Testicular Pathology
Germ Cell Tumors
_Most common type of testicular tumor (>95% of cases), and they usually occur between 15-40 years of age.,
_Patients will often present with a firm testicular mass that cannot be transilluminated., (hypoechoic)
_Can be classified as one of the following types:
Seminoma (55% of cases) are highly responsive to radiotherapy, metastasize late, and have an excellent prognosis.
Nonseminomas (45% of cases) show variable response to treatment and often metastasize early
Yolk sac tumors
Embryonal carcinoma and teratoma
Choriocarcinoma.,
_Tumor markers:
Yolk sac: high AFP
Choriocarcinoma: high b-HCG
embryonal, teratoma: high AFP or b-HCG
seminoma: high ALP and rarely HCG..
_The risk factors for germ cell tumors of the testicle include the following:
Cryptorchidism (most common)
Androgen Insensitivity
Family history of testicular cancer
Down Syndrome
Klinefelter syndrome.,
_The diagnosis of testicular cancer is often made with ultrasound, which reveals a hypoechoic intratesticular mass..
Seminoma
_The most common testicular tumor (40%) that originates in the germinal epithelium or the seminiferous tubules.,; resembles ovarian dysgerminoma.
Testicular ultrasound showing a hypoechoic intratesticular mass.
_On histology will reveal clear, polygonal germ cells with round nuclei and prominent nucleoli that are arranged into lobules and surrounded by septa. There is often a lymphocytic infiltrate and granulomas. Grossly these tumors appear as a bulky, gray tumor without hemorrhage or necrosis.,
lymphocytic infiltrate:
_Most commonly present with painless testicular enlargement.,
_Highly radiosensitive and have an excellent prognosis with treatment. Later stage neoplasms often require surgical resection (orchidectomy)..
Embryonal Carcinoma
_Rare malignant tumor comprised of immature, primitive cells that form papillary/glandular structures. Metastasis is commonly hematogenous.,
_On histology will appear as sheets of undifferentiated cells with marked nuclear atypia, prominent nucleoli, and focal glandular differentiation or papillary morphology.,
Gross appearance is a pale grey, bulky, hemorrhagic and necrotic tumor.
_Are less radiosensitive than seminomas, and also more aggressive with an intermediate prognosis. Chemotherapy may result in differentiation into another type of germ cell tumor (e.g. teratoma).,
_The clinical presentation includes the following:
Palpable testicular mass
Painful., (Note: this is different from other testicular tumors, which are usually painless)
Choriocarcinoma
_Malignant tumor of syncytiotrophoblasts and cytotrophoblasts (placenta-like tissue, but villi are absent). It is the most aggressive testicular tumor; poor prognosis..
_On histology reveal mixed proliferation of syncytiotrophoblasts (large multinucleated cells with eosinophilic cytoplasm that produce beta-hCG) and cytotrophoblasts (mononuclear cells with clear cytoplasm)..
The gross appearance is a small primary tumor with extensive necrosis and hemorrhage.
_Tumor marker used to monitor and/or confirm the diagnosis is an elevated hCG (human chorionic gonadotropin) in nearly 100% of cases. This may present as gynecomastia, because if you recall hCG has a similar alpha subunit as LH (↑ LH → breast development)
The alpha-subunit of beta-hCG is similar to the alpha-subunit of LH, FSH, and TSH. This can result in hyperthyroidism. The beta-subunit is the unique subunit to each hormone, and is responsible for the majority of their physiologic effects.,
_Commonly metastasize hematogenously, most commonly to the lungs (causing hemoptysis), brain (causing hemorrhagic stroke), and liver.,
Testicular Teratomas
_In males are malignant (often squamous cell malignancy). This is important to remember, because the mature teratoma (dermoid cyst) in females is benign..
_aka dermoid cyst.,
Non Germ cell
_Resemble sex cord-stromal tissues of the testicle, and they are usually benign. The two most common types are Leydig cell and Sertoli cell tumors..
Leydig cell tumor
_Benign tumor of Leydig cells that produces androgens and may also produce estrogens..
_Patient presentation will depend on age; precocious puberty in children and gynecomastia in adult men.,
_A characteristic finding on microscopy is intracytoplasmic Reinke crystals(rod-shaped crystals) within the neoplastic Leydig cells..
Sertoli Cell Tumor
_Benign tumor of Sertoli cells that is comprised of tubules. It most commonly does not produce hormones and therefore presents as a testicular mass..
Testicular Lymphoma
_Most common cause of testicular cancer found in males >60 years old. They are often bilateral, and arise due to metastasis.,
Diffuse large B cell Non-Hodgkin
_The most common testicular lymphoma subtype.,
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