Germ Cell Tumors Pure 67% Seminoma 53% Typical 52% Spermatocytic 1% Embryonal Ca 10% Teratoma 3% Yolk Sac Tumor 0.4% Polyembryoma 0.3% Choriocarcinoma 0.3%

Germ Cell Tumors Pure 67% Seminoma 53% Typical 52% Spermatocytic 1% Embryonal ca 10% Teratoma 3% Yolk sac tumor 0.4% Polyembryoma 0.3% Choriocarcinoma 0.3%

Mixed 33%

Seminoma

1 Seminoma

Seminoma

2 Seminoma Granulomas

Necrotic Seminoma

Seminoma+SynT

3 Seminoma YST Oct 3/4 Oct 3/4

OCT 3/4

Seminoma – Differential Diagnosis

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

4 Spermatocytic Seminoma

Spermatocytic Seminoma

5 Spermatocytic Seminoma

Emb CA

6 Emb CA

Emb CA

7 Emb CA

Immunostains for Seminoma vs. Embryonal Carcinoma (EC) Stain Sem. EC *AE1/AE3 + ++ *CD30 ++ C-kit ++ + Podoplanin ++ +

Mixed GCT

8 Chorio

Chorio

Emb CA + Seminoma

9 YST + Sem

YST + Sem

YST + Sem – OCT 3/4

10 Regressed GCT

Regressed GCT

11 Regressed GCT

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

Pohl et al. J Urol 172:2370, 2004

YST

12 YST

Teratoma

Epidermoid Cyst

13 Epidermoid Cyst

Sex Cord-Stromal Tumors

Leydig cell tumors Sertoli cell tumors Sertoli-Leydig cell tumors Granulosa cell tumors, adult and juvenile Mixed and unclassified tumors

Leydig Cell Tumor

1-3 % of testicular neoplasms 2-94 (mean 36) years of age Unilateral in 99 % Occasional gynecomastia 2-5% malignant

14 LCT

LCT

TESTICULAR SERTOLI CELL TUMORS

• Sertoli cell tumor, not otherwise specified • Large cell calcifying • Sclerosing • Tumors in Peutz-Jeghers syndrome

15 Sertoli cell tumor (SCT)

SCT

16 SCT

Juvenile GCT (JGCT)

JGCT

17 JGCT

Testicular Tumors in the 50 + Age Group

• Lymphoma • Metastases • Spermatocytic Seminoma

Lymphoma

18 Lymphoma

Mets To Testis

• Prostate 43% • Lung 15% • Colon 10% • Kidney 10% • Stomach 7% • Melanoma 4% • Misc. 11%

Prost. Ca

19 Met Melanoma

Paratesticular Tumors

Sertoliform rete cystadenoma Rete carcinoma Adenomatoid tumor Malignant mesothelioma Mullerian carcinomas

Adenomatoid Tumor (ADT)

20 ADT

Mesothelioma

21 Mesothelioma

Retinal anlage tumor (RAT)

RAT

22 Testicular tumor of adrenogenital syndrome (TTAGS)

TTAGS

23 Malakoplakia

Malakoplakia

Viral orchitis

24 Viral orchitis

Sertoli cell nodule

Fibromatous periorchitis

25 Fibrous pseudotumors

Fibrous pseudotumor

Fibromatous periorchitis

26 Meconium periorchitis

Meconium periorchitis

Vanishing testis syndrome

27 Vanishing testis syndrome

Hemorrhagic infarction

Infarction of appendix testis

28 Granulomatous orchitis

Sclerosing lipogranuloma