INSTRUCTORS ONLY

Repro Path Lab 2

GONADAL PATH LAB:
Ovarian and Testicular Pathology

Ovary

Gross Photo
[WebScope] [ImageScope]

Case History:
18-year-old with an adnexal mass noted on her first pelvic examination. She relates no symptoms.

1. This section IS from the ovary, but may bear no histologic resemblance to "normal" ovarian histology. What is this entity?

2. Ectoderm, mesoderm, endoderm: try to identify examples of each.

Ovary

Gross Photo
[WebScope] [ImageScope]

Case History:
30-year-old with a protuberant abdomen and 50 pound weight gain over two years. A large, smooth-walled, multiloculated ovarian cyst is removed, filled with mucoid material.

1. What is the histologic type of this epithelial neoplasm?

2. Is it benign, LMP (borderline), or malignant? Justify your designation.

Ovary

Gross Photo
[WebScope] [ImageScope]

Case History:
A 52-year-old presents with an elevated CA-125. On physical exam she has ascites and a pelvic-abdominal mass.

1. The histology of the ovary on the slide is representative of the histology seen in multiple implants throughout the abdominal cavity and omentum. Very classic papillary serous morphology with micropapillary architecture, infiltrative growth, and a wide range of atypical cytological features. No other disease is noted outside the abdominal cavity.
   
   What is your diagnosis?

2. What is the surgical stage, based upon the description above?

3. What other conditions/entities can cause elevation of CA-125?

Ovary

Gross Photo
[WebScope] [ImageScope]

Case History:
50-year-old with an endometrial biopsy demonstrating hyperplasia. A hysterectomy was performed and an incidental enlargement of the left ovary was noted. Cut section revealed a solid-yellow tumor with areas of hemorrhage. (See [WebScope] [ImageScope] from Uterine Lab.)

1. What is the ovarian cell-line from which this neoplasm arose?

2. What is the diagnosis? Are there any characteristic "microscopic keys" with which this tumor is associated?

3. Why does the patient have endometrial hyperplasia?

4. Name some other ovarian functioning tumors.

Ovary

[WebScope] [ImageScope]

Case History:
18-year-old with abdominal pain. A solid pelvic mass is noted on sonography. Serum AFP is elevated. Serum ß-hCG is negative. CA-125 is slightly elevated. A unilateral ovarian mass is noted at surgery with no evidence of extra-ovarian pathology. The tumor is 15cm, solid with hemorrhage.

1. What is the ovarian cell-line from which this neoplasm arose?

2. What is this patient's diagnosis?

3. Can you find a Schiller-Duval body?

4. Make a table of the germ cell tumors seen in the ovary and testis along with their associated tumor markers.

Testis

[WebScope] [ImageScope]

Normal Testis:
From the tunica propria of seminiferous tubules to the lumen, one sees spermatogenic cells in the following order:

1. Spermatogonia (small dark nucleus)
2. Primary spermatocyte (largest cell in series)
3. Secondary spermatocyte (relatively transient cell)
4. Spermatids
5. Spermatozoa

Sertoli cells are difficult to identify in tubules with normal spermatogenesis, which tends to obscure them.

Interstitial cells (Leydig cells) possess eosinophilic cytoplasm and are located between tubules.

Testis

Ovary

Dysgerminoma[WebScope] [ImageScope] (view in comparison with below)

[WebScope] [ImageScope];

Case History:
40-year-old man noted swelling and tenderness of his right testicle for several months prior to orchiectomy.

1. What is this patient's diagnosis?

2. What is the ovarian tumor which is histologically similar to this tumor?

3. Ovarian and Testicular Germ cell tumors have similar histologic counterparts as they all arise from the undifferentiated germ cell. What are some of the key differences between ovarian & testicular germ cell tumors?

Testis

[WebScope] [ImageScope]

Case History:
This patient had received radiation and cytotoxic drug therapy for a systemic neoplasm. The analysis of his semen revealed azospermia.

Also called the "Sertoli cell only" syndrome because all or most of the spermatogonia are absent, this represents germinal aplasia of the testis. There is no evidence of maturation of germ cells. The decrease in number of germ cells has unmasked the Sertoli cells which are the most prominent cells in the tubules. The tubular tunic propria is not significantly thickened.

1. Is this a reversible form of infertility?

The answers to the path lab questions will be posted approximately 48-72 hours after the lab sessions. These are abbreviated answers, not a full discussion of the topics. You can find them in the M2 CTools site resources. In the folder for each sequence the will be a folder called 'Path Lab Resources'