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Risk factors of carcinoma of the testis

White people
Cryptorchidism
Intersex syndromes: Androgen insensitivity syndrome & gonadal dysgenesis.
Family history (brothers with germ cell tumors)
Describe Risk factors for Prostate Carcinoma
Age-more than 50
Race-more black
Genetic predisposition
Hormones:Androgens
Enviromental factors:fat intake for example will elevate testosterone levels.
Seminoma & embryonal carcinoma and others
Classification
Testicular carcinoma is divided into 2 major categories:
Germ cell tumors (90-95%)
mostly malignant seminoma, embryonal carc, yolk.
Nongerm cell tumors: stromal and sex cord, derived from Sertoli and leydig cells (5-10%)
mostly benign
Germ cell tumors are further divided into seminomas and non-seminomas
- Seminoma and embryonal carcinoma
- Both are part of germ cell tumors
Seminoma - has single histologic pattern
-40-50 years
-50% of testicular germ cell tumors; histologically identical to ovarian dysgerminoma
-soft, well demarcated, grey-white bulging tumors
-can have a foci of coagulation necrosis without hemorrhage
-large, uniform cells with distinct cell borders, clear, glycogen rich cytoplasm, round nuclei,
conspicuous nucleoli
-can be accompanied ill-defined granulomatous reaction
Histology:
Single histologic pattern
Sheets of uniform white cells with clear or watery cytoplasm
Large central nucleous
Poorly demarcated lobules with delicate septa and Ly
Spermatocytic Seminoma
-65+ years -uncommon
-lack lymphocytic infiltrates, granulomas, and syncytiotrophoblasts -don't metastasize and not
associated with intratubular germ cell neoplasia
-variable shaped polygonal cells in nodules or sheets
NON SEMINOMA
Embryonal carcinoma- carcinoma has mixed pattern
Gross:
20-30year old
Poorly demarcated small gray-white tumor with hemorrage and/or necrosis
20% penetration of tunica albuginea
frequent component of mixed germ cell tumor
Histology:
tumor cells: look large and primitive; basophilic ctoplasm; indistinct borders; large
nuclei; prominent nucleoli
Composed of primitive anaplastic tumor cells that grow in solid sheets or in glandular
or tubular pattern, and irregular papillae
Mitoses and giant cells are common
Yolk Sac Tumor

-3, good prognosis


-tumors are large and can be well demarcated
-low cuboidal to columnar epithelial cells forming microcysts, lacelike patterns, sheets,
glands and pappilae.
-Schiller-Duvall bodies: a structure resembling primitive glomeruli.
Choriocarcinoma
-20-30
-primary tumars are often small, nonpalpable lesions (even with extensive metastasis)
-cytotrophoblastic: sheets of small cuboidal cells irregularly mixed with or capped by large
eosinophilic synctial cells containing multiple dark pleomorphorphic nuclei
Metastasis of Non-Seminoma Describe (primary lesions can be same in distance)
- metastasize earlier
- Hematogenous metastases are most common in the liver and lungs
- Metastatic lesions may be identival to the primary testicular tumor or may contain
elements of other germ cell tumors
PSA is elevated in 20-30% BPH and in 80% of carcinomas
Free PSA in serum also importent: more than 25% free PSA is low risk of cancer
Benign Prostate Hyperplasia
BPH always occur in the inner transitional zone near lumen, may result in luminal
obstruction of the urethra. The hyperplasia is containing both glandular and fibromuscular
stromal elements. The hyperplastic glands are also characterized by lining of columnar
epithelium with a peripheral layer of basal cells. The proteinacous corpora amylacea is
accumulated in the glandular lumina.
Foci of squamous hyperplasia
small areas of infarction
Consequences of BPH
only 10% of men get symptoms. Most common is: lower urinary tract obstruction(often in
form of difficulty in starting the stream of urine and intermittent interruption of the urinary
stream while voiding), urinary urgency, frequency and nocturia (all indication of bladder
irritation). Can lead to residual urine in bladder, that then can lead to infectin.
In some cases BPH leads to complete obstruction, leaing to painful distention of bladder
and if not treated hydronephrosis
Mention type of testicular germ cell tumors
Testicular germ cell tumors are subclassified into seminomas and nonseminomas germ cell
tumors.
1. seminoma
2. Embryonal carcinoma
3. Yolk sac tumor
4. Choriocarcinoma
5. Tetratoma
6. Mixed tumor.
Consequences of Adenocarcinoma of Prostate
- Often clinically silent
- Can have urinary dysfunction, hematuria and sexual dysfuctions.
- Ostoblastic metastases can occur
Importance of PSA in prostatic carcinoma
PSA is a marker of carcinoma of prostate
Released by prostatic cells to the semen
Normal PSA is less than 4ng/mg
Markers of different testicular tumors , mention
tumor markers:

1. seminoma - 10% of patients have elevated hCG


2. Embryonal carcinoma - Negative( pure embryonal carcinoma)
3. Yolk sac tumor- 90% of patients have elevated AFP
4. Choriocarcinoma -100% of patients have elevated hCG
5. Teratoma- Negative( pure teratoma)
Mixed tumor- 90% of patients have elevated hCG and AFP
Gleason scale grading system explain how it works etc
Grades Carcinoma of prostate
Based of degree of architectural differentiation of tumor cells
5 grades
on
the
basis of
glandular patterns of differentiation.
o Grade 1: most well differentiated tumors. grade 5: show no glandular differentiation
But the final score is between 2 and 10 because it takes into consideration the tumor
heterogenicity
o 2?4?low grade o 5?7?intermidiate grade o 8?10?high grade Ex.: Gleason score 7 (3 + 4)

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