CLINICAL PATHOLOGYThe foundation of clinical medicine.

Shashidhar Venkatesh MurthyA/Prof & Head of Pathology

College of Medicine & Dentistry

MGS4: Male Genital: Testes Tumors

CPC : Term4 Week4 - MGS 4/6System : Male Genital System.Topic : 1: Overview 2: STD 3: Orchitis 4: Tumours 5: Penis 6: GLS

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Testes Tumors: Features: Commonest tumour of young males, painless swelling. Etiology: Idiopathic, Undescended testes (10%, 10 times) Classification:

95% Germ cell Tumours, Seminoma 45% - good prognosis. Non seminoma (NSGT) 45% - poor prognosis.

Embryonal ca, Teratoma, Chriocarcinoma, Mixed - common

5% Sertoli / Leydig cell tumours. Clinical features:

Adults 20-40y – Seminoma. Children <10y – NSGT- Yolksac tum. Painless, dragging, unilateral, solid. Metastases – Para aortic LN*.

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Seminoma: Commonest Germ cell tumour, 20-40y. Firm, grey, smooth, painless, Many subtypes: classical*, spermatocytic etc.. Microscopy: uniform clear cells + lymphocytes. Mixed seminoma Seminoma + Teratoma, embryonal carcinoma or

choriocarcinoma (βhCG 10%). Etc.

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Seminoma Testes:

Lymphocytes

Clear cells

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Seminoma Testes:

Lymphocytes

Clear tumour cells

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NSGT: Embryonal Ca Clinical: painless swelling, hemorrhagic,

malignant, poor prognosis, metastases. Germ cell tumor – embryonic cells. Gross: Hemorrhagic, necrotic tumor. Adults: Embryonal Ca. Children: Yolksac tumor. Tumor Marker: AFP (α feto protein) Microscopy: Pleomorphic cells, embryoid

structures. Pink AFP globules in cells.

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NSGT: Teratoma / Teratocarcinoma

> 1 tissue type (mature / immature) Teratoma + other germ cell tum (Embryonal ca) Common, 10-30y, aggressive, poor prognosis. Both βhCG & AFP +ve - if mixed.

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Testes Tumors: summary Germ cell Tumours (95%)

Gonadal: SeminomaNon Seminoma Germ Cell tum (NSGT) Embryonic: Embryonal ca. Extraembryonic: Yolk sac tum, Choriocarcinoma. Somatic: Teratoma Mixed: (40%)

Tumor – Incidence Age Tumor MarkerSeminoma 50% 40-50y 10% βhCG

Embryonal ca. 20-30y Negative (pure)

Yolk sac tumour < 3y 90% AFP

Choriocarcinoma 20-30y 100% βhCG

Teratoma (Pure) All ages Negative

Mixed 15% 15-30y 90% βhCG & AFP