Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 16 views

    Case 5

    Uploaded by

    medico
    A 35-year-old male presented with a growing painless right testicular mass over several months. Ultrasound revealed a homogeneous hypoechoic solid mass. Right radical orchiectomy was performed. Grossly, the mass was a well-demarcated, homogeneous, solid tan nodule. Microscopically, the tumor cells were arranged in small nests separated by fibrous septa containing lymphocytes, with clear to amphophilic cytoplasm and large polygonal nuclei. The differential diagnosis included yolk sac tumor, spermatocytic tumor, and embryonal carcinoma. However, the findings were most consistent with a testicular seminoma.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Case 5

    Uploaded by

    medico
    16 views28 pages
    A 35-year-old male presented with a growing painless right testicular mass over several months. Ultrasound revealed a homogeneous hypoechoic solid mass. Right radical orchiectomy was performed. Grossly, the mass was a well-demarcated, homogeneous, solid tan nodule. Microscopically, the tumor cells were arranged in small nests separated by fibrous septa containing lymphocytes, with clear to amphophilic cytoplasm and large polygonal nuclei. The differential diagnosis included yolk sac tumor, spermatocytic tumor, and embryonal carcinoma. However, the findings were most consistent with a testicular seminoma.

    Original Description:

    Case presentation

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    A 35-year-old male presented with a growing painless right testicular mass over several months. Ultrasound revealed a homogeneous hypoechoic solid mass. Right radical orchiectomy was performed. Grossly, the mass was a well-demarcated, homogeneous, solid tan nodule. Microscopically, the tumor cells were arranged in small nests separated by fibrous septa containing lymphocytes, with clear to amphophilic cytoplasm and large polygonal nuclei. The differential diagnosis included yolk sac tumor, spermatocytic tumor, and embryonal carcinoma. However, the findings were most consistent with a testicular seminoma.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    16 views28 pages

    Case 5

    Uploaded by

    medico
    A 35-year-old male presented with a growing painless right testicular mass over several months. Ultrasound revealed a homogeneous hypoechoic solid mass. Right radical orchiectomy was performed. Grossly, the mass was a well-demarcated, homogeneous, solid tan nodule. Microscopically, the tumor cells were arranged in small nests separated by fibrous septa containing lymphocytes, with clear to amphophilic cytoplasm and large polygonal nuclei. The differential diagnosis included yolk sac tumor, spermatocytic tumor, and embryonal carcinoma. However, the findings were most consistent with a testicular seminoma.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 28

    CASE PRESENTATION

    CSU JI Kneekie M. Borromeo


    CLINICAL DATA
    35 YEAR OLD, MALE
    CHIEF COMPLAINT: TESTICULAR MASS
    HISTORY
    ● 6 months PTA, the patient noted with a marble sized painless mass on his
    right testis. No consult done.
    ● 3 months PTA, the mass is gradually enlarging. Still no consult done.
    ● 2 months PTA, still with the growing mass. Now approximately 4 cm. Still
    no consult done.
    ● 1 month PTA, due to progressing testicular mass. The patient prompted
    consult where ultrasound was done revealing homogeneous hypoechoic solid
    mass.
    PROCEDURE DONE

    Right radical orchiectomy


    GROSS PICTURE

    Well demarcated, homogeneous,


    Lobulated soft brown tissue tumor solid tan with surface nodularity and
    lobulation
    MICROSCOPIC

    The tumor cells are arranged in small nests or trabeculae separated


    by delicate fibrous septa containing lymphocytes.
    MICROSCOPIC
    ● Round to polyhedral cells with distinct
    cell borders
    ● lymphocytic infiltrate within fibrous
    septa.
    ● Cytoplasm are clear to amphophilic.
    ● Nuclei are polygonal and may have a flat
    edge giving a squared off appearance.
    ● Large nuclei and prominent nucleoli
    SALIENT FEATURES
    ● 35yo, Male
    ● Progressing testicular painless mass
    ● Ultrasound: Homogeneous hypoechoic mass
    ● Gross: Well demarcated, homogeneous solid tan mass
    ● Microscopic:
    ❖ tumor cells are arranged in small nests separated by delicate fibrous septa
    containing lymphocytes
    ❖ Cytoplasm are clear to amphophilic.
    ❖ Nuclei are polygonal and may have a flat edge giving a squared off appearance
    ❖ Large nuclei and prominent nucleoli
    Differential Diagnosis
    Take-off point: Testicular Mass
    1. Yolk Sac Tumor
    2. Spermatocytic Tumor
    3. Embryonal Carcinoma
    YOLK SAC TUMOR
    Germ cell neoplasm composed of cells / structures reminiscent of
    embryonic / fetal yolk sac, allantois and extraembryonal mesenchyme.

