Diseases of the liver and pancreas

Enlarged Placentas

• 
  Syphilis
  
• 
  Diabetes mellitus
  
• 
  Rh hemolytic disease (erythroblastosis fetalis)
  

Multiple Gestation

• 
  Dizygotic (fraternal twins)-fertilization of two separate ova producing twins that are genetically different-same or different sexes
  
• 
  Monozygotic twins-early division of a single fertilized ovum producing twins that are identical and same sex
  
• 
  MONOCHORIONIC=identical twins whether monoamniotic (Siamese twins, fetal to fetal transfusion, entanglement in umbilical cord) or diamniotic
  
• 
  DICHORIONIC=fraternal or identical twins
  

• 
  Identical twins can arise from a dichorionic, diamniotic placenta if the division of the fertilized ovum occurs before the chorion is formed (before day 3 following fertilization).
  
• 
  If the division of the morula occurs after the chorion is complete, then the placenta will be monochorionic and may be diamniotic or monoamniotic
  

Chorioamnionitis

• 
  Infection of the fetal membranes
  
• 
  Usually from an ascending infection from the vagina and cervix or premature rupture of the membranes for greater than 18 hours
  

• 
  Group B Streptococci (Strep. agalactiae)
  
• 
  Funisitis may also occur (infection of the umbilical cord)
  

Villitis

• 
  Infection of the chorionic villi resulting from endometritis or transplacental passage of organisms delivered by way of the maternal circulation (hematogenous infections): acute villitis is usually caused by maternal bacterial sepsis
  
• 
  Microorganisms:
  
• 
  Bacteria: T. pallidum, M. tuberculosis, Mycoplasma, Chlamydia
  
• 
  Viruses: rubella, CMV, herpes-usually chronic villitis or chronic chorioamnionitis
  
• 
  Protozoa: toxoplasma
  
• 
  Fungi: Candida
  

ID/CC A 30 year old white primigravida at 36 weeks of gestation visits her obstetrician for the first time in her pregnancy complaining of swollen legs and headache.

HPI Her medical history is unremarkable, and her pregnancy has apparently developed with no complications until the onset of her symptoms

PE VS: hypertension (BP 170/110). PE: excessive weight gain; funduscopic exam does not show changes of hypertensive retinopathy; 3+ pitting pedal edema; 1+ periorbital edema; 3+proteinuria

Pregnancy-Induced Hypertension

• 
  Usually occurs after the 12th week of gestation (MC the 32 week) in primigravidas
  
• 
  Pre-eclampsia: sudden development of maternal hypertension, edema and proteinuria (nephrotic syndrome)
  
• 
  Eclampsia: includes generalized convulsions
  

• 
  Etiology:
  
• 
  Loss of the protective effect of uterine prostaglandin E which neutralizes the vasoconstrictive effect of angiotensin II
  
• 
  Predisposing factors:
  
• 
  Primigravidas
  
• 
  Polyhydramnios
  
• 
  Preexisting hypertension or diabetes mellitus
  
• 
  Hydatidiform mole (PIH in first trimester is presumptive evidence for a mole)
  

Gestational Trophoblastic Disease

• 
  A gestational neoplasm should be suspected when the uterus is too large for date and no fetal heart sounds or movements are detected
  
• 
  Hydatidiform moles, invasive moles, and choriocarcinoma
  
• 
  All three secrete beta hCG
  
• 
  Increased theca lutein cysts
  

ID/CC A 25 year old Filipina in her 20th week of pregnancy presents with vaginal bleeding but no pain

HPI She has been feeling inordinated nauseated and has suffered from ringing in her ears
PE VS: moderate hypertension (BP 150/95). Uterus large for gestational age; lower extremity 2+

nonpitting edema

Labs Markedly increased beta hCG. UA: proteinuria but no casts seen on microscopic exam. Elevated blood uric acid level.

