Testicular Tumours

Testicular TumorsDr.HaleemullahH.O

Introduction

Testicular tumors are rare.

1 2 % of all malignant tumors.

Most common malignancy in men in the 15 to 35 year age group.

Benign lesions represent a greater percentage of cases in children than in adults.

Most curable solid neoplasm

Age - 3 peaks 2 4 yrs 20 40 yrs above 60 yrs

Testicular cancer is one of the few neoplasms associated with accurate serum markers.

Most curable solid neoplasms and serves as a paradigm for the multimodal treatment of malignancies.

AETIOLOGY OF TESTICULAR TUMOURCryptorchidism Klinefelters syndromeTesticular atrophyTraumaSex hormone fluctuations, estrogen administration during pregnancyRace Carcinoma in situPrevious testicular cancer

CRYPTORCHIDISM & TESTICULAR TUMOURRisk of Carcinoma developing in undescended testis is

14 to 48 times the normal expected incidence

CLASSIFICATION I.Primary Neoplasms of Testis. A.Germ Cell Tumor. B.Non-Germ Cell Tumor .

II. Secondary Neoplasms.

III .Paratesticular Tumors.

Germ cell tumors1. Seminomas - 40% (a) Classic Typical Seminoma (b) Anaplastic Seminoma (c) Spermatocytic Seminoma

2. Embryonal Carcinoma - 20 - 25%

3. Teratoma - 25 - 35% (a) Mature (b) Immature

4. Choriocarcinoma - 1%

5. Yolk Sac Tumour

Non Germ Cell Tumors

1.Specialized gonadal stromal tumor(a)Leydig cell tumor(b)sertoli cell tumor 2. Gonadoblastoma

3.Miscellaneous Neoplasms(a)Carcinoid tumor (b) Tumors of ovarian epithelial sub types

SeminomaThe commonest variety of testicular tumourAdults are the usual target (4th and 5th decade); never seen in infancyRight > Left TestisStarts in the mediastinum: compresses the surrounding structure.Patients present with painless testicular mass 30 % have metastases at presentation, but only 3% have symptoms related to metastases

Seminoma

Cut potato appearance

Embryonal carcinoma25yr 35yr3 6 % of TTSmall, rounded irregulr massInvading tunica vaginalisCut surfaceGreyish white, fleshyAreas of necrosis, hemorrhagePoorly defined capsule

ChoriocarcinomaA rare and aggressive tumour (5yrs survival is 5%)Typically elevated hCGPresents with disseminated diseaseMetastasis to lungs and brainPrimary is very small and often exhibit NO TESTICULAR ENLARGEMENTSmall palpable nodule may be present.Prone to hemorrhage, sometimes spontaneous (lungs and brain)

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TeratomaChildren 38% - benignAdults 3% - metastatic potentialAFP - 20% 25%MetastasisResistent both Chemo, RadiationMature TeratomaDifferentiated elements form 2 or more embryonic germ cell layersectoderm, endoderm & mesodermImmature TeratomaUndifferentiated primitive tissuesMalignant TeratomaMalignant changes

TeratomaMore than one germ cell layer in various stages of maturation & differentiationLarge, lobulated, non-homogenousCut surfaceVariably sized cystsGelatinous, mucinous, hyalinized materialIntersposed solid islands cartilage/ bone/pancreatic/ liver/ intesttinal/ muscle/ neural/ connective tissue

Immature Teratoma Areas of fibrosis & hemorrhage

Mature Teratoma

Yolk sac tumorMost common Infants & childrenAdults in combination AFPPure formHomogenous yellowish, mucinousHistologyEmbryoid bodiesResemble 1 to 2 week old embryos (