Spermatocytic tumor

Last updated
Spermatocytic tumor
Other namesSpermatocytic tumour
Spermatocytic seminoma high mag.jpg
Micrograph of a spermatocytic tumor. H&E stain.
Specialty Pathology, urology

Spermatocytic tumor, previously called spermatocytic seminoma, is a neoplasm of the testis (i.e. a tumour of the testis), and classified as a germ cell tumour.

Contents

The name of the tumour comes from the similarity (under the microscope) between the small cells of the tumour and secondary spermatocytes.

Signs and symptoms

Spermatocytic tumor is a rare tumour, making up only one to two percent of all testicular germ cell tumours. Men presenting with this tumour are generally 50 to 60 years old, and its occurrence is rare in men under 30 years old. Most present with slow, painless testicular enlargement, which may involve both testes. [1]

Diagnosis

Spermatocytic tumors are diagnosed based on tissue from orchiectomy (or partial orchiectomy), done for a lesion suspicious for cancer on medical imaging.[ citation needed ]

The macroscopic appearance of the tumour is of a mutinodular grey-white to tan coloured mass with gelatinous, haemorrhagic and necrotic areas. The tumour may extend beyond the testis. [1]

Histologic appearance

Histologically, spermatocytic tumors consist of three cell populations: [2]

The cells are generally packed into nodules, and have a loose, sheet-like arrangement that is commonly interrupted by interstitial oedema. Unlike classical seminoma, fibrous septation and lymphocytic infiltrates are not seen. Cells undergoing mitosis are common, as are cells undergoing apoptosis. [1]

Intratubular growth of spermatocytic tumor can be seen, however there is no intratubular germ cell neoplasia of unspecified type (IGCNU). The intratubular growth probably accounts for the appearance of separate tumour nodules within the testis.

Immunostaining for most of the usual testicular germ cell tumour markers is negative (i.e. placental alkaline phosphatase (PLAP), vimentin, actin, desmin, alpha fetoprotein (AFP), OCT4, human chorionic gonadotropin (hCG), and carcinoembryonic antigen (CEA)).

Rarely, spermatocytic tumors may show sarcomatoid differentiation, most commonly as undifferentiated spindled cells intermingled within the typical-appearing spermatocytic tumor cells. Rhabdomyosarcomatous differention has also been described. [1]

Relation to seminoma

Spermatocytic tumor is not considered a subtype of seminoma and, unlike seminoma and most other germ cell tumours, it does not arise from intratubular germ cell neoplasia . [3] It has not been described as arising in locations outside the testis, and does not occur in association with other germ cell tumours. [1]

Treatment

Unlike classical seminoma, spermatocytic tumors rarely metastasise, so radical orchidectomy alone is sufficient treatment, and retroperitoneal lymph node dissection and adjuvant chemotherapy or radiotherapy are generally not required. [1]

Related Research Articles

Testicular cancer Medical condition

Testicular cancer is cancer that develops in the testicles, a part of the male reproductive system. Symptoms may include a lump in the testicle, or swelling or pain in the scrotum. Treatment may result in infertility.

Leydig cell Androgen-producing cell adjacent to the seminiferous tubules of the testicle

Leydig cells, also known as interstitial cells of Leydig, are found adjacent to the seminiferous tubules in the testicle. They produce testosterone in the presence of luteinizing hormone (LH). Leydig cells are polyhedral in shape, and have a large prominent nucleus, an eosinophilic cytoplasm and numerous lipid-filled vesicles.

Choriocarcinoma Medical condition

Choriocarcinoma is a malignant, trophoblastic cancer, usually of the placenta. It is characterized by early hematogenous spread to the lungs. It belongs to the malignant end of the spectrum in gestational trophoblastic disease (GTD). It is also classified as a germ cell tumor and may arise in the testis or ovary.

Ependymoma Medical condition

An ependymoma is a tumor that arises from the ependyma, a tissue of the central nervous system. Usually, in pediatric cases the location is intracranial, while in adults it is spinal. The common location of intracranial ependymomas is the fourth ventricle. Rarely, ependymomas can occur in the pelvic cavity.

Sex cord–gonadal stromal tumour Medical condition

Sex cord–gonadal stromal tumour is a group of tumors derived from the stromal component of the ovary and testis, which comprises the granulosa, thecal cells and fibrocytes. In contrast, the epithelial cells originate from the outer epithelial lining surrounding the gonad while the germ cell tumors arise from the precursor cells of the gametes, hence the name germ cell. In humans, this group accounts for 8% of ovarian cancers and under 5% of testicular cancers. Their diagnosis is histological: only a biopsy of the tumour can make an exact diagnosis. They are often suspected of being malignant prior to operation, being solid ovarian tumours that tend to occur most commonly in post menopausal women.

Germ cell tumor Medical condition

Germ cell tumor (GCT) is a neoplasm derived from germ cells. Germ-cell tumors can be cancerous or benign. Germ cells normally occur inside the gonads. GCTs that originate outside the gonads may be birth defects resulting from errors during development of the embryo.

Seminoma Medical condition

A seminoma is a germ cell tumor of the testicle or, more rarely, the mediastinum or other extra-gonadal locations. It is a malignant neoplasm and is one of the most treatable and curable cancers, with a survival rate above 95% if discovered in early stages.

Embryonal carcinoma Medical condition

Embryonal carcinoma is a relatively uncommon type of germ cell tumour that occurs in the ovaries and testes.