Imaging:US: “snowstorm” appearance and no fetus in uterine cavity

Hydatidiform Moles

• 
  Incidence high in Asian countries; associated with alpha-thalassemia (spontaneous abortions)
  
• 
  Chorionic villi are swollen, avascular, and resemble clusters of grapes
  
• 
  Ultrasound shows “snowstorm” appearance
  
• 
  Present with PAINLESS vaginal bleeding, usually during 1st trimester
  
• 
  Uterus too large for gestational age; Increased beta-hCG
  
• 
  The entire chromosome component is derived from the sperm;
  
• 
  Complete mole: no associated embryo; may have choriocarcinomas; full chromosome set (46XX most common; fertilized by two sperm or one diploid sperm
  
• 
  Partial mole: embryo; no choriocarcinomas; partial chromosome set (trisomy); fertilized by either two sperm or one diploid sperm
  

Invasive Moles

• 
  May invade the myometrium and metastasize
  

• 
  “invasive” implies that molar villi and trophoblasts have extended more deeply and widely than the normal uterine implantation
  

• 
  More common in patients over 40
  
• 
  Still considered a benign tumor
  

ID/CC A 29 year old Vietnamese female visits her family doctor because of protracted nausea, vaginal bleeding, dyspnea, and hemoptysis

HPI Her history reveals one previous normal gestation and one spontaneous abortion as well as a dilatation and curettage four months ago for a hydatidiform mole

PE Vaginal examination with speculum reveals a bluish-red vascular tumor and enlarged uterus; adnexa and ovaries are normal

Labs Markedly elevated serum and urinary hCG levels

Imaging CXR: multiple metastatic nodules

Choriocarcinoma

• 
  Arise from complete hydatidiform moles in 50% of cases, previous abortions in 25%, and normal or ectopic pregnancies in the remainder; makes -hCG and human placental lactogen
  
• 
  Only composed of trophoblastic tissue and lack villous structures; composed of a central core of cytotrophoblasts surrounded by a covering of syncytiotrophoblasts
  
• 
  Metastasize to lungs (cannon-ball metastases)
  
• 
  Also go to vagina, brain and liver
  
• 
  Sensitive to chemotherapy (actinomycin D and methotrexate***)
  

Gestationally derived Choriocarcinomas






Syncytotrophoblasts are the cells with groups of nuclei and a large mass of cytoplasm (small arrow). Cytotrophblasts are the cells in the central portions (large arrow)

Diseases of the Male Genital Tract &Testicular Tumors
St Christopher’s College of Medicine

Male Genital Tract

• 
  Penis:
  

• 
  Congenital Anomalies
  

• 
  Hypospadias and Epispadias
  
• 
  Phimosis
  

• 
  Inflammations
  
• 
  Tumors
  

• 
  Benign tumors
  
• 
  Carcinoma in situ
  
• 
  Carcinoma
  

• 
  Testis and Epididymis
  
• 
  Prostate
  

Hypospadias and Epispadias

• 
  Abnormal site of external uretheral meatal opening
  
• 
  Due to malformation of the urethral groove and urethral canal
  
• 
  Abnormal openings can either be on
  

• 
  Ventral surface of the penis - Hypospadias
  
• 
  Dorsal surface of the penis - Epispadias
  

• 
  Commonly associated with
  

• 
  Failure of normal descent of the testes
  
• 
  Malformations of the urinary tract
  

Clinical Significance:

• 
  If the abnormal opening is constricted - partial urinary obstruction >Cystitis > spread to the rest of urinary tract
  
• 
  Are a possible causes of sterility in men
  

• 
  Orifice situated near the base of the penis > normal ejaculation and insemination are hampered or totally blocked
  

Hypospadias

Epispadias

Phimosis

• 
  Prepucial orifice too small to permit its normal retraction
  
• 
  Congenital / acquired by inflammatory scarring of the prepuce
  
• 
  Clinical Significance:
  
• 
  Interferes with cleanliness and permits the accumulation of secretions under the prepuce > development of secondary infections and possibly carcinoma
  
• 
  Paraphimosis: When a phimotic prepuce is forcibly retracted over the glans penis, marked constriction and subsequent swelling may block the replacement of the prepuce
  

• 
  Is extremely painful
  
• 
  May be a potential cause of urethral constriction and serious acute urinary retention.
  

Inflammations

• 
  Specific infections:
  

• 
  Syphilis, gonorrhea
  
• 
  Chancroid
  
• 
  Granuloma inguinale
  
• 
  Lymphopathia venereum
  
• 
  Genital herpes
  

• 
  Nonspecific infections:
  

• 
  Balanoposthitis
  

Inflammations

Balanoposthitis:

• 
  Is a nonspecific infection of the glans and prepuce
  
• 
  Caused by a wide variety of organisms
  

• 
  Pyogenic bacteria (staphylococci, coliforms)
  
• 
  Fungi (Candida albicans)
  
• 
  Mycoplasmas
  
• 
  Chlamydia
  

• 
  Encountered in patients having phimosis or a large, redundant prepuce
  

• 
  This interferes with cleanliness
  
• 
  Predisposes to bacterial growth within the accumulated secretions and smegma
  

• 
  If neglected such inflammations may lead to frank ulcerations of the mucosal covering of the glans
  
• 
  If they persist and become chronic > further inflammatory scarring of the phimosis > aggravation of the underlying condition.
  