    ● Testicular Mass ● 35 yo

    Microscopic: Microscopic:
    ● (-) Schiller-Duval Bodies
    ● Sheets of polygonal clear to amphophilic
    cells
    ● Solid nests or trabeculae of polygonal Radiology: heterogeneous echogenicity
    eosinophilic cells
    ● Large nuclei and prominent nucleoli
    Gross:
    ● Poorly circumscribed, nonencapsulated, predominantly solid
    ● (-) Hemorrhage, necrosis
    SPERMATOCYTIC TUMOR
    is a polymorphous triphasic germ cell neoplasm recapitulating
    spermatogonia development and unrelated to germ cell neoplasia in situ
    (GCNIS)

    ● 35 yo Microscopic:
    ● (-) Tripartite cytology
    ● (+) Fibrous Septa
    ● Painless testicular mass
    ● (+) Lymphocytic infiltrate

    ● GROSS: Homogenous, lobulated Radiology: heterogeneous signal,


    nodule including hyperechoic and hypoechoic
    components

    ● GROSS: (-) Hemorrhage and


    Necrosis
    Embryonal Carcinoma
    Malignant germ cell tumor composed of primitive epithelial tumor cells
    recapitulating early stages of embryonic development

    ● 35 yo, Microscopic:
    ● indistinct cell borders with nuclear
    overlapping
    ● Painless testicular mass
    ● (+) Fibrous Septa
    ● (+) Lymphocytic infiltrate

    GROSS: Poorly circumscribed with


    hemorrhage and necrosis
    TESTICULAR
    SEMINOMA
    Seminomas are the most common type of germ cell tumor, making up
    about 50% of these tumors. The peak incidence is the third decade
    and they almost never occur in infants.
    CASE DISCUSSION
    ANATOMY OF THE TESTIS
    Testis
    ● Ellipsoid-shaped
    ● Composed of ∼ 600 seminiferous tubules,
    which connect to the rete testis
    ● Surrounded by a thick capsule (tunica
    albuginea)
    ● Connect to the abdominal wall via the
    spermatic cord
    Testicular lobules
    ● Interlobular septa divide the testis into
    testicular lobules.
    ● Each testicular lobule contains 1–4
    seminiferous tubules.
    MICROSCOPIC

    SPERMATIDS
    PRIMARY AND
    SECONDARY
    SPERMATOCYTE
    SPERMATOGONIA

    BM OF
    SEMINIFEROUS
    TUBULES

    LEYDIG cell
    MICROSCOPIC
    ETIOLOGY
    ● Unknown but is associated with the following risk factors:
    ● Cryptorchidism
    ● Genetics- family history of testicular CA
    ● Environmental factors
    ○ history of testicular trauma
    ○ being overweight or obese (increased BMI)
    ○ exposure to estrogens during prenatal development
    ○ immunosuppression
    PATHOGENESIS
    CLINICOPATHOLOGIC FEATURES

    ● Painless enlargement of the testis


    ● Sensation of heaviness
    ● Acute testicular pain from intratesticular hemorrhage in around 10%
    ● Metastatic disease symptoms in around 10%
    ● Asymptomatic presentation in around 10% of cases
    ● Elevated serum human chorionic gonadotropin (hCG) levels
    ● Minimal AFP elevations
    GROSS FINDINGS

    Seminoma of the testis appears as


    a fairly well-circumscribed, pale,
    fleshy, homogeneous mass
    MICROSCOPIC FINDINGS

    The classic seminoma cell is large and round to polyhedral and has a distinct cell
    membrane; clear or watery-appearing cytoplasm; and a large, central nucleus with
    one or two prominent nucleoli
    IMMUNOHISTOCHEMICAL FEATURES

    ● Seminoma contain isochromosome 12p and express OCT3/4 and NANOG


    ● Seminoma cells may also stain positively for placental alkaline phosphatase
    (PLAP)
    ● KIT activating mutations
    ● A few scattered keratin-positive cells may also be present.
    RADIOLOGIC FINDINGS
    PROGNOSIS
    ● Currently, all stages have at least a 90% cure rate
    Cure rates by stage are as follows:
    ● Stage I: 98%-100%
    ● Stage II (B1/B2 nonbulky): 98%-100%
    ● Stage II (B3 bulky) and stage III: 90% complete response to chemotherapy and
    86% durable response rate to chemotherapy.
    TREATMENT
    ● Orchiectomy provides both diagnosis and therapy. Orchiectomy alone cures most stage I
    seminomas.
    Preferred treatments for more advanced stages are as follows:
    ● Stage IIA - Radiotherapy or chemotherapy with bleomycin, etoposide, and cisplatin (BEP) or
    etoposide and cisplatin (EP)
    ● Stage IIB - Chemotherapy (preferred) with BEP or EP or radiotherapy in select non-bulky (≤3
    cm) cases
    ● Stage IIC, III (good risk) - Chemotherapy with BEP (category 1) or EP (category 1)
    ● Stage IIC, III (high risk) - Chemotherapy with BEP (category 1) or etoposide, mesna,
    ifosfamide and cisplatin (VIP)
    STAGING
    THANK YOUUU!

    You might also like