Neoplasia of Testes and Scrotal Mass

Question 1

most common malignancy in med age 15-34

Answer 1

testicular germ cell tumors

• incidence per 100,000 is 1.5
• the germ cell mutation growth starts in intra-uterine life.

Question 2

for testicular germ cell tumors (the most common malig in med age 15-34), what stage are often caught?

Answer 2

majority presents with stage 1 where they are confined to the testes, often cured by orchiectomy alone.

SOME will relapse

Question 3

risk factors for testicular germ cell tumors

Answer 3

– undesended testis

• testicular feminization
• family hisotry of testicular cancer
• in utero exposure to exogensou esterogens
• maternal exposure to DES

Question 4

clinical presentation and diagnosis of testicular germ tumor

Answer 4

• usually painless swelling or testicular nodules
• back pain (retroperitoneal metastasis), hemoptysis (lung metastasis)

DX: US, CT abdo and chest, MRI

• serum tumor markers (AFP, betaHCG, LDH)

Question 5

t/f we can screen young males for testicular germ tumors

Answer 5

false. no reliable screening tests

Question 6

Answer 6

Question 7

components of resection during a gross radical orchiectomy

Answer 7

Question 8

Serum Tumor Markers
for testicular cancer (germ cell tumors

Answer 8

) Unknown
 Normal limits
 Alpha-fetoprotein (AFP) elevation
 Beta-subunit of human chorionic gonadotropin (b-hCG)
elevation  Lactate dehydrogenase (LDH) elevation

Question 9

note: testicular germ cell tumors can be a seminoma vs a non seminomatous GCT.
- many are mixed

Question 10

Which tumor markers allow you to differentiate between seminoma and non seminoma GCT? Other tests?

Answer 10

seminomas LACK AFP and hCG elevations

- seminomas more likely to present in mean age 40 years, well cirucmscribed, solid and uniform tumor. Can be unilobated or multilovated.

non-semonimatous GCT can be embryonal, teratoma, yolk sac tumor, or choriocarcionma, and most are mixed of all these tissues. THEY WILL HAVE AFP and HCG ELEvATIONs

SEMINOMAS ARE RESPONSIVE TO RADIATION– if the patient is not receptive to radiation, it might be a non-seminoma

Question 11

for seminomas what predicts relapse in clinical stage 1?

Answer 11

1. tumor size >4cm
2. rete testis invasion

Question 12

Nonseminomatous Germ Cell Tumors Prognosis

Answer 12

• cure rate is 90% at all stages– 1/3 of NSGCT present with metastatic disease
• prognosis generally depends on extent of serum markers elecation, and older age is a worse prognosis.

Question 13

non seminomatous germ cell tumors gross appearance key findigns

Answer 13

a bit more necrotic looking.

Question 14

recall that non seminomatous germ cell tumors have different subtypes, but most are miced. what is the most ocmmon component in NSGCT?

Answer 14

embryoal carcinoma.

higher risk of relapse if predominant components.

In mixed GCT, yolk sac tumor in a stage I tumor may
convey better prognosis

Question 16

type of non-seminomatous germ cell tumor that presents with metastatic disase and marked elevation of HCG

Answer 16

choriocarcinoma.