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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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