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Flashcards in Testicular Cancers Deck (51)
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1

Etiology of testicular cancer 

Congenital

  • 3-14 times more likely in undescended testes
  • Abnormal germ cell morphology
  • Gonadal dysgenesis
  • Elevated temperature
  • Hormonal disease
  • Interferece with blood supply

2

Etiology of testicular cancer 

Aquired

  • Trauma
  • Hormonal fluctuation
  • Infections→MUMPS induced atrophy
    • in addition to non specific infections

3

Testicular tumors 

Risk factors

  • Cryptorchidism
    • 10% of tumors with the risk increasing the higher up the testes are in the abdomen 
  • Genetics
    • Whites are 5X more succeptible than blacks
  • SIblings of patients are 10X more at risk
  • Kleinfelter syndrome
  • Li-Fraumeni syndrome
  • Prior testicular germ cell/intratubular tumor

4

Genetic marker for all germ cell tumors

Isochrome of the short arm of ch 12 ie i12p

5

Genetic marker for Intratubular germ cell tumor

66% have alteration in p53 locus

6

Familial cases are linked to 

  • Tyrosine kinase receptor→KIT and BAK
    • involved in gonadal development
  • Transcription factors→OCT3/4 and NANOG
    • maintain pluripotent stem cells

7

Incidence of testicular cancer 

AGE

Most common solid tumor 20-30

RACE
Whites are 4-5 times more likely

SIDE

Right>left

SES

High SES are twice as likely

Geographical 

Highest in Scan ger and swis

Intermediate in UK and US

Low in africa and asia

 

8

Lymphoma common in which age group

>50

9

Yolk sac tumor common in which age group

Infancy and childhood

10

Pure teratoma common in which age group

Pediatric 

11

Lymphatic spread of RIGHT tumor

Inter aortocaval at L2 →precaval→preaortic→right common iliac→right external iliac

12

Left testicular cancer lymphatic spread

paraaortic at renal hilum→preaortic→common iliac→left external iliac

13

Blood metastatsis 

  1. Lung
  2. Liver
  3. Brain
  4. Bone
  5. Kidney
  6. Adrenal
  7. GIT
  8. Spleen

14

Haematological investigatons

  • Hb
  • Blood urea or serum creatnine
  • