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Testis and epididymis
Germ cell tumors
Carcinoid
Author: Rafael Jimenez, M.D., Mayo Clinic (see Authors page))
Revised: 13 January 2010, last major update - January 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Low grade neuroendocrine carcinoma, similar to counterpart at other sites
● Usually monomorphic cells growing in solid nests, trabeculae or pseudoglands
Terminology
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● Also called pure neuroendocrine carcinoma
Epidemiology
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● Rare (<1% of testicular neoplasms), mean age 46 years
Etiology
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● Carcinoid tumors are neuroendocrine tumors derived from enterochromaffin (Kulchitsky) cells that secrete serotonin, and most commonly arise in GI and respiratory tracts
● In testis, presumed to be a monodermal teratoma, although 20% have other teratomatous elements
Clinical features
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● Only 10% have clinical carcinoid syndrome
Prognostic factors
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● Metastatic disease is associated with carcinoid syndrome, tumor size 7 cm or more (Cancer 1993;72:1726)
Case reports
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● 12 year old boy with nodal metastases (J Pediatr Surg 2005;40:e19)
● 25 year old man with intratubular germ cell neoplasia in surrounding tissue (J Clin Pathol 2005;58:1331)
● 41 year old man with incidental tumor found at elective sterilization (J Androl 2004;25:338)
● 76 year old man with metastatic carcinoid tumor (Archives 1981;105:515)
Treatment
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● Excision; occasionally metastasizes
Gross description (Macroscopy)
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● Solid, yellow-tan, well circumscribed
● Cysts reflect other teratomatous elements
Gross images
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Solid, tan cut surface
Micro description (Histopathology)
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● Islands of cells forming small acini; cords forming rosettes or sheets
● Cells have granular eosinophilic cytoplasm, round nuclei with granular chromatin
● Usually no intratubular germ cell neoplasia, no/minimal mitotic activity, usually minimal atypia or necrosis
Micro images
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Islands of tumor cells in lower right Tumor cells have eosinophilic cytoplasm
and salt and pepper chromatin
Well defined acini and solid islands Cells have eosinophilic cytoplasm and
Of cells separated by fibrous stroma round nuclei with coarsely granular chromatin
Organoid pattern with minimal atypia Insular pattern, chromogranin+
Various images
Cytology description
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● Isolated or sheets of tumor cells with granular cytoplasm, round nuclei, uniformly distributed fine chromatin
Positive stains
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● Cytokeratin, chromogranin, synaptophysin, serotonin (AJCP 2003;120:182)
Negative stains
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● OCT4, CD30, c-kit, TTF-1 and CDX2
Electron microscopy descriptions
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● Neurosecretory granules
Molecular / cytogenetics description
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● i(12p) (Clin Cancer Res 2008;14:1393)
Differential Diagnosis
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● Metastatic carcinoid to testis: usually bilateral, multifocal, vascular invasion, case report of metastasis to scrotum at AJCP 1991;96:664
● Sertoli cell tumors: lacks prominent cytoplasmic granularity and coarse chromatin; inhibin+
End of Testis and epididymis > Germ cell tumors > Carcinoid
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