I- TUMORS GERM :
A- CLASSIFIED DESTUMEURS GERM (TG) :
• Germ cell tumors Seminomatous TGS : Séminome
• Germ cell tumors Nonseminomatous NSGT :
– embryonal carcinoma
• Tumors Mixed serminales : Séminome + Choriocarcinome + yolk sac tumor ….
B- THE TUMOR MARKERS :
Have a key role in the monitoring of patients:
• NSGT with choriocarcinoma or syncytiotrophoblast
• TGS with syncitiotrophoblastes
AFP (alpha-foeto-proteine) :
• NSGT with sac tumor
C- TUMORS GERM Seminomatous :
1- Séminome :
The most common testicular pure TG: 40 at 45% TG. occurs between 30 and 45 years.
N There is no increase in serum markers except to syncitiotrophoblastiques seminoma cells present increased 13 HCG.
Macroscopie : single well defined nodule or multiple nodules ± confluent. The tumor is homogeneous pinkish-white or grayish, firm.
histology : tumor population is monomorphic, made of clear cytoplasm in large cells or finely eosinophilic PAS +.
L’Architecture: massive or cord, dotted fibrous septa and lymphocytic elements .A granulomatous reaction is observed in about half of cases
prognosis: the risk of recurrence and metastasis are associated with tumor stage
2- Séminome spermatocytaire :
1 at 2% germ cell tumors.
Comes after 50 years
It is not associated with any risk factor for germ cell tumors
It is never associated with other histological types TG
Macroscopie : tumor 3 at 15 cm, often multinodular, whitish or pale yellow, sometimes presenting aspects mucoid
histology : Cell population comprising small cells, intermediate sized cells without glycogen and some larger cells sometimes multinucleated.
Immunohistochemistry : most of the markers are negative.
the Prognosis : Well, in principle does not require treatment after orchiectomy.
D- TUMORS GERM Nonseminomatous (TGNS) :
Occur in young men between 15 and 35 years. represent 60% Testicular Tumors.
They consist of embryonic and / or differentiated tissues, ectodermal origin, endodermal and mesenchymal, pure or combined in various proportions.
Macroscopie : The heterogeneous NSGT, associated with hemorrhagic and necrotic alterations
1- embryonal carcinoma :
Macroscopie : Tumor badly limited, often reworked by necrosis and hemorrhage.
histology: Tumor composed of poorly differentiated epithelial cells, to clear cytoplasm. Some syncytiotrophoblast elements can be individually.
The architecture is compact, adenoid or tubulopapillary.
Mitosis and vascular emboli are very common.
Immunohistochimie : PLAP + focally in 85 at 90 % cases. AFP+: discuss making the association with Tm yolk
2- yolk sac tumor :
macroscopie : nodule, solid, with myxoid areas or even gelatinous cystic
microscopy : The reticular or micro cystic aspects are the most characteristic. It also describes aspects macro cystic, papillary, solid, glandulaires.
Immunohistochimie : AFP (alphafoetoproteine ) : positive
3- Choriocarcinome :
Pure is exceptional choricarcinome. It is associated with other histological types.
N it is observed that in 15% of NSGT.
Mixed forms contain isolated syncytiotrophoblast elements responsible for elevated serum Beta hCG.
Macroscopie : Appearance pseudoplacentaire and is characterized by the presence of hemorrhagic and necrotic alterations
histology : Association cytotrophoblast homes and malignant Syncytiotrophoblast. The stroma is still bleeding.
4- Mature and immature teratoma :
Macroscopie : Tumor involving solid areas and cystic areas. Sometimes cysts are small fluid containing mucoid
histology : they are usually made of pluritissulaires haphazardly distributed differentiated adult tissues:
squamous epidermal kind + cutaneous appendices,
Respiratory or entéroide epithelium and cartilage are the most usual structures.
occasionally: nerve glial, muscular, bony, renal
The presence of tissue blastema and embyonnaires tubes is also usual.
Immunohistochimie : AFP + in the digestive type of mature structures, pulmonary or hepatic.
- In adults: metastatic potential in forms pure or not tératomateuses tératomateuses (sac or embryonic carcinoma tumor).
- In children prepubescent: tératomateuses the lesions are usually indolent course.
5- Germ cell tumors composed of more than one cell type :
They are called mixed, complexes, combining at least 2 preceding forms.
All combinations are possible. The most common association is the terato- carcinoma 26 %
Association Embryonic carcinoma and seminoma : 16 %
• embryonic carcinoma + teratoma + Tm vitelline : 11%
• Histologic factor of poor prognosis, correlated with metastatic disease are :
* changing markers rates
* A large proportion of embryonal carcinoma > 50 at 80%
* Presence of vascular or lymphatic emboli
II- Tumors sex cord stromal gonadal :
• Tumors sex cord tumors are usually in Leydig cells or Sertoli cells. These are accompanied by a dyshormonal context and are often benign.
• The malignancy of these Tm is often asserted only upon the occurrence of metastases.
• The poor prognostic criteria :
- the patient's age > at 50 years,
- Size of the Tm > at 5 cm
- vascular emboli
- index mitotique > at 5 for mitosis 10 champs
1- Leydig cell tumors :
• Raising testosterone and serum estrogen
• 3% these are bilateral Tm.
• They always seem benign in children
• In adults 10 at 15 % have a malignant potential.
Macroscopie : Tm small, very limited , from 3 at 5 cm diameter, closed, yellow- Orange cutting.
histology : dense and homogeneous population of large polyhedral cells with acidophilic nucleoli cores.
• crystals are observed in intracellular Reinke 1/3 Tm.
2- Sertoli cell tumor : (TS)
The different types of TS, high fat, sclerosing, large calcifying cells and malignant occur rather in adults.
TS large calcifying cells is seen at any age, on average 16 Porcine reproductive years in a context like, the Carney syndrome ( adenome hypophysiare, myxoma, corticosurrenaliennen skin hyperplasia lentiginose), a sydrome Peutz-Jeghers (intestinal polyps, lentiginoge skin).
Bilateral Tm are always benign.
Macroscopie : Tm very limited multi-lobed, yellowish or greyish an average size 3,5 cm. The alterations are rare
histology : Diffuse proliferation strip or nodules. The cells are organized in bays tubes or cords. The stromal edema or hyalinized.
Testicular Tumors 10 at 20 % TS are malignant is observing only in adults.
Dr K's course. Benabaddou – Faculty of Constantine