Balanoposthitis

Tumors of the Penis

• 
  Benign
  

• 
  Condyloma Acuminatum
  

• 
  Carcinoma in situ
  

• 
  Bowen’s Disease
  
• 
  Erythroplasia of Queyrat
  
• 
  Bowenoid papulosis
  

• 
  Carcinoma of the penis
  

Condyloma Acuminatum

• 
  Benign tumor
  
• 
  Caused by human papillomavirus (HPV)-types 6 and 11
  
• 
  Is related to the common wart (verruca vulgaris)
  
• 
  May occur on any moist mucocutaneous surface of the external genitals in either sex
  

Condyloma Acuminatum

• 
  Occur most often about the coronal sulcus and inner surface of the prepuce
  
• 
  Consist of single or multiple sessile or pedunculated, red papillary excrescences
  
• 
  Vary from 1 to several millimeters in diameter
  

Condyloma Acuminatum

• 
  Low magnification reveals the papillary (villous) architecture
  

Condyloma Acuminatum

Histologically:

• 
  Branching, villous, papillary connective tissue stroma
  
• 
  Covered by a thickened hyperplastic epithelium
  
• 
  Superficial hyperkeratosis
  
• 
  Thickening of the underlying epidermis (acanthosis)
  
• 
  The normal orderly maturation of the epithelial cells is preserved.
  
• 
  Clear vacuolization of the prickle cells (koilocytosis), characteristic of HPV infection, is noted in these lesions
  
• 
  Basement membrane is usually intact, and there is no evidence of invasion of the underlying stroma
  

Condyloma Acuminatum

• 
  Clear vacuolization of the prickle cells (koilocytosis) - characteristic of HPV infection
  

Carcinoma In Situ

• 
  It is a histologic term to describe epithelial lesions having the cytologic changes of malignancy confined to the epithelium with no evidence of local invasion or distant metastases
  
• 
  Considered a precancerous condition because of its potential to evolve into invasive cancer
  
• 
  In the external male genitalia, three lesions that display histologic features of carcinoma in situ have been described:
  

• 
  Bowen’s disease
  
• 
  Erythroplasia of Queyrat
  
• 
  Bowenoid papulosis
  

Bowen’s disease

• 
  Occurs in the genital region of both males and females
  
• 
  >35 years of age group
  
• 
  Involves the shaft of the penis and the scrotum
  
• 
  Grossly:
  
• 
  Appears as a solitary, thickened, gray-white, opaque plaque with shallow ulceration and crusting
  
• 
  Histologically:
  
• 
  Epidermis shows proliferation with numerous mitoses
  
• 
  Cells are markedly dysplastic with large hyperchromatic nuclei
  
• 
  Total lack of orderly maturation
  
• 
  Dermal-epidermal border is sharply delineated by an intact basement membrane
  
• 
  Over the span of years, Bowen’s disease may become invasive and transform into typical squamous cell carcinoma in ~ 10 to 20% of patients.
  
• 
  Occurrence of visceral cancer in ~30% of cases of Bowen’s Disease.
  

Bowen’s disease

• 
  Dermal-epidermal border is sharply delineated by an intact basement membrane
  

Bowen’s disease

• 
  Hyperchromatic and dysplastic epithelial cells
  

Erythroplasia of Queyrat

• 
  Appears on the glans and prepuce as single or multiple shiny red, sometimes velvety plaques
  

Histologically:

• 
  Dysplasia is of variable severity
  

• 
  From mild disorientation of cells to a picture indistinguishable from that of Bowen’s disease.
  

• 
  Like Bowen’s disease, it has the potential to develop into invasive carcinoma.
  
• 
  In contrast to Bowen’s disease, there is no reported association with visceral malignancy.
  

Bowenoid papulosis

• 
  Occurs in sexually active adults
  
• 
  Clinically it differs from Bowen’s disease by
  

• 
  Younger age of patients
  
• 
  Presence of multiple (rather than solitary), pigmented (reddish brown) papular lesions
  

• 
  Histologically:
  

• 
  It is indistinguishable from Bowen’s disease
  

Carcinoma

• 
  Squamous cell carcinoma of the penis represents about 1% of cancers in males in the United States.
  
