Page 506 - Concise Pathology for Exam Preparation ( PDFDrive )

17 Male Genital Tract 491

• Sertoli cells are present, but there is no spermatogenesis.
• Leydig cells are prominent.

Q. Classify testicular tumours. Describe their clinicopathological
features.
Ans. Testicular tumours are classified based on their origin.
Classification of Testicular Tumours
1. Germ cell tumours
(a) Seminomatous tumours
(i) Classical semi as noma
(ii) Spermatocytic seminoma
(b) Nonseminomatous tumours
(i) Yolk sac tumour
(ii) Choriocarcinoma
(iii) Embryonal carcinoma
(iv) Germ cell tumours with multiple histological patterns, eg, embryonal
carcinoma with teratoma and choriocarcinoma with others
(c) Teratoma
2. Sex cord-stromal tumours
(a) Sertoli cell tumours
(b) Leydig cell tumours

Clinicopathological Features of Testicular Tumours

• All testicular tumours are derived from totipotent germ cells, which can show progressive
and retrogressive differentiation; therefore, metastatic tumours may sometimes show
a different histology as compared to the primary lesion, eg, an embryonal carcinoma
presents as a teratoma in the metastatic lesion.
• Most testicular tumours are derived from intratubular germ cell neoplasia (ITGCN),
which is also commonly seen in their vicinity. Exceptions are paediatric yolk sac tumour,
teratomas and spermatocytic seminoma. ITGCN is found to be present as early as intra-
uterine life. It remains innocuous till puberty when it progresses to seminomatous
(SGCT) or nonseminomatous tumours (NSGCT) subsequent to activating mutations,
eg, reduplication of the short arm of chromosome 12 and kit activation. ITGCN is his-
tologically characterized by presence of atypical primordial cells with large pleomorphic
nuclei and clear cytoplasm.
• Germ cell tumours present as painless enlargement of testes. Their segregation into two
categories (SGCTs and NSGCTs) is based on their different clinical behaviour.
• Biopsy of a testicular mass is associated with a risk of tumour spillage; therefore, any
testicular mass is considered neoplastic unless proven otherwise and radical orchiectomy
is performed based on this assumption.
• Lymphatic spread is common; retroperitoneal paraaortic lymph nodes are the first to be
involved followed by mediastinal and supraclavicular lymph nodes.
• Haematogenous spread commonly involves lungs, liver, brain and bone.
• Germ cell tumours secrete polypeptide hormones and certain enzymes that can be detected
in the blood, eg, AFP (a-fetoprotein), HCG (human chorionic gonadotrophins), PLAP (pla-
cental alkaline phosphatase), placental lactogen and LDH (lactate dehydrogenase).
• These hormones are useful in:
• Diagnosis and staging of testicular germ cell tumours
• Monitoring response to therapy
• Elevated levels of HCG and AFP are most often associated with NSGCTs (marked elevation
is seen in yolk sac tumour and choriocarcinoma).
• Non-Hodgkin lymphoma is the most common testicular tumour after the fifth decade.
• Staging of testicular germ cell tumours:
- Stage I: Tumours confined to testis, epididymis or spermatic cord

mebooksfree.com