testicular neoplasm
TRANSCRIPT
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8/13/2019 Testicular Neoplasm
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TESTICULAR NEOPLASM
Most important cause of firm, painless enlargement of the testis.
5/100 000 males.
20-34 yrs old.
95% arise from germ cells.
Cause- unknown.
Cryptorchidism a/w 3-5x increase of risk of cancer. (10% of thecancer case)
Intersex syndrome increase risk.
More common in white.
MORPHOLOGY
Seminomas
(Classic seminomas)
Large, soft, well-demarcated, usually homogeneous,gray-white
tumour
Microscopically:
Large + uniform cells distanct cell borders clear, glycogen-rich cytoplasm round nuclei with conspicuous nucleoliSpermatocytic seminomas
A mixture of medium-sized cells, large uninucleate or
multinucleate tumour cells, and small cells with round nuclei
Embyronal carcinomas
Ill-defined, invasive masses The constituent cells are large and primitive looking, with
basophilic cytoplasm, indistinct cell borders, and large
nuclei with prominent nucleoli
Yolk sac tumours
Often large and may be well demarcated Low cuboidal to columnar epithelial cells forming
microcyst, sheets, glands, and papillae, often associated
with eosinophilic hyaline globules
Schiller-Duvall bodiesChoriocarcinomas
Small, nonpalpable lesions Sheets of small cuboidal cells irregularly intermingled with
or capped by large, eosinophilic syncytial cells
Teratomas
Masses that on cut surface often contain cysts andrecognizable areas of cartilage
Mature teratomas- fully differentiated tissues Immature teratomas- immature somatic elementsMixed germ cell tumours
40% of all testicular germ cell neoplasms Combinations of the any of the described patterns Most common-combination of teratoma, embryonal
carcinoma, and yolk sac tumours
Classification testicular germ cell tumors:
Tumours w 1 histologic pattern
Seminoma
Non-seminomatous
Embryonal carcinoma Yolk sac tumour Choriocarcinoma Teratomas
Mature Immature With malignant transformation ofsomatic elements
Tumours w multiple histologic pattern
CLINICAL FEATURES
Seminomas Non-seminomatous germ cell
noeplasm
Often remain confinedto the testis for
prolonged intervals
Metastases- iliac +para-aortic lymph
nodes (upper lumbar
region)
Hematogenous spreadoccur later
Metastasize ealier :
haematogenous + lymphatic
(lung +liver)
Painless enlargement of testis
STAGING
Stage I: tumour confined to the testis
Stage II: regional lymph node metastases only
Stage III: nonregional lymph node and/or distant organ metastases
SPECIAL FEATURES
Assay of tumour markers:- secreted by tumor cell
- important for clinical evaluation + staging
hCG- produced by: synthiotropoblastic- always in choriocarcinoma + seminoma (xde
cytotropoblastic)
AFP:- is a glycoprotein synthesized by fetal yolk sac
-indicate for the present of nonseminomatous
- bcoz yolk sac x found in pure seminomas
TREATMENT
Chemotherapy
Tx determine by:
-Histologic pattern
-The stage of disease at the time of diagnosis
Seminoma:
-radiosensitive
-respond well to chemotherapy
Non seminomatous tumour:
-platinum-based chemotherapy regimens.
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