• 
  Is extremely rare among Jews and Moslems
  

• 
  Protection apparently conferred by circumcision
  

• 
  Prevention of accumulation of smegma
  

• 
  Carcinomas are usually found in patients between the ages of 40 and 70.
  

Carcinoma of the Penis

• 
  Begins on the glans or inner surface of the prepuce near the coronal sulcus
  
• 
  First observable changes
  

• 
  A small area of epithelial thickening accompanied by graying and fissuring of the mucosal surface
  

• 
  With progression
  

• 
  An elevated papule that often ulcerates
  

• 
  By the time most patients seek medical attention
  

• 
  Large characteristic malignant ulcers having necrotic, secondarily infected bases with ragged, irregular, heaped-up margins
  

• 
  In far-advanced lesions
  

• 
  Ulceroinvasive disease destroys the entire tip of the penis or large areas of the shaft
  

Carcinoma of the Penis

• 
  Second pattern of macroscopic tumor growth
  

• 
  Papillary tumor that simulates the condyloma
  
• 
  Progressively enlarges to form a cauliflower-like, ulcerated, fungating mass
  

Histologically:

• 
  Both the papillary and ulceroinvasive lesions are squamous cell carcinomas similar to those that occur elsewhere on the skin surface.
  

Carcinoma of Penis

Carcinoma of Penis

Clinical Course

• 
  Carcinoma of the penis is a slowly growing, locally metastasizing lesion
  
• 
  Often is present for a year or more before it is brought to medical attention.
  

• 
  Unawareness of the significance of the developing papule
  
• 
  Existence of a phimosis that completely hides the developing lesion
  

• 
  Lesions are nonpainful until they undergo secondary ulceration and infection.
  
• 
  Frequently bleed
  
• 
  Metastasis: To inguinal and iliac lymph nodes
  
• 
  Prognosis: Related to the stage of advancement of the tumor.
  

• 
  Limited lesions without invasion of the inguinal lymph nodes: 66% 5-year survival rate
  
• 
  Metastasis to the lymph nodes: 27% 5-year survival.
  

Male Genital Tract

• 
  Penis
  
• 
  Testis and epididymis
  

• 
  Congenital anomalies
  

• 
  Cryptorchidism
  

• 
  Regressive changes
  

• 
  Atrophy
  

• 
  Inflammations
  

• 
  Non-specific epididymitis and orchitis
  
• 
  Granulomatous (Autoimmune) orchitis
  
• 
  Specific inflammations
  

• 
  Vascular disturbances
  

• 
  Torsion
  

• 
  Testicular tumors
  

• 
  Germ cell tumors
  
• 
  Sex cord-stromal tumors
  
• 
  Testicular lymphoma
  

• 
  Prostate
  

Normal Testis

• 
  Body
  
• 
  Epididymis
  
• 
  Spermatic cord
  

Cryptorchidism

• 
  Is synonymous with undescended testes
  
• 
  Found in ~1% of 1 year old boys
  
• 
  Represents a complete or incomplete failure of the intra-abdominal testes to descend into the scrotal sac
  
• 
  Testicular descent occurs in two phases:
  

• 
  Trans-abdominal phase
  

• 
  Testis comes to lie within the lower abdomen/ brim of the pelvis
  
• 
  Controlled by Mullerian-Inhibiting substance
  

• 
  Inguino-scrotal phase
  

• 
  Descent is through the inguinal canal into the scrotal sac
  
• 
  Is androgen dependent
  
• 
  Commoner
  

Cryptorchidism

• 
  Is unilateral in the majority of cases
  

• 
  May be bilateral in 25% of patients
  

• 
  Cryptorchid testis is small in size and is firm in consistency owing to fibrotic changes
  
• 
  Histologic changes in the malpositioned testis begin as early as two years of age
  

• 
  An arrest in the development of germ cells
  
• 
  Associated marked hyalinization and thickening of the basement membrane of the spermatic tubules
  

• 
  Histologic deterioration, leading to a paucity of germ cells, has also been noted in the contralateral (descended) testis in patients with unilateral cryptorchidism
  

Cryptorchidism

• 
  When the testis lies in the inguinal canal, it is particularly exposed to trauma and crushing against the ligaments and bones.
  
• 
  Concomitant inguinal hernia frequently accompanies.
  
