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Presented by Dr. Matoso and prepared by J. Stephen Nix.
32 yo male with testicular tumor
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Question 1 of 1
1. Question
32 yo male with testicular tumor.
Correct
Correct D
Histology:
The tumor is composed of a mixed population of small blue cells with marked nuclear atypia and fibrillary background and an epithelial component forming glandular spaces. There is necrosis and nuclear pseudopallisading in areas within the small blue cell component.
Discussion:
Neoplastic neuroglial differentiation outside of the central nervous system is rare and has been reported mainly in association with teratomas, the great majority of them ovarian or gynecologic in origin. In men, testicular tumors with neuroglial neoplasms are extremely rare. neuroglial differentiation and neoplasms are rare in testicular germ cell tumors and are most commonly associated with teratomas; they can be seen in primary and metastatic sites. They exhibit the full range of neuroglial differentiation including developing CNS to gliomas/glioneuronal tumors WHO grades I-IV. None of the cases showed results consistent with ATRX, IDH or BRAF alterations, suggesting they have different oncogenic mechanisms than their CNS counterparts. This case was diagnosed as glioblastoma (WHO grade IV) arising in a teratoma based on the presence of marked nuclear pleomorphism, foci of necrosis, and positive immunostaining for GFAP and OLIG2.
References:
- Matoso A, Idrees MT, Rodriguez FJ, Ibrahim J, Perrino CM, Ulbright TM, Epstein JI. Neuroglial Differentiation and Neoplasms in Testicular Germ Cell Tumors Lack Immunohistochemical Evidence of Alterations Characteristic of Their CNS Counterparts: A Study of 13 Cases. Am J Surg Pathol. 2018.
- Sangruchi T, Sobel RA. Microglial and neural differentiation in human teratomas. Acta Neuropathol. 1989;78:258-263.
Incorrect
Correct D
Histology:
The tumor is composed of a mixed population of small blue cells with marked nuclear atypia and fibrillary background and an epithelial component forming glandular spaces. There is necrosis and nuclear pseudopallisading in areas within the small blue cell component.
Discussion:
Neoplastic neuroglial differentiation outside of the central nervous system is rare and has been reported mainly in association with teratomas, the great majority of them ovarian or gynecologic in origin. In men, testicular tumors with neuroglial neoplasms are extremely rare. neuroglial differentiation and neoplasms are rare in testicular germ cell tumors and are most commonly associated with teratomas; they can be seen in primary and metastatic sites. They exhibit the full range of neuroglial differentiation including developing CNS to gliomas/glioneuronal tumors WHO grades I-IV. None of the cases showed results consistent with ATRX, IDH or BRAF alterations, suggesting they have different oncogenic mechanisms than their CNS counterparts. This case was diagnosed as glioblastoma (WHO grade IV) arising in a teratoma based on the presence of marked nuclear pleomorphism, foci of necrosis, and positive immunostaining for GFAP and OLIG2.
References:
- Matoso A, Idrees MT, Rodriguez FJ, Ibrahim J, Perrino CM, Ulbright TM, Epstein JI. Neuroglial Differentiation and Neoplasms in Testicular Germ Cell Tumors Lack Immunohistochemical Evidence of Alterations Characteristic of Their CNS Counterparts: A Study of 13 Cases. Am J Surg Pathol. 2018.
- Sangruchi T, Sobel RA. Microglial and neural differentiation in human teratomas. Acta Neuropathol. 1989;78:258-263.
