4. Testicular Tumours Flashcards
(123 cards)
1
Q
Incidence of Testicular Tumours
A
- Practically 99% of testicular neoplasms are malignant
* They constitute 1-2% of malignant tumours in males
2
Q
Age of Testicular Tumours
A
Occur at a relatively young age.
3
Q
Side of Testicular Tumours
A
Bilateral in 3-5% of cases
4
Q
ETIOLOGY of Testicular Tumours
A
- Incompletely descended testes, especially the intra-abdominal variety.
- Klinefelter’s syndrome
- An isochromosome 12p is present in about 80 % of the testicular cancers.
5
Q
Meaning of isochromosome 12p in ETIOLOGY of Testicular Tumours
A
The short arm of chromosome 12 on both sides of
the centromere
An isochromosome is a chromosome that has lost one of its arms and replaced it with an exact copy of the other arm
6
Q
CLASSIFICATION of Testicular Tumours
A
- Germ cell tumours 86%
- Interstitial tumours (rare). 1.5%
- Lymphoma (Extra nodal) 7%
- Other tumours 5.5 %
7
Q
Germ cell tumours in CLASSIFICATION of Testicular Tumours
A
- Seminoma 40%
- Teratoma 32%
- Combined seminoma and teratoma 14%
8
Q
Alternative name for Teratoma in Germ cell tumours in CLASSIFICATION of Testicular Tumours
A
Non seminomatous Germ Cell Tumors “NSGCT”
9
Q
Pathology of Testicular Tumours
A
- Germ cell tumours 86%
* Interstitial tumours (rare). 1.5%
10
Q
Germ cell tumours Pathology of Testicular Tumours
A
- Seminoma
2. Teratoma
11
Q
Seminoma in Germ cell tumours Pathology of Testicular Tumours
A
- Age
- CeII of origin
- Macroscopic Picture
- Cut Section
- Microscopic Picture
- Spread
12
Q
Age in Seminoma in Germ cell tumours Pathology of Testicular Tumours
A
35-45 years of age.
13
Q
CeII of origin of Seminoma in Germ cell tumours Pathology of Testicular Tumours
A
Seminiferous tubules
14
Q
Macroscopic Picture of Seminoma in Germ cell tumours Pathology of Testicular Tumours
A
شبه البطاطس لما تتحمر
* Moderate to large
- firm and smooth
- sometimes it is lobulated
15
Q
The reason why the tumour is sometimes lobulated in Macroscopic Picture of Seminoma in Germ cell tumours Pathology of Testicular Tumours
A
due to the presence of fibrous septa
16
Q
Cut Section of Seminoma in Germ cell tumours Pathology of Testicular Tumours
A
- homogenous
* pink creamy in colour.
17
Q
Microscopic Picture of Seminoma in Germ cell tumours Pathology of Testicular Tumours
A
- Cells resemble spermatocytes (rounded or oval with clear cytoplasm & large rounded nuclei).
- Lymphocytic infiltration of the tumour.
18
Q
Significance of Lymphocytic infiltration of the tumour in Microscopic Picture of Seminoma in Germ cell tumours Pathology of Testicular Tumours
A
Indicates good immunity and good Localization
19
Q
Spread of Seminoma in Germ cell tumours Pathology of Testicular Tumours
A
Lymphatics to the para-aortic and iliac L.Ns.
20
Q
Teratoma in Germ cell tumours Pathology of Testicular Tumours
A
- Age
- CeII of origin
- Macroscopic Picture
- Cut Section
- Microscopic Picture
- Spread
21
Q
Age in Teratoma in Germ cell tumours Pathology of Testicular Tumours
A
20-35 years of age
22
Q
CeII of origin of Teratoma in Germ cell tumours Pathology of Testicular Tumours
A
Embryonic totipotent cells in the rete testes
23
Q
Meaning of Embryonic totipotent cells
A
Can give rise to Endo ecto mesoderm
24
Q
Macroscopic Picture of Teratoma in Germ cell tumours Pathology of Testicular Tumours
A
- Variable size.
* always having a smooth surface
25
The reason why the tumour is always having a smooth surface in Macroscopic Picture of Teratoma in Germ cell tumours Pathology of Testicular Tumours
Usually molded by the tunica albuginea so always having a smooth surface
26
Cut section of Teratoma in Germ cell tumours Pathology of Testicular Tumours
* Heterogenous
* yellowish in colour
* showing cysts that contain gelatinous material & cartilage nodules.
27
Microscopic Picture of Teratoma in Germ cell tumours Pathology of Testicular Tumours
Teratomas are subdivided into 5 subtypes based on histopathologic characteristics:
1. Differentiated teratoma
2. Malignant teratoma intermediate "MTl"
3. Malignant teratoma anaplastica "MTA"
4. Malignant teratoma trophoplastica 'MTT"
5. Endodermal sinus tumour "EST"
28
Meaning of histopathologic characteristics in Microscopic Picture of Teratoma in Germ cell tumours Pathology of Testicular Tumours
Degree of differentiation
29
Prognosis of Differentiated teratoma in Microscopic Picture of Teratoma in Germ cell tumours Pathology of Testicular Tumours
Good
30
Alternative name for Malignant teratoma intermediate in Microscopic Picture of Teratoma in Germ cell tumours Pathology of Testicular Tumours
Teratocarcinoma.
31
Malignant teratoma anaplastica in Microscopic Picture of Teratoma in Germ cell tumours Pathology of Testicular Tumours
* Alternative name
| * Behavior and prognosis
32
Alternative name for Malignant teratoma anaplastica in Microscopic Picture of Teratoma in Germ cell tumours Pathology of Testicular Tumours
Embryonal carcinoma
33
Behavior and prognosis of Malignant teratoma anaplastica in Microscopic Picture of Teratoma in Germ cell tumours Pathology of Testicular Tumours
It a highly malignant tumour with very bad prognosis
34
Malignant teratoma trophoplastica in Microscopic Picture of Teratoma in Germ cell tumours Pathology of Testicular Tumours
* Alternative name
* Meaning of Trophoblastica
* Incidence
* Behavior
* Pathogenesis
35
Alternative name for Malignant teratoma trophoplastica in Microscopic Picture of Teratoma in Germ cell tumours Pathology of Testicular Tumours
choriocarcinoma
36
Meaning of Trophoblastica in Malignant teratoma trophoplastica in Microscopic Picture of Teratoma in Germ cell tumours Pathology of Testicular Tumours
Similar to placenta
37
Incidence of Malignant teratoma trophoplastica in Microscopic Picture of Teratoma in Germ cell tumours Pathology of Testicular Tumours
rare
38
Behavior of Malignant teratoma trophoplastica in Microscopic Picture of Teratoma in Germ cell tumours Pathology of Testicular Tumours
It is the most aggressive malignant tumour known
39
Pathogenesis of Malignant teratoma trophoplastica in Microscopic Picture of Teratoma in Germ cell tumours Pathology of Testicular Tumours
Cytotrophoblast and syncytiotrophoblast without villus formation.
40
Endodermal sinus tumour in Microscopic Picture of Teratoma in Germ cell tumours Pathology of Testicular Tumours
* Alternative name
* Incidence
* Prognosis
41
Alternative names for Endodermal sinus tumour in Microscopic Picture of Teratoma in Germ cell tumours Pathology of Testicular Tumours
* Yolk sac tumour "YST"
| * Infantile embryonal carcinoma
42
Incidence of Endodermal sinus tumour in Microscopic Picture of Teratoma in Germ cell tumours Pathology of Testicular Tumours
It is the most common testicular tumor in infants under 3 and young boys
43
Prognosis of Endodermal sinus tumour in Microscopic Picture of Teratoma in Germ cell tumours Pathology of Testicular Tumours
Excellent prognosis
44
Spread of Teratoma in Germ cell tumours Pathology of Testicular Tumours
Blood spread mainly to the lungs & liver.
45
Carcinomas spread by blood :
* FTC
* Teratoma
* Prostatic carcinoma
* Breast carcinoma
* Bronchogenic carcinoma
* Renal cell carcinoma
46
Interstitial cell tumours Pathology of Testicular Tumours
1. Leydig cell tumour
| 2. Sertoli cell tumour
47
Leydig cell tumour in Interstitial cell tumours Pathology of Testicular Tumours
* Age
| * Pathogenesis
48
Age of Leydig cell tumour in Interstitial cell tumours Pathology of Testicular Tumours
Usually occurs before puberty
49
Pathogenesis of Leydig cell tumour in Interstitial cell tumours Pathology of Testicular Tumours
* It produces excessive amounts of androgens
| * leading to infant Hercules
50
infant Hercules in Pathogenesis of Leydig cell tumour in Interstitial cell tumours Pathology of Testicular Tumours
sexual precocity and extreme muscular development due to excessive amounts of androgens produced by Leydig cell tumour
51
Sertoli cell tumour in Interstitial cell tumours Pathology of Testicular Tumours
* Age
* Pathogenesis
* Behavior
52
Age of Sertoli cell tumour in Interstitial cell tumours Pathology of Testicular Tumours
Occurs after puberty
53
Pathogenesis of Sertoli cell tumour in Interstitial cell tumours Pathology of Testicular Tumours
* It produces estrogens
| * leading to gynaecomastia, loss of libido & aspermia
54
Behavior of Sertoli cell tumour in Interstitial cell tumours Pathology of Testicular Tumours
The tumour is benign and orchiectomy cures.
55
CLINICAL PICTURE OF Testicular Tumours
* Typical presentation
| * Atypical presentation
56
Typical presentation in CLINICAL PICTURE OF Testicular Tumours
* Symptoms
| * Examination
57
Symptoms in Typical presentation in CLINICAL PICTURE OF Testicular Tumours
1. Painless enlargement of the testis.
2. Sense of heaviness
3. History of trauma
58
Sense of heaviness in Symptoms in Typical presentation in CLINICAL PICTURE OF Testicular Tumours
occur when the testes reaches 2-3 times its normal size.
59
History of trauma in Symptoms in Typical presentation in CLINICAL PICTURE OF Testicular Tumours
In 10% of cases the patient gives history of trauma that merely attracts his attention to the presence of a swelling
60
Examination in Typical presentation in CLINICAL PICTURE OF Testicular Tumours
1. The testis
2. The epididymis
3. Secondary hydrocele
4. The para-aortic lymph nodes
5. The inguinal lymph nodes
61
The testis Examination in Typical presentation in CLINICAL PICTURE OF Testicular Tumours
* Enlarged, hard, smooth and heavy, later, soft protuberances appear.
* Testicular sensation is lost early in the course of the disease.
62
The epididymis Examination in Typical presentation in CLINICAL PICTURE OF Testicular Tumours
وهم
* at first it is normal.
* Later on there is obliteration of the epididymal sinus.
* Then it becomes infiltrated with the tumour
63
Secondary hydrocele in Examination in Typical presentation in CLINICAL PICTURE OF Testicular Tumours
* Lax secondary hydrocele is present in 10% of cases
| * Just rim of fluid in tunica vaginalis
64
The para-aortic lymph nodes Examination in Typical presentation in CLINICAL PICTURE OF Testicular Tumours
May be palpable just above the umbilicus
65
The inguinal lymph nodes Examination in Typical presentation in CLINICAL PICTURE OF Testicular Tumours
Are not affected unless the scrotal skin is infiltrated
66
Atypical presentation in CLINICAL PICTURE OF Testicular Tumours
1. Occult presentation
2. An abdominal mass with an empty scrotal compartment
3. Hormonal effects
4. Hurricane type
5. Simulation of acute epididymo-orchitis
6. Acute hydrocele.
67
Occult presentation in Atypical presentation in CLINICAL PICTURE OF Testicular Tumours
* Meaning of occult
* Cough, dyspnea and haemoptysis with Teratoma
* Enlarged supraclavicular L.N, particularly on the left side with Seminoma
68
Meaning of occult in Occult presentation in Atypical presentation in CLINICAL PICTURE OF Testicular Tumours
Silent presentation in local organ but spread to distant organs
69
The reason why left supraclavicular LN++ is indicative of abdominal malignancy
Para aortic drain to cisterna chyli then to thoracic duct
Due to obstruction of drainage of thoracic duct to left innominate vein by malignant cells then flow is reversed so malignant cells reach left supraclavicular
So left supraclavicular LN++ is indicative of abdominal malignancy
70
An abdominal mass with an empty scrotal compartment in Atypical presentation in CLINICAL PICTURE OF Testicular Tumours
Should raise the suspicion of malignant transformation in an abdominal undescended testis.
71
Hormonal effects in Atypical presentation in CLINICAL PICTURE OF Testicular Tumours
* Infant Hercules with Leydig cell tumours
| * Gynaecomastia with Sertoli cell tumours
72
Hurricane type in Atypical presentation in CLINICAL PICTURE OF Testicular Tumours
Fatal termination occurs due to metastases from highly malignant tumours
73
highly malignant tumours in Hurricane type in Atypical presentation in CLINICAL PICTURE OF Testicular Tumours
* Malignant Teratoma Trophoplastica (Choriocarcinoma)
| * Malignant Teratoma Anaplastica "MTA"
74
Simulation of acute epididymo-orchitis in Atypical presentation in CLINICAL PICTURE OF Testicular Tumours
Acute pain and swelling are due to haemorrhage in the tumour
75
Pathogenesis of Acute hydrocele in Atypical presentation in CLINICAL PICTURE OF Testicular Tumours
Due to transudation
76
Differential Diagnosis of Testicular Tumours
1. Old clotted haematocele.
| 2. Calcified hydrocele
77
Staging of Testicular Tumours
Stage I
Stage ll
Stage lll
Stage lV
78
Stage I in Staging of Testicular Tumours
Tumour in the testis only.
79
Stage ll in Staging of Testicular Tumours
involvement of lymph nodes below the diaphragm.
80
Stage lll in Staging of Testicular Tumours
Involvement of lymph nodes above the diaphragm
81
Stage lV in Staging of Testicular Tumours
Systemic metastases mainly pulmonary & hepatic metastases
82
Investigations of Testicular Tumours
(A) Diagnostic Investigations for 1ry lesion
(B) Investigations for secondaries
83
Diagnostic Investigations for 1ry lesion in Investigations of Testicular Tumours
1. Scrotal ultrasound :
2. Frozen section biopsy via inguinal approach
3. Tumour markers
84
Benefits of Scrotal ultrasound in Diagnostic Investigations for 1ry lesion in Investigations of Testicular Tumours
* Confirms the presence of the testicular tumour
| * Differentiates it from other lesions.
85
Frozen section biopsy via inguinal approach in Diagnostic Investigations for 1ry lesion in Investigations of Testicular Tumours
* Alternative name
* Cautions
* Procedures
86
Alternative name for Frozen section biopsy via inguinal approach in Diagnostic Investigations for 1ry lesion in Investigations of Testicular Tumours
Chevassu technique
87
Cautions in Frozen section biopsy via inguinal approach in Diagnostic Investigations for 1ry lesion in Investigations of Testicular Tumours
Biopsy should never be taken through the scrotum neither by incision nor by needle aspiration
88
The reason why Biopsy should never be taken through the scrotum neither by incision nor by needle aspiration in Cautions in Frozen section biopsy via inguinal approach in Diagnostic Investigations for 1ry lesion in Investigations of Testicular Tumours
as this will lead to local implantation with subsequent involvement of the inguinal L.N.
89
Procedures of Frozen section biopsy via inguinal approach in Diagnostic Investigations for 1ry lesion in Investigations of Testicular Tumours
a. Through an inguinal incision the spermatic cord is identified and isolated at the internal inguinal ring.
b. A vascular clamp is applied as high as possible on the spermatic cord
c. The testis split opened & any doubtful lesion is subjected to frozen biopsy
90
The reason why A vascular clamp is applied as high as possible on the spermatic cord in Procedures of Frozen section biopsy via inguinal approach in Diagnostic Investigations for 1ry lesion in Investigations of Testicular Tumours
to avoid the risk of blood dissemination while manipulating the tumour.
91
Tumour markers in Diagnostic Investigations for 1ry lesion in Investigations of Testicular Tumours
a. Beta fraction of human chorionic gonadotrophin (B- HCG)
b. Alpha fetoprotein (alpha - FP) :
c. Lactate dehydrogenase ( LDH ).
92
Beta fraction of human chorionic gonadotrophin in Tumour markers in Diagnostic Investigations for 1ry lesion in Investigations of Testicular Tumours
* Raised in 100% of patients with MTT.
| * Raised in 10% of patients with seminoma.
93
Alpha fetoprotein in Tumour markers in Diagnostic Investigations for 1ry lesion in Investigations of Testicular Tumours
Elevated in 75% of teratocarcinomas
94
Lactate dehydrogenase in Tumour markers in Diagnostic Investigations for 1ry lesion in Investigations of Testicular Tumours
Also tumour marker in :
* leukemia
* lymphoma
95
Investigations for secondaries in Investigations of Testicular Tumours
1. Chest X-ray & C.T scan chest.
2. CT scan abdomen
3. I.V.P : OLD
96
CT scan abdomen in Investigations for secondaries in Investigations of Testicular Tumours
For para-aortic lymph nodes and liver deposits"
97
I.V.P in Investigations for secondaries in Investigations of Testicular Tumours
* Detects the position of the kidneys to be shielded during radiotherapy.
* Detects the presence and extent of retroperitoneal metastases
98
TREATMENT of Testicular Tumours
* Plan of management
* Treatment of seminoma
* Treatment of Teratoma
99
Plan of management in TREATMENT of Testicular Tumours
1. Initial treatment is by high retrograde Inguinal orchiectomy.
2. Further management depends on the pathology and stage of the tumour.
100
Treatment of seminoma in TREATMENT of Testicular Tumours
* Plan of management
| * Stage by stage management
101
Plan of management in Treatment of seminoma in TREATMENT of Testicular Tumours
* Treat one stage ahead To achieve complete recovery As it is curable
* So we must be aggressive with the TTT
102
Stage by stage management in Treatment of seminoma in TREATMENT of Testicular Tumours
Stage I Treatment
Stage ll Treatment
Stage lll Treatment
Stage lV Treatment :
103
Stage I Treatment in Stage by stage management in Treatment of seminoma in TREATMENT of Testicular Tumours
* Radiotherapy to para-aortic lymph nodes and iliac lymph nodes
* in the form of inverted Y technique .
104
Stage ll Treatment in Stage by stage management in Treatment of seminoma in TREATMENT of Testicular Tumours
* Stage I Treatment
| * Radiotherapy is extended to the mediastinum and left supraclavicular L.N.
105
Stage lll Treatment in Stage by stage management in Treatment of seminoma in TREATMENT of Testicular Tumours
Radiotherapy & chemotherapy using cisplatinum
106
Stage lV Treatment in Stage by stage management in Treatment of seminoma in TREATMENT of Testicular Tumours
Mainly chemotherapy using cisplatinum with or without radiotherapy
107
Treatment of Teratoma in TREATMENT of Testicular Tumours
* Note about Teratoma
* Stage by stage management
* Retroperitoneal lymphadenectomy
108
Note about Teratoma in Treatment of Teratoma in TREATMENT of Testicular Tumours
The tumour is radio-resistant
109
Stage by stage management in Treatment of Teratoma in TREATMENT of Testicular Tumours
Stage I Treatment
Stage ll-lV Treatment
110
Stage I Treatment in Stage by stage management in Treatment of Teratoma in TREATMENT of Testicular Tumours
* Follow up by tumour markers
| * Repeated C.T scanning.
111
Stage ll-lV Treatment in Stage by stage management in Treatment of Teratoma in TREATMENT of Testicular Tumours
Chemotherapy using combination of :
* Cisplatinum
* methotrexate
* bleomycin
* vincristine
112
Significance of Cisplatinum in TREATMENT of Testicular Tumours
Perfect in germ cell tumours
113
Retroperitoneal lymphadenectomy in Treatment of Teratoma in TREATMENT of Testicular Tumours
* Indication
| * Disadvantage
114
Indication of Retroperitoneal lymphadenectomy in Treatment of Teratoma in TREATMENT of Testicular Tumours
sometimes needed in teratoma for residual LN
| after Chemotherapy
115
Disadvantage of Retroperitoneal lymphadenectomy in Treatment of Teratoma in TREATMENT of Testicular Tumours
Retrograde ejaculation occurs after this operation due to interruption of the sympathetic nerve supply to the bladder neck
116
Alternative name for bladder neck in Disadvantage of Retroperitoneal lymphadenectomy in Treatment of Teratoma in TREATMENT of Testicular Tumours
* Sphincter vesicae
| * Internal urethral sphincter
117
PROGNOSIS of Testicular Tumours
* Seminoma Prognosis
| * Teratoma Prognosis
118
Seminoma Prognosis in PROGNOSIS of Testicular Tumours
* Stage I & II Prognosis
| * Stage III & IV Prognosis
119
Stage I & II Prognosis in Seminoma Prognosis in PROGNOSIS of Testicular Tumours
5 years survival rate is 95%.
120
Stage III & IV Prognosis in Seminoma Prognosis in PROGNOSIS of Testicular Tumours
5 years survival rate is 75%.
121
Teratoma Prognosis in PROGNOSIS of Testicular Tumours
* Stage I & II Prognosis
| * Stage III & IV Prognosis
122
Stage I & II Prognosis in Teratoma Prognosis in PROGNOSIS of Testicular Tumours
5 years survival rate is 85%
123
Stage III & IV Prognosis in Teratoma Prognosis in PROGNOSIS of Testicular Tumours
5 years survival rate is 60%
