Term
| what are the major types of testicular tumors? |
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Definition
| *germ cell tumors: seminomas and non-seminomas and *sex cord-stromal tumors |
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Term
| where do most testicular tumors arise? |
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Definition
| from germ cells - which are aggressive and can spread rapidly |
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Term
| what demographics are at a higher risk for testicular CA? |
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Definition
| whites between 15-34 yrs old |
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Term
| what % of CA deaths is testicular CA responsible for? |
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Definition
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Term
| what is an important risk factor for testicular CA? |
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Definition
| cryptorchidism (undescended testis) |
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Term
| what characterizes the 2 types of germ cell tumors? |
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Definition
| seminomatous: tumors composed of cells that resemble *primordial cells or early gonocytes*. non-seminomatous: tumors composed of undifferentiated cells that resemble *embryonic stem cells - but the malignant cells can differentiate into various lineages, generating yolk sac tumors, choriocarcinomas, and teratomas*. |
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Term
| do most germ cell tumors have a single tissue component, or do they usually contain both seminomatous and nonseminomatous components |
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Definition
| 60% of germ cell tumors contain both seminomatous and non-seminomatous components |
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Term
| what lesions do most germ cell tumors arise from? |
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Definition
| *intratubular germ cell neoplasia* (ITGCN), which is believed to occur in utero and remain dormant until puberty when it may progress in to seminomatous and nonseminomatous components |
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Term
| how does intratubular germ cell neoplasia appear? |
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Definition
| cells w/large nuclei, clear cytoplasm that are about 2x the size of normal germ cells |
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Term
| what are some genetic characteristics specific to intratubular germ cell neoplasia? |
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Definition
| many ITGCNs retain the expression of the transcription factors *OCT3/4 and NANOG - which are expressed w/pluripotentiality* and are expressed normally in embryonic stem cells. ITGCNs also feature *additional copies of the short arm of chr 12* (also seen in germ cell tumors and all invasive tumors regardless of histologic type). activating mutations of c-KIT are present in ITGCNs (also seen in seminomas). |
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Term
| what % of males with ITGCN develop invasive germ cell tumors? |
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Definition
| 50% of males with ITGCN develop invasive germ cell tumors within 5 yrs of dx. (it is hypothesized that many if not all patients with ITGCN have ability to develop invasive tumors) |
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Term
| which is the most common type of germ cell tumor? |
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Definition
| seminomas - which make up 50% of these germ cell tumors |
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Term
| what characterizes germ cell tumors in terms of incidence, genetics, and morphology? |
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Definition
| peak incidence: 3rd decade. genetics: seminomas contain isochromosome 12p, express OCT3/4 & NANOG, and 25% have c-KIT activating mutations. morphology: seminomas are *bulky masses (~10x size of normal testis) appearing homogeneous, white, w/a lobulated cut surface usually w/o hemorrhage or necrosis. |
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Term
| can a seminoma grow to replace most of the testes? |
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Definition
| yes, and this appears homogeneous w/fibrous septae between lobules and a yellow color indicative of glycogen |
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Term
| how do seminomas appear histologically? |
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Definition
| microscopically seminomas are composed of sheets of uniform cells divided into lobules by fibrous septae containing a *moderate amount of lymphocytes*. seminoma cells are large, round to polyhedral w/a prominent nucleus, a prominent nucleolus, clear cytoplasm and well defined cell borders. mitoses vary in frequency and the cytoplasm contains glycogen. (unique appearance) |
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Term
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Definition
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Term
| what are biomarkers seminomas can be stained for? |
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Definition
| c-KIT, OCT4, and PLAP (placental alkaline phosphatase) |
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Term
| what % of seminomas contain syncytiotrophoblasts? |
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Definition
| 15% of seminomas contain syncytiotrophoblasts which is *accompanied by elevation of serum human chorionic gonadotropin (hCG) levels |
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Term
| can seminomas have granulomatous reactions? |
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Definition
| yes, which are ill-defined |
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Term
| what is an anaplastic seminoma? |
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Definition
| a subtype of seminoma, which has greater cellularity, nuclear irregularity, more frequent mitoses, *tumor giant cells* (looks worse) - but is *not associated with w/worse prognosis. |