• 
  Sterility can occur in
  

• 
  bilateral cryptorchidism
  
• 
  uncorrected unilateral cryptorchidism
  

• 
  contralateral descended testis may also be deficient in germ cells
  

• 
  Undescended testis is at a greater risk of developing testicular cancer
  
• 
  Requires surgical correction (Orchiopexy – placement of testis in the scrotal sac) preferably before histologic deterioration sets in at two years of age
  

Normal Testis

Cryptorchid Testis

Atrophy

Causes:

• 
  Progressive atherosclerotic narrowing of the blood supply in old age
  
• 
  End stage of an inflammatory orchitis, whatever the etiologic agent
  
• 
  Cryptorchidism
  
• 
  Hypopituitarism
  
• 
  Generalized malnutrition, or cachexia
  
• 
  Obstruction to the outflow of semen
  
• 
  Irradiation
  
• 
  Prolonged administration of female sex hormones
  

• 
  Treatment of patients with carcinoma of the prostate
  

• 
  Exhaustion atrophy may follow the persistent stimulation produced by high levels of follicle-stimulating pituitary hormone.
  

Atrophy

Torsion

• 
  Twisting of the spermatic cord may cut off the venous drainage and the arterial supply to the testis.
  
• 
  Usually, however, the thick-walled arteries remain patent so that intense vascular engorgement and venous infarction follow
  
• 
  Usual precipitating cause is some violent movement or physical trauma
  
• 
  There are predisposing causes:
  

• 
  Incomplete descent
  
• 
  Absence of the scrotal ligaments or the gubernaculum testis
  
• 
  Atrophy of the testis so it is abnormally mobile within the tunica vaginalis
  
• 
  Abnormal attachment of the testis to the epididymis
  

Torsion

Torsion

• 
  Immediate surgery is required to reduce the risk of testicular loss (< 4 hours)
  
• 
  Contralateral orchiopexy prophylactically (high incidence of bilaterality)
  
• 
  Atrophic testicle should be removed due to possible autoimmune destruction of contralateral testis
  
• 
  “Doughnut sign” seen with Tc99 MRI scan
  

• 
  Due to central testicular ischemia and circumferential collateral flow
  

Testicular Tumors

• 
  Two types:
  

• 
  Germ Cell Tumors
  

• 
  Highly aggressive
  
• 
  Early metastasis
  
• 
  15-34 year age group peak incidence
  
• 
  Most common tumor of men
  
• 
  Whites > blacks
  

• 
  Non-Germ Cell Tumors
  

• 
  Derived from Sex cord / Stroma
  
• 
  Benign
  
• 
  Some produce steroids leading to endocrinologic syndrome
  

Germ Cell Tumors - Seminoma

• 
  Seminomas are the most common type of germinal tumor (50%)
  
• 
  The type most likely to produce a uniform population of cells
  
• 
  Almost never occur in infants
  
• 
  Peak in the fourth decade
  
• 
  A nearly identical tumor arises in the ovary, where it is called dysgerminoma
  

Seminoma

• 
  ~ 15% of seminomas contain syncytial giant cells that resemble the syncytiotrophoblast of the placenta both morphologically and in that they contain HCG.
  

• 
  In this subset of patients, serum HCG levels are also elevated
  

Spermatocytic Seminoma

• 
  It is an uncommon tumor
  
• 
  The age of involvement is much later than for most testicular tumors
  
• 
  Affected individuals are generally over the age of 65 years
  
• 
  In contrast to classic seminoma, it is a slow-growing tumor that rarely if ever produces metastases
  
• 
  Hence the prognosis is excellent
  

Seminoma

Seminoma

Histological Types

Seminoma (classical):

• 
  Well-demarcated tan-white homogeneous mass composed of uniform cells in lobules separated by a fine stroma.
  
• 
  Tumour cells are large and round with a large central hyperchromatic nucleus, prominent nucleoli and a sharp cell border
  
• 
  The cells contain glycogen.
  
• 
  Classical seminoma is radiosensitive with favourable prognosis after orchidectomy and postsurgical irradiation.
  

