Stem 2 A 69-year-old male presented with 1 month history of bilateral groin lumps. O/E firm non-tender lumps with grey scales. Doppler ultrasound findings include diffuse testicular infiltration, enlargement with hypervascularity, or multifocal areas of hypoechoic, solid and hypervascular nodules within testes. Orchidectomy was done & testicles were found to be white tan pink & fleshy. Pathology report: Malignant cells are pleomorphic and non-cohesive, with large irregular nuclei and prominent nucleoli. There is vascular invasion and sclerosis of seminiferous tubules. No intratubular germ cell neoplasia. The neoplastic cells typically express CD20 In light of the pathology report given, what's the diagnosis? SpoilerLymphoma Talk about classification of testicular tumours & give an example for each? Germ Cell Tumour SpoilerSeminoma: classic, spermatocytic, anaplastic. Teratoma Choriocarcinoma Yolk sac Non-germ cell tumour SpoilerSex cord stromal:Non-seminoma: Leydig cell tumour Sertoli cell Others: metastasis and lymphoma Describe the microscopic morphology of testicular teratoma vs seminoma? Seminoma SpoilerSheet-like cord of cells separated by fibrous septa that contain lymphocytes. Large, prominent nucleoli Teratoma !Composed of various types of cells or organs component He presents with PE a year later & is found to have large mass at the region of para-aortic LNs compressing renal vessels. Debulking surgery done, but tumour can't be totally resected. Frozen section showed thyroid tissue. Why? SpoilerTeratoma has the 3 germ cell lines (mesoderm, endoderm, ectoderm) which can differentiate to any of its derivatives Whats name for a monodermal thyroid-predominant teratoma specifically in the ovary SpoilerIt is called struma ovarii Explain findings in adenocarcinoma SpoilerFailure of differentiation and subsequent malignant transformation of epithelial differentiation line. What's the composition of PE? SpoilerPlatelets Polymerized fibrin Admixed circulatory cells Which clotting factor allowing polymerization of fibrin? SpoilerActivated factor 8 Explain coagulation cascade Intrinsic Pathway SpoilerTrigger: Internal damage to the blood vessel wall (e.g. plaque rupture). Initiation: Exposure of negatively charged surfaces, such as collagen, activates factor XII (Hageman factor).Initiation: Cascade: A series of reactions involving factors XII, XI, IX, VIII, and X. Extrinsic Pathway SpoilerTrigger: External trauma causing tissue injury Initiation: Tissue factor (TF) is released from damaged cells, which activates factor VII Cascade: Cascade: Activated factor VII (VIIa) activates factor X. Activated factor X (Xa) joins the common pathway Common Pathway Convergence: Both the intrinsic and extrinsic pathways converge at the activation of factor X. Thrombin Formation: Factor Xa, along with factor V, calcium, and phospholipids, activates prothrombin to form thrombin. Fibrin Formation: Thrombin converts fibrinogen into fibrin, which forms a mesh-like structure that traps platelets and blood cells, forming a blood clot What is the cause of PE in this patient? Explain SpoilerVenous stasis (compression) Hypercoagulable state (tumour) Where could a β-hCG found in a normal male? SpoilerSeminal plasma