Warthins tumor Medical condition

Warthin's tumor, also known as papillary cystadenoma lymphomatosum, is a benign cystic tumor of the salivary glands containing abundant lymphocytes and germinal centers. It is named for pathologist Aldred Scott Warthin, who described two cases in 1929.

Testicular microlithiasis Medical condition

Testicular microlithiasis is an unusual condition diagnosed on testicular ultrasound. It is found in between 1.5 to 5% of normal males, and may be found in up to 20% of individuals with subfertility. It is an asymptomatic, non-progressive disease.

Germinoma Medical condition

A germinoma is a type of germ-cell tumor, which is not differentiated upon examination. It may be benign or malignant.

Mediastinal germ cell tumors are tumors that derive from germ cell rest remnants in the mediastinum. They most commonly occur in the gonad but occasionally elsewhere.

Splenogonadal fusion

Splenogonadal fusion is a rare congenital malformation that results from an abnormal connection between the primitive spleen and gonad during gestation. A portion of the splenic tissue then descends with the gonad. Splenogonadal fusion has been classified into two types: continuous, where there remains a connection between the main spleen and gonad; and discontinuous, where ectopic splenic tissue is attached to the gonad, but there is no connection to the orthotopic spleen. Patients with continuous splenogonadal fusion frequently have additional congenital abnormalities, most commonly cryptorchidism.

Germ cell neoplasia in situ Medical condition

Germ cell neoplasia in situ (GCNIS) represents the precursor lesion for many types of testicular germ cell tumors. As the name suggests, it represents a neoplastic process of germ cells that is confined to the spermatogonial niche.

Sarcoidosis is a systemic disease of unknown cause that results in the formation of non-caseating granulomas in multiple organs. The prevalence is higher among blacks than whites by a ratio of 20:1. Usually the disease is localized to the chest, but urogenital involvement is found in 0.2% of clinically diagnosed cases and 5% of those diagnosed at necropsy. The kidney is the most frequently affected urogenital organ, followed in men by the epididymis. Testicular sarcoidosis can present as a diffuse painless scrotal mass or can mimic acute epididymo-orchitis. Usually it appears with systemic manifestations of the disease. Since it causes occlusion and fibrosis of the ductus epididymis, fertility may be affected. On ultrasound, the hypoechogenicity and ‘infiltrative’ pattern seen in the present case are recognized features. Opinions differ on the need for histological proof, with reports of limited biopsy and frozen section, radical orchiectomy in unilateral disease and unilateral orchiectomy in bilateral disease. The peak incidence of sarcoidosis and testicular neoplasia coincide at 20–40 years and this is why most patients end up having an orchiectomy. However, testicular tumours are much more common in white men, less than 3.5% of all testicular tumours being found in black men. These racial variations justify a more conservative approach in patients of Afro-Caribbean descent with proven sarcoidosis elsewhere. Careful follow-up and ultrasonic surveillance may be preferable in certain clinical settings to biopsy and surgery, especially in patients with bilateral testicular disease.

Sertoli cell tumour Medical condition

A Sertoli cell tumour, also Sertoli cell tumor, is a sex cord-gonadal stromal tumor of Sertoli cells. They can occur in the testis or ovary. They are very rare and generally peak between the ages of 35 and 50. They are typically well-differentiated, and may be misdiagnosed as seminomas as they often appear very similar.

Leydig cell tumour Medical condition

Leydig cell tumour, also Leydig cell tumor, (testicular) interstitial cell tumour and (testicular) interstitial cell tumor, is a member of the sex cord-stromal tumour group of ovarian and testicular cancers. It arises from Leydig cells. While the tumour can occur at any age, it occurs most often in young adults.

Scrotal ultrasound Medical ultrasound examination of the scrotum.

Scrotalultrasound is a medical ultrasound examination of the scrotum. It is used in the evaluation of testicular pain, and can help identify solid masses.

Extracranial germ cell tumor Type of tumor

An Extracranial Germ-Cell Tumor (EGCT) occurs in the abnormal growth of germ cells in the gonads and the areas other than the brain via tissue, lymphatic system, or circulatory system. The tumor can be benign or malignant (cancerous) by its growth rate. According to the National Cancer Institute and St. Jude Children's Research Hospital, the chance of children who are under 15 years old having EGCTs is 3%, in comparison to adolescents, a possibility of 14% with aged 15 to 19 can have EGCTs. There is no obvious cut point in between children and adolescents. However, common cut points in researches are 11 years old and 15 years old.

Ovarian germ cell tumors (OGCTs) are heterogeneous tumors that are derived from the primitive germ cells of the embryonic gonad, which accounts for about 2.6% of all ovarian malignancies. There are four main types of OGCTs, namely dysgerminomas, yolk sac tumor, teratoma, and choriocarcinoma.

References

  1. 1 2 3 4 5 6 Mills, S (ed.) 2009.Sternberg's Diagnostic Pathology. 5th Edition. ISBN   978-0-7817-7942-5
  2. Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. ISBN   0-7216-0187-1.
  3. Müller J, Skakkebaek NE, Parkinson MC (February 1987). "The spermatocytic seminoma: views on pathogenesis". Int. J. Androl. 10 (1): 147–56. doi: 10.1111/j.1365-2605.1987.tb00176.x . PMID   3583416.
Classification
D