Seminoma

• 
  Low magnification showing clear seminoma cells divided into poorly demarcated lobules by delicate septa
  

Seminoma

• 
  High power view of clear seminoma cells
  

Histological Types

Embryonal Carcinoma:

• 
  A highly malignant tumour with variable pattern
  

• 
  Glandular
  
• 
  Alveolar
  
• 
  Tubular
  

• 
  The cells resemble anaplastic epithelial cells
  
• 
  Spread is by lymphatics but haematogenous dissemination is frequent
  
• 
  Prognosis is poor
  

Embryonal Cell Carcinomas

• 
  Sheets of undifferentiated cells and glandular differentiation
  

Histological Types

Yolk-Sac Tumour:

• 
  Also known as Infantile Embryonal Carcinoma or Endodermal Sinus Tumor
  
• 
  Most common testicular tumor in infants and children upto 3 years
  
• 
  Microscopically characterised by distinctive perivascular structures and hyaline globules
  
• 
  Tumour contains demonstrable alpha-fetoprotein
  
• 
  Spread is via lymphatics and blood
  

Histological Types

Choriocarcinoma:

• 
  A highly malignant tumour composed of two elements –
  

• 
  Cytotrophoblastic cells
  
• 
  Syncytiotrophoblastic cells.
  

• 
  Serum and urinary Human chorionic gonadotrophin (HCG) is elevated
  
• 
  Distinct propensity to haematogenous dissemination.
  

Histological Types

Teratoma:

• 
  A histologically complex tumour composed of tissue derived from more than one of the three primary germ layers:
  

• 
  Ectodermal elements (skin, hair, keratin and skin appendages)
  
• 
  Mesodermal elements (e.g. bone, cartilage, smooth muscle)
  
• 
  Endodermal elements (e.g. intestine and bronchial mucosa, thyroid, etc).
  

• 
  Subdivided into mature and immature teratomas.
  
• 
  Teratomas in adults are capable of metastasis, even if they appear entirely mature.
  
• 
  For unknown reasons, differentiated mature teratomas of testis in infants and small children are usually benign.
  

Germ Cell Tumours (mixed type)
Age Incidences of Germ-Cell Tumors

Tumour Markers

Human chorionic gonadotrophin (HCG)

• 
  Secreted by syncytiotrophoblastic cells in the placenta
  
• 
  Elevated levels are seen in most choriocarcinomas, some embryonal carcinomas and some seminoma containing syncytiotrophoblasts.
  

Alpha-fetoprotein (AFP)

• 
  Secreted in yolk sac tumors and some embryonic carcinoma.
  

Significance of Tumour Markers

• 
  Detection of non-seminomatous elements
  
• 
  Detection of recurrence
  
• 
  Detection of metastasis
  

Non-Germ Cell Tumors

Leydig (Interstitial) Cell Tumors

• 
  Tumors of Leydig cells may elaborate
  

• 
  Androgens
  
• 
  Androgens + estrogens
  
• 
  Corticosteroids
  

• 
  They arise at any age
  
• 
  Majority between 20 - 60 years of age
  
• 
  The most common presenting feature is testicular swelling
  

• 
  In some patients gynecomastia may be the first symptom
  

• 
  In children, hormonal effects, manifested primarily as sexual precocity, are the dominating features
  

Morphology

• 
  Most are benign tumors
  
• 
  Form circumscribed nodules <5 cm in size
  
• 
  Have golden-brown, homogeneous cut surface
  

Histologically:

• 
  Tumorous Leydig cells are large and round or polygonal, and they have an abundant granular eosinophilic cytoplasm with a round central nucleus.
  
• 
  The cytoplasm frequently contains lipid granules, vacuoles, or lipofuscin pigment, but, most characteristically, rod-shaped crystalloids of Reinke occur in about 25% of the tumors
  

Sertoli Cell Tumors (Androblastoma)

• 
  Tumors of Sex Cord - Gonadal Stroma
  
• 
  Composed entirely of Sertoli cells or may have a component of granulosa cells
  
• 
  Some induce endocrinologic changes
  

• 
  Estrogens or androgens may be elaborated
  
• 
  Only infrequently in sufficient quantity to cause precocious masculinization or feminization.
  
• 
  As with Leydig cell tumors - gynecomastia may appear
  

Sertoli Cell Tumors (Androblastoma) - Morphology

• 
  Appear as firm, small nodules with a homogeneous gray-white to yellow cut surface.
  

Histologically:

• 
  Tumor cells arranged in distinctive trabeculae
  
• 
  Tendency to form cord-like structures resembling immature seminiferous tubules
  
• 
  Majority of Sertoli cell tumors are benign
  

Testicular Lymphoma

• 
  Lymphomas account for 5% of testicular neoplasms
  
• 
  Most common form of testicular cancer in men over the age of 60.
  
• 
  In most cases, disseminated disease is already present at the time of detection of the testicular mass
  

• 
  Only rarely does it remain confined to the testis
  

• 
  Histologic type in almost all cases is the diffuse large cell lymphoma
  
• 
  The prognosis is extremely poor.