germ cell tumors - cdn.ymaws.com...embryonal ca 10% teratoma 3% yolk sac tumor 0.4% polyembryoma...

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Germ Cell TumorsPure 67%

Seminoma 53%Typical 52%Spermatocytic 1%

Embryonal ca 10%yTeratoma 3%Yolk sac tumor 0.4%Polyembryoma 0.3%Choriocarcinoma 0.3%

Mixed 33%

Seminoma

Seminoma

2

Seminoma

Seminoma

Seminoma

3

Seminoma Granulomas

Necrotic Seminoma

Seminoma+SynT

4

Seminoma Oct 3/4

YSTOct 3/4

OCT 3/4

Seminoma – Differential Diagnosis

• Spermatocytic seminoma• Embryonal carcinoma y• Choriocarcinoma• Solid yolk sac tumor• Lymphoma• Sertoli cell tumor

5

Spermatocytic Seminoma

Spermatocytic Seminoma

Spermatocytic Seminoma

6

Spermatocytic Seminoma

Emb CA

Emb CA

7

Emb CA

Emb CA

Emb CA

8

Emb CA

Immunostains for Seminoma vs. Embryonal Carcinoma (EC)

Stain Sem. EC

*AE1/AE3 + ++

*CD30 ++

C-kit ++ +

Podoplanin ++ +

Mixed GCT

9

Chorio

Chorio

Emb CA + Seminoma

10

YST + Sem

YST + Sem

YST + Sem – OCT 3/4

11

Regressed GCT

Regressed GCT

Regressed GCT

12

Regressed GCT

Testicular Tumors in Children

•Teratomas 48%•Yolk sac tumor 15%•Epidermoid cyst 14%•Epidermoid cyst 14%•Sex cord tumors 13%•Miscellaneous 10%

Pohl et al. J Urol 172:2370, 2004

YST

13

YST

Teratoma

Epidermoid Cyst

14

Epidermoid Cyst

Sex Cord-Stromal Tumors

Leydig cell tumorsSertoli cell tumorsSertoli-Leydig cell tumorsGranulosa cell tumors, adult and juvenileMixed and unclassified tumors

Leydig Cell Tumor

1-3 % of testicular neoplasms2-94 (mean 36) years of ageUnilateral in 99 %Occasional gynecomastia2-5% malignant

15

LCT

LCT

TESTICULAR SERTOLI CELL TUMORS

• Sertoli cell tumor, not otherwise specified

• Large cell calcifying

• Sclerosing

• Tumors in Peutz-Jeghers syndrome

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Sertoli cell tumor (SCT)

SCT

SCT

17

SCT

Juvenile GCT (JGCT)

JGCT

18

JGCT

Testicular Tumors in the50 + Age Group

• Lymphoma

• Metastases

• Spermatocytic Seminoma

Lymphoma

19

Lymphoma

Mets To Testis

• Prostate 43%

• Lung 15%

• Colon 10%

• Kidney 10%

• Stomach 7%

• Melanoma 4%

• Misc. 11%

Prost. Ca

20

Met Melanoma

Paratesticular Tumors

Sertoliform rete cystadenomacystadenoma

Rete carcinomaAdenomatoid tumorMalignant mesotheliomaMullerian carcinomas

Adenomatoid Tumor (ADT)

21

ADT

Mesothelioma

Mesothelioma

22

Mesothelioma

Retinal anlage tumor (RAT)

RAT

23

Testicular tumor of adrenogenital syndrome (TTAGS)

TTAGS

TTAGS

24

Malakoplakia

Malakoplakia

Viral orchitis

25

Viral orchitis

Sertoli cell nodule

Fibromatous periorchitis

26

Fibrous pseudotumors

Fibrous pseudotumor

Fibromatous periorchitis

27

Meconium periorchitis

Meconium periorchitis

Vanishing testis syndrome

28

Vanishing testis syndrome

Hemorrhagic infarction

Infarction of appendix testis

29

Granulomatous orchitis

Sclerosing lipogranuloma

Sclerosing lipogranuloma