Testicular & Paratesticular Diseases

• Medical:
  • [sperm morphology, HERE ]
  • testicular biopsies:
    • aspermia work-up: if tubules OK and lots of sperm, then mechanical blockage is between testicle and ejaculatory duct
    • hypospermia work-up:
  • Cysts:
    • spermatocoel: should see spermatocytes in lumen and some ciliated lining cells
    • cystic transformation of the rete testis² (or other areas).
    • mesothelial inclusion cyst:[LMC-04-1924; LMC-04-6249]
    • chylocoel of tunica:
  • inlammatory or postinflammatory & other lesions:
    • spermatic granuloma
    • inflammatory pseudotumor, to include "proliferative funiculitis", a myofibroblastic lesion resembling nodular fasciitis of soft tissue & thought to possibly be secondary to ischemia (sometimes related to torsion)².
    • epididymitis: post vasectomy vs. "intact" vas, to include vasa nodosa
    • epidydimal or vasa ampullary perilumenal fibromyocytic hyperplasia and structural blending: ampullary epithelia rich in lipofuscin pigment¹ and may be within spectrum of "smooth muscle hyperplasia of testicular adnexa"²[L12-580 removed instead of total orchiectomy after bilateral Marcane pain block caused temporary orchalgia relief, rulling out referred pain]. This change in epididymis (partially) was complicated by micro-focal spermatic granuloma change [L12-2814].
    • post-ischemic changes:
      • infarct and/or fibrous scar
      • epididymal granulomatous ischemic lesion²
    • torsion & trauma changes.
    • specific infectious inflammatory changes .
    • rete testis:
      • calcifying nodules
    • vasculitis

   

• benign:
  • adenomatoid tumor
  • tunica fibroma or fibromatosis
  • adenomatous hyperplasia, any location (occult to lesional size) from rete area to ejaculatory duct & including vas & its ampulla.
  • cribriform hyperplasia of rete testis².
• malignant:
  • mixed
• pure seminomatous:
  • cytological features: on Pap or Wright's stain, the fragile cytoplasm leaks and forms a lacy "tigroid" background pattern [LMC-02-3339]; cellular smear, dispersed cells, large nuclei with distinct nucleoli, pale cytoplasm
  • histology:
    • classic seminoma: it has a uniform population of large cells that form sheets and nests separated by delicate connective tissue (see Images 3-4). Leukocytic infiltration (20%), multinucleated cells, syncytiotrophoblasts (7-35%), and microcalcifications (60%) may be present. Upon gross examination, the tumor has a uniform yellow color and bulges from the cut surface. Classic seminoma is the most common histologic type.
    • anaplastic seminoma: it is observed in 5-15% of patients with seminomas. Histopathology is as described for classic seminoma but with increased mitotic figures. Patients tend to present at more advanced stages (our correct DX explains the advanced stage [L08-12278]) than those with classic seminoma, but stage prognosis is similar.
    • The third is spermatocytic seminoma, and it is a rare variant that occurs in older adults. Histopathology shows tumor cells arranged in solid sheets, containing poorly developed inconspicuous septae without leukocytic infiltrate. No glycogen is present. Small, medium, and large cell types are observed. Orchiectomy alone is sufficient treatment; metastases are rare.
    • 100% auto-infacted seminoma: we have seen this.
  1. pure non-seminomatous:
     1. embryonal: cytology of cellular smears, aggregates, large nuclei, large nucleoli
     2. other
     3. lymphoma
     4. sarcoma
• The Testicular Cancer Resource Center

1. Sternberg SS, Histology for Pathologists, 1992, 977 pages.
2. Rosai J, Rosai AND Ackerman's Surgical Pathology, 9th Ed., vol. 1, p. 1361-1465, 2004.

(posted 6/11/02; latest addition 5 March 2012)