Clinical Pathology · MU Sofia

105. Inflammatory diseases of the testis. Testicular tumors - types according to histological classification and origin.

Covers orchitis, its causes such as chlamydia, gonorrhoea, mumps and ischaemia after inguinal hernia, and its complications. It then moves to testicular tumours, their incidence and germ-cell versus sex-cord origin, and lists the main germ-cell types with peak ages and histological features. A labelled micrograph of seminoma is included, along with a short note on how serum tumour markers AFP and hCG point to specific components.

Inside: 1 section · 1 labelled picture · 15 flashcards · 2 min

Topic 105 of 138 in the MU Sofia syllabus for Clinical Pathology (Medicine, Year 4). The free AceMed note covers it in 1 section, about 333 words (2 min of reading), with 15 flashcards.

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  1. Inflammatory diseases of the testis. Testicular tumors - types according to histological classification and origin

Inflammatory diseases of the testis. Testicular tumors - types according to histological classification and origin

Inflammatory diseases of the testis

Inflammatory lesions of the testis are more common in the epididymis than in the testis proper. Orchitis is the term given to inflammation of the testis, it involves swelling, pain, hematospermia, hematuria and often involves the epididymis.

Causes can be due to STDs such as chlamydia and gonorrhea, and as a result of mumps. Ischemic orchitis may result from damage to the blood vessels of the spermatic cord during inguinal hernia and can lead to testicular atrophy. Common bacteria, infections are E.coli, Staph and Strep.

When untreated, orchitis can lead to infertility, loss of the testis, and rarely death.

Testicular tumours

Testicular tumours are the most common cause of painless testicular enlargement, and occur with greater incidence in those with undescended testis and testicular dysgenesis. Incidence is 6/100,000, 95% arise from germ cells and are all malignant, while the 5% that arise from Sertoli or Leydig cells are usually benign. Below we consider some of the germ cell tumours:

  • Seminoma - peak incidence 30-40 y.o., sheets of uniform polygonal cells with clear cytoplasm and lymphocytes in stroma
  • Embryonal carcinoma - peak incidence 20-30 yr, poorly differentiated, pleomorphic cells in cords, sheets, papillary formation containing some yolk sac and choriocarcinoma cells
  • Yolk sac tumour - 3 yrs, poorly differentiated endothelial like cuboidal/columnar cells
  • Choriocarcinoma - Cytotrophoblast and syncytiotrophoblast without villus
  • Teratoma - tissues from all three germ layers with various differentiation levels
  • Mixed tumour - commonly teratoma and embryonal carcinoma

H&E, seminoma: sheets of large uniform cells with clear cytoplasm, distinct borders and big central nucleoli, divided by fibrous septa that carry lymphocytes.

Image: “Histopathology of seminoma” by Mikael Häggström , M.D. Author info - Reusing images - Conflicts of interest: None Mikael Häggström , M.D. Consent note , CC0, via Wikimedia Commons.

Remember: serum tumour markers point to the component:

  • AFP: yolk sac tumour (look for Schiller-Duval bodies)
  • hCG: choriocarcinoma (very high levels)
  • Pure seminoma: AFP is normal; hCG is normal or only mildly raised by scattered syncytiotrophoblasts

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