Flashcards in Lecture 25 Deck (28):
What are the types of scrotal masses?
Describe non-testicular scrotal masses?
What are the types of testicular scrotal masses?
Inflammation of the epididymis (can be due to TB).
Collection of blood around the testis.
What is the clinical presentation of testicular tumours?
1. Enlargement or irregularity of testis - usually painless.
2. May be with metastatic disease - neglected primary tumour or small primary tumour.
3. Hormonal effects - gynaecomastia.
What are the statistics of testicular germ cell tumours (GCT)?
In NZ 6/100,000. There are two types:
1. Seminoma - 40%.
2. NSGCT - 60%.
There is 2% of male malignancy, and it is the most commonest solid cancer for 20-40yo.
Describe germ cell neoplasms?
Origin - totipotent cells.
sites - i) testis and ovary. ii) midline site (mediastinum, pineal gland and sacrococcygeal).
What are the types of testicular GC tumours?
2. Non-seminomatous GCT.
There is also a combined tumour (both seminoma and NSGCT).
What are the types of NSGCT?
1. Embryonal carcinoma.
4. Yolk sac tumour.
Describe the differentiation that occurs in germ cell neoplasms?
The totipotent cell will either undergo:
1. Gonadal germ cell differentiation -> seminoma.
2. Embryonic differentiation -> teratoma, choriocarcinoma, yolk sac tumour.
Describe the age incidence of testicular GC tumours?
NSGCT tend to occur slightly younger, the seminoma will occur a little bit older (wouldn't find after the age of 60).
What is the aetiology of testicular GC tumours?
1. Genetic factors - low incidence in african americans, undescended testes.
2. Environmental factors - none known.
What is the pathogenesis of testicular GC tumours?
1. Cryptorchidism - 40% increase of risk of getting a GCT, and 12% of GCT patients have undescended testes.
2. Gonadal dysgensis - male pseudohermaphriditism.
3. Intratubular germ cell neoplasia (CIS) - the above conditions predispose to CIS; biopsy of testis to diagnose CIS in predisposed patients.
Describe the genetic changes in GCT?
1. 12p increased copies (usually isochromosome 12p).
2. Many other chromosomal gains and losses.
3. Seen in seminoma and NSGCT.
4. Not seen in aediatric GCT or spermatocytic seminoma.
Describe the macroscopic appearance of GCT?
1. Expands the testis and replaces the normal tissue.
2. It is confined within T.albuginea.
3. Cut surface:
-Seminoma - homogenous cream with granular necrosis.
-Teratoma - variegated: cartilage, cysts, cream/grey necrotic areas.
-Choriocarcinoma - haemorrhagic.
-Yolk sac tumour - grey gelatinous.
Describe the microscopic appearance of a seminoma?
Generally large clear cells with large nuclei and intense lymphocytic infiltrate in the stroma.
Describe the microscopic appearance of an embryonal carcinoma?
Epithelial cells, with high grad enuclei, and loose stroma.
Describe the microscopic appearance of a teratoma?
Sometimes show primitive embryonic type tissues, won't see epithelium or stroma (immature) or sometimes it can be a mature teratoma (composed of mature tissue).
Describe the diagnosis of GCT?
1. Clinical examination - important to examine the testis. Sometimes metastatic cancer can occur in the testis.
2. Ultrasound, to confirm.
3. Inguinal orchidectomy.
4. Pathological examination.
Describe the staging of the GCT?
1. Chest XRAY.
2. CT scan of chest, abdomen and pelvis.
3. Serum tumour markers.
Describe the local invasion spread of testicular GCT?
This spread is uncommon and can spread to:
-Rete testis and epididymis.
-Through tunica albuginea.
Describe the lymphatic spread of testicular GCT?
Common iliac and para-aortic nodes.
Describe the haematogenous spread of testicular GCT?
Can spread to the lung, liver and others and later in seminomas.
What are the tumour markers?
1. HCG - choriocarcinomas, malignant teratomas and soem seminomas (containg syncytiotophoblastic cells).
2. AFP - yolk sac tumours and malignant teratomas.
Describe the management of a seminoma tumour (post-orchidectomy)?
The cure is >90%.
1. Nil or minor I.n. involement - radiotherapy: 25-30 gray to pelvic, abdo.nodes.
2. Extensive I.n. involvement - platinum-based chemotherapy.
Describe the management of a NSGCT (post-orchidectomy)?
The cure is >90%.
1. Examination chest xray, Ct, markers.
2. treat any recurrence with platinum-based chemotherapy.