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Term
| how would the morphology of a mixed/combined testicular tumor appear? |
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Definition
| a solid area (seminomatous) and a hemorrhagic areas (non-seminomatous) |
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Term
| what is a spermatocytic seminoma? |
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Definition
| a slow growing tumor that does not cause metastasis (excellent prognosis) which lacks: lymphocytes, syncytiotrophoblasts, extra-testicular sites of origin, but it is associated with: admixture w/other germ cell tumors and ITGCN. spermatocytic seminomas are uncommon - about 1-2% of testicular germ cell tumors and are usually seen in pts past 65 yrs old. (distinctly different from the classic seminoma) |
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Term
| what is the morphology of spermatocytic seminomas? what kinds of cells do they contain? |
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Definition
| spermatocytic seminomas have a *soft gray cut surface that sometimes has *mucoid cysts and contains a mix of 3 cell types: *medium sized cells (most w/round nucleus and eosinophilic cystoplasm), *smaller cells (w/a narrow rim of eosinophilic cytoplasm), and scattered *giant cells (not trophoblastic). |
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Term
| how do embryonal CAs compare to seminomas? what demographic are they associated with? |
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Definition
| embryonal CAs are more aggressive than seminomas, but do not usually replace the entire testis. they are seen in 20-30 yr old males. |
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Term
| what is the morphologic appearance of embryonal CAs grossly? what is their macro/micro growth pattern? |
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Definition
| grossly: the cut surface of embryonal CA is variegated, poorly demarcated at the margins and contains foci of hemorrhage and necrosis (unlike homogeneous seminomas). embryonal CA *often extends to the tunica albuginea, the epididymis or cord. cells w/in embryonal CA grow in an alveolar or tubular pattern, sometimes w/papillary convolutions. |
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Term
| how do embryonal CAs appear histologically? |
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Definition
| embryonal CA lacks well-formed glands and cells have nuclei which are *basally situated w/apical cytoplasm (like in teratomas). the neoplastic cells have an epithelial appearance are *large and anaplastic w/hyperchromatic (*dark) and prominent nucleoli. cell borders are indistinct (w/marked variation in cell/nuclear shape) and mitotic figures, giant cells are common. *generally: diffuse pattern of growth.* more undifferentiated lesions may have sheets of cells. |
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Term
| what biomarkers are associated with embryonal CA? |
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Definition
| OCT 3/4, PLAP, CD30, cytokeratin (last 2 not seen in seminomas). embryonal CA is **negative for c-KIT (difference from seminoma)** |
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Term
| who doe the yolk sac tumor usually affect? |
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Definition
| the yolk sac tumor/endodermal sinus tumor is the most common testicular tumor found in infants/children up till 3 yrs old (good prognosis in this age group). in adults, a pure yolk sac tumor is rare and usually mixed w/embryonal CA. |
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Term
| why are yolk sac tumors called such? |
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Definition
| they take on the appearance of the yolk sac |
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Term
| how do yolk sac tumors appear grossly? microscopically? |
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Definition
| grossly: homogeneous yellow, white, mucinous appearance - resembles a small seminoma. microscopically: lace-like w/a network of medium sized cells (cuboidal or flattened). papillary structure and solid cords of cells are also observed. |
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Term
| what are *schiller-duval bodies*? what do they contain? what do they resemble? |
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Definition
| these entities are seen in 50% of yolk sac tumors (not pathognomonic) and consist of a mesodermal core w/a central capillary and visceral parietal layer (resemble primitive glomeruli) and contain *AFP, *alpha 1 antitrypsin, and *eosinophilic hyaline-like globules (may present inside and outside the cytoplasm). schiller-duval bodies may also resemble endodermal sinuses. |
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Term
| how does a schiller duval body appear? |
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Definition
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Term
| what characterizes a choriocarcinoma? |
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Definition
| a *highly malignant tumor, rare in its pure form and usually smaller than 5 cm (often causes no testicular enlargement and only forms a small palpable nodule). hemorrhage and necrosis are common. |
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Term
| what are the 2 cell types seen in choriocarcinoma? |
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Definition
| *synctiotrophoblastic cells: large w/many *irregular and lobular hyperchromatic (dark) nuclei and abundant eosinophilic vacuolated cytoplasm w/hCG (makes sense w/chorioCA) in the cytoplasm and *cytotrophoblastic cells: *more regular, polygonal w/distinct cell borders and clear cytoplasm growing in cords or masses w/a single, uniform nucleus. |
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Term
| how does a choriocarcinoma appear grossly? microscopically? |
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Definition
| grossly: reddish, hyperemic w/hemorrhage. microscopically: 2 cell populations, some are more anaplastic and blend in with one another (syncytiotrophoblastic) while others are more clear cut with well defined cell membranes and borders (cytotrophoblastic). |
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Term
| what characterizes teratomas found in the testes? |
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Definition
| teratomas have various cellular and organoid components similar to more than one germ cell layer. they may occur at any age, though pure forms of teratoma are more common in infancy and children and in adults teratomas are more commonly mixed w/other germ cell tumors. |
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Term
| what characterizes teratomas morphologically? |
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Definition
| teratomas are usually large ~5-10 cms, w/a heterogeneous gross appearance of solid and cystic areas and composed of cartilage, neuronal tissue, squamous cells, muscle, and thyroid tissue. the elements may be mature (resembling adult tissue) or immature (resembling fetal/embryonal tissue). |
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Term
| what characterizes testicular teratomas w/mature and immature features? what characterizes teratomas w/malignant transformation? |
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Definition
| mature teratoma: all tissues are well differentiated. immature teratoma: teratomas w/immature tissue in the stroma, epithelium, or neural component. teratoma w/malignant transformation: malignancy in derivative of one or more germ cell layers, such as SCC adenoCA or sarcoma (mostly benign tissue w/a neoplasm included). |
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Term
| what is a teratocarcinoma? how does it appear grossly? |
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Definition
| a mixture of a teratoma and embryonal carcinoma. gross appearance: multicystic areas, solid, hemorrhagic, and necrotic foci in the areas of the embryonic CA. the teratoma portion may be mature or immature. |
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Term
| what is another name for teratocarcinoma? |
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Definition
| NSGCT (non-seminomatous germ cell tumor) followed w/a list of the relative components. |
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Term
| what are some of the clinical features of germ cell tumors? tx? |
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Definition
| clinical features: painless enlargement of the testis. seminomas tend to be larger, more fleshy and choriocarcinomas tend to be smaller. tx: orchiectomy |
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Term
| how might germ cell tumors spread and where? |
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Definition
| lymphatically to para-aortic nodes - may spread to the mediastinum and supraclavicular nodes. hematogenously to brain, lungs, liver. histology of metastasis may be different from its primary tumor. |
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Term
| how are germ cell tumors classified as a part of diagnosis? |
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Definition
| into broad categories: seminoma and non-seminomatous germ cell tumors (NSGCTs - more aggressive, poorer prognosis) |
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Term
| what are the stages of germ cell tumor spread? |
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Definition
| stage 1: tumor confined to testis, epididymis or spermatic cord. stage 2: distant spread confined to retroperitoneal nodes below diaphragm. stage 3: metastases outside retroperitoneal nodes above the diaphragm (still curable) |
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Term
| are seminomas radio-sensitive? |
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Definition
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Term
| are NSGCTs sensitive to chemotherapy? |
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Definition
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Term
| what are the sex cord-gonadal tumors? |
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Definition
| leydig and sertoli cell tumors |
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Term
| what characterizes leydig cell tumors? |
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Definition
| leydig cells tumors can arise at any age, but most commonly 20-60 yrs old. their *most common feature is generalized testicular swelling, though a common initial sign is *gynecomastia (decreased libido) or *sexual precocity - leydig cell tumors may elaborate androgens, estrogens or corticosteroids. |
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Term
| how do leydig cell tumors appear grossly? microscopically? |
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Definition
| grossly: typically less than 5 cm, golden brown and a homogeneous cut surface. microscopically: similar to their normal counterparts - round, polygonal w/an *abundant granular eosinophilic cytoplasm and a round central nucleus. the cytoplasm of leydig cell tumors contains *lipid granules, vacuoles or *lipofuscin pigment. *reinke crystals, rod shaped crystals are associated with leydig cell tumors.* |
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Term
| what is the malignant potential for leydig cell tumors? |
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Definition
| most are benign - ~10% are invasive |
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Term
| what characterizes sertoli tumor cells? how do they appear grossly? microscopically? what is their level of malignant conversion? do they produce hormones? |
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Definition
| sertoli tumor cells appear grossly as firm, small nodules w/a homogenous gray-white cut surface. microscopically, cells are *arranged in trabeculae that form cord-like structures and tubules*. calcium deposits may also be visible. most are benign, less than 10% become malignant. sertoli cell tumors are typically hormonally silent. |
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