Approach to testicular tumors

Approach to Testicular Tumors

What is new in 2016?

• ITGCN is now GCNIS • Germ cell neoplasia in situ• Does not involve entire tubule

• Add ‘Intratubular’ if it involves entire tubule– Intratubular seminoma – Intratubular embryonal

New classification

GCT derived from GCNIS

GCT unrelated to GCNIS Sex cord Stromal

Misc tumors Hematolymphoid Tumors of

collecting duct and rete testis

Most neoplastic scrotal masses ultimately prove to be germ cell tumours and are recognisable with routine haematoxylin and

eosin‐stained sections

Age Medical history

Tumour site (testicular vs

paratesticular)Gross

Before we see the slide !

Age

Congenital / <6 mths

• Juvenile granulosa cell tumour

Children >6 mths

• YST• Teratoma• Sex cord‐

stromal tumours

Young men

• GCT – seminomatous

• Sex cord‐stromal tumours

Older men

• Spermatocytic tumor

• Sex cord‐stromal tumours

• Metastasis• Lymphoma

History

Undescended testisPrevious diagnosis of a germ cell tumour or GCNIS or IT

GCT

Possibility of a GCT very high

Previous or current carcinoma, lymphoma or

leukaemia

Likely secondary tumour

Gross

Seminomas

• Nodules of homogenous white or tan tissue 

Non‐seminomatous germ cell tumours

• Zones of haemorrhage or necrosis

Teratoma

• Cystic • Tooth • Cartilage

Sex cord stromal

• Yellow or tan

Tumor markers

LDH : Seminomas and non‐seminomatous GCT

AFP : YST ; correlates with the amount of tumour in

mixed germ cell tumours.

hCG : choriocarcinoma and in seminoma and mixed

germ cell tumours as syncytiotrophoblast cells

are commonly present in a scattered fashion

Inhibin : Leydig cell tumour, Sertoli cell tumour

Hormones

Small minority

Rare androgen excess or

gynaecomastia resulting from hCG

hCG also has thyroid stimulating activity -

hyperthyroidism

Hypercalcaemia: parathyroid

hormone‐like substance – seminoma

Steroid producing : leydig –

Pseudopuberty

Gynecomastia : Sex cord stromal

Patterns on histology

Diffuse cells with pale to clear cytoplasm  

Glandular/tubular Microcystic

Oxyphilic cells Spindle cells

Cells with pale to clear cytoplasm in a diffuse arrangement

Seminoma 

Spermatocytic tumor

Solid variant of embryonal carcinoma

Solid pattern yolk sac tumour

Sertoli cell tumour and Leydig cell tumour

Metastases

Lymphoma

Tumours with a glandular/tubular pattern

Embryonal carcinoma and yolk sac tumour

Occasional cases of seminoma

Sertoli cell tumours usually have tubular architecture in at least some foci of the tumour

Rete testis

Metastases

Tumours with a microcystic pattern

Yolk sac tumour

Seminomas

Leydig cell tumours

Sertoli cell tumours

Paratesticular adenomatoid tumours.

Oxyphilic tumours

Leydig cell tumours 

Large cell calcifying Sertoli cell tumour

Hepatoid yolk sac tumour

Carcinoid tumour

Intratesticular adenomatoid tumour

Metastatic tumours 

Tumours in children

Yolk sac tumour

Juvenile granulosa cell tumour

Intratubular atypical cells

Paratesticular tumours with a glandular‐like, tubular or papillary pattern

Metastatic adenocarcinoma

Mullerian‐type epithelial tumours

Adenomatoid tumour

Mesothelioma

Tumours with spindle cell morphology

Leydig cell tumours

Gonadal stromal fibromas 

Malignant mesotheliomas

Rhabdomyosarcoma 

Renike crystals

Hyaline globules

Schiller Duval bodies

Call Exner bodies

Synchiotrophoblasts

Summarise

Thank You