | ||
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{{Main|Seminoma}} | {{Main|Seminoma}} | ||
==Spermatocytic | ==Spermatocytic tumour== | ||
{{Main|Spermatocytic | *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. | ||
==Choriocarcinoma== | ==Choriocarcinoma== | ||
{{Main|Choriocarcinoma}} | {{Main|Choriocarcinoma}} | ||
These are aggressive tumours. | These are aggressive tumours. | ||
==Teratoma of the testis== | ==Teratoma of the testis== | ||
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==Adenocarcinoma of the rete testis== | ==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= | =See also= | ||
*[[Genitourinary pathology]]. | *[[Genitourinary pathology]]. | ||
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*[[Vas deferens]]. | *[[Vas deferens]]. | ||
*[[Spermatic cord]]. | *[[Spermatic cord]]. | ||
*[[Paratesticular region]]. | |||
=References= | =References= |
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