What do we think if we see a scrotal mass? what are the options
Inflammation of epididymis due to tuberculosis
Blood collection within scrotum
Clinical presentation of testicular tumours
Enlargement or irregularity of testis: usually painless
- May be with metastatic disease: neglected or smal primary tumour
Hormonal effects: gynaecomastia
Testis needs to be removed, through inguinal approach, (through scrotum → tumour cells in wound → cancer in inguinal nodes)
Testicular Germ cell tumours
Predominating tumour of the testis (really no epithelial tumours)
*there are some ovarian germ cell tumours.
2% male malignancy but commonest solid tumour
Types of Testicular germ cell tumours
1. Embryonal carcinoma:
2. Teratoma: mixture of tissues
3. Choriocarcinoma: chorion/placenta
4. Yolk sac Tumour
Origin and sites of germ cell Neoplasms
Origin: Totipotent cells
Sites: testis and ovary, midline site (mediastinum, pineal gland, sacrococcygeal)
Age incidence of types
NSGCT: slightly younger
Seminoma: slightly older
Genetic factors of testicular tumours
- Low incidence in africans/black american
- Slight increase in family members
- cryptorchidism: undescended testes
**no known environmental factors
Predisposing conditions that can cause the pathogenesis of Testicular tumours
- Cryptorchidism (undescended testes): 40x increased risk, ~12% of GCT patients have this
- Gonadal Dysgenesis: progressive loss of germ cells in embryonic gonads
- Intratubular Germ cell Neoplasia (CIS): predisposed by above conditions. in-situ tumor.
Genetic changes in testicular tumours
Almost always present is increased/amplifide 12p (short arm of chromosome 12)
-Many other chromosomal gains + losses
-Seen in seminoma and NSGCT
**not seen in paediatric GCT (pure yolk sac/teratomas, very different!) or spermatocytic seminoma
Differentiation of testicular tumours
Embryonic differentiation: NSGCT
Macroscopic appearance of Testicular tumours
Easily seen, expands testis and replaces normal tissue.
Confined within Tunica Albuginea
Seminoma: homogenous cream with granular necrosis
Teratoma: Variegated: cartilagem cycsts, cream/grey necrotic areas
Yolk sac tumours: grey gelantinous
Teratoma: Lots of variation, cysts, cartilage etc
Seminoma, relatively homogenous, grey/white
Right: embryonal carcinoma
How do you get a diagnosis?
STaging is done by?
How do the tumours spread
Local invasion is extremely rare.
Lymphatic spread: common iliac and para-aortic
HCG: in choriocarcinomas, malignant teratomas or some seminomas
AFP: (produced by liver and yolk sac) yolk sac tumours, malignant teratomas
will be v v high with tumours!!
Management post testis removal
Seminoma: removal + radiation
NSGCT: removal + surveillance + chemo
Very high cure rates!!!
Squamous cell carcinoma of the penis