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Pathology – Testicular Germ Cell Tumors
Testicular germ cell neoplasms: A group of malignant tumors of the testis derived from germ cells. Epidemiology More than 90% of testicular cancers are categorized as germ cell tumors, predominantly affecting young men between the ages of 20 and 45.
Aetiology The principal risk factor is cryptorchidism, which increases the risk by three to fivefold. Additional prenatal risk factors include low birth weight and being tiny for gestational age. No reliable risk factors for adulthood have been discerned.
Carcinogenesis: Most germ cell malignancies arise from a precursor condition known as intratubular germ cell neoplasia (ITGCN), characterized by neoplastic germ cells localized within the seminiferous tubules. The disease process likely begins in fetal development, with ITGCN observable in childhood and young adulthood, during which further genetic abnormalities lead to malignant transformation. A commonly identified structural chromosomal aberration is the gain of 12p sequences.
Presentation • Most individuals present with a non-painful testicular tumor. Approximately 10% have symptoms indicative of metastatic disease, primarily back pain attributed to retroperitoneal lymph node metastases or cough/dyspnea stemming from pulmonary metastases. Serum neoplastic biomarkers Alpha-fetoprotein (AFP) is frequently associated with the presence of yolk sac elements. Beta human chorionic gonadotrophin (B HCG) is associated with the presence of syncytiotrophoblastic cells, which may appear individually in a pure seminoma or as a key component of choriocarcinoma. Macroscopy: Pure seminomas generally exhibit lobulated tan lesions. Teratomas often have both cystic and solid components. Mixed cancers generally have diverse morphological characteristics. Histopathology
Seminoma comprises sheets or clusters of polygonal cells distinguished by translucent or eosinophilic cytoplasm and spherical nuclei containing one or two nucleoli. A lymphocytic infiltration is commonly detected within the tumor.
Teratoma comprises tissues that mimic either undeveloped fetal tissues or mature adult tissues.
Embryonal carcinoma comprises anaplastic cells distinguished by large vesicular nuclei featuring prominent nucleoli. The tumors may manifest in solid sheets or form glandular structures.
The yolk sac tumor comprises small, somewhat pleomorphic cells that display various architectural configurations, primarily reticular and microcystic.
Choriocarcinoma has a mixture of syncytiotrophoblastic and cytotrophoblastic cells. Profuse bleeding and necrosis often transpire. Germ cell cancers may comprise entirely one subtype or a mixture of multiple kinds.
Prognosis: Excellent, with 5-year survival rates of 98% in the majority of countries. This indicates the high sensitivity of germ cell cancers to modern platinum-based chemotherapy protocols.
TNM 7 pathological staging of testicular germ cell
tumours
Primary tumour (T)
pT1: tumour limited to the testis without lymphovascular invasion.
pT2: tumour limited to the testis with lymphovascular invasion or
tumour extending through the tunica albuginea with involvement of the
tunica vaginalis.
pT3: tumour invades the spermatic cord with or without lymphovascular
invasion.
pT4: tumour invades the scrotum with or without lymphovascular
invasio
Testicular germ cell neoplasms: A group of malignant tumors of the testis derived from germ cells. Epidemiology More than 90% of testicular cancers are categorized as germ cell tumors, predominantly affecting young men between the ages of 20 and 45.
Aetiology The principal risk factor is cryptorchidism, which increases the risk by three to fivefold. Additional prenatal risk factors include low birth weight and being tiny for gestational age. No reliable risk factors for adulthood have been discerned.
Carcinogenesis: Most germ cell malignancies arise from a precursor condition known as intratubular germ cell neoplasia (ITGCN), characterized by neoplastic germ cells localized within the seminiferous tubules. The disease process likely begins in fetal development, with ITGCN observable in childhood and young adulthood, during which further genetic abnormalities lead to malignant transformation. A commonly identified structural chromosomal aberration is the gain of 12p sequences.
Presentation • Most individuals present with a non-painful testicular tumor. Approximately 10% have symptoms indicative of metastatic disease, primarily back pain attributed to retroperitoneal lymph node metastases or cough/dyspnea stemming from pulmonary metastases. Serum neoplastic biomarkers Alpha-fetoprotein (AFP) is frequently associated with the presence of yolk sac elements. Beta human chorionic gonadotrophin (B HCG) is associated with the presence of syncytiotrophoblastic cells, which may appear individually in a pure seminoma or as a key component of choriocarcinoma. Macroscopy: Pure seminomas generally exhibit lobulated tan lesions. Teratomas often have both cystic and solid components. Mixed cancers generally have diverse morphological characteristics. Histopathology
Seminoma comprises sheets or clusters of polygonal cells distinguished by translucent or eosinophilic cytoplasm and spherical nuclei containing one or two nucleoli. A lymphocytic infiltration is commonly detected within the tumor.
Teratoma comprises tissues that mimic either undeveloped fetal tissues or mature adult tissues.
Embryonal carcinoma comprises anaplastic cells distinguished by large vesicular nuclei featuring prominent nucleoli. The tumors may manifest in solid sheets or form glandular structures.
The yolk sac tumor comprises small, somewhat pleomorphic cells that display various architectural configurations, primarily reticular and microcystic.
Choriocarcinoma has a mixture of syncytiotrophoblastic and cytotrophoblastic cells. Profuse bleeding and necrosis often transpire. Germ cell cancers may comprise entirely one subtype or a mixture of multiple kinds.
Prognosis: Excellent, with 5-year survival rates of 98% in the majority of countries. This indicates the high sensitivity of germ cell cancers to modern platinum-based chemotherapy protocols.
TNM 7 pathological staging of testicular germ cell
tumours
Primary tumour (T)
pT1: tumour limited to the testis without lymphovascular invasion.
pT2: tumour limited to the testis with lymphovascular invasion or
tumour extending through the tunica albuginea with involvement of the
tunica vaginalis.
pT3: tumour invades the spermatic cord with or without lymphovascular
invasion.
pT4: tumour invades the scrotum with or without lymphovascular
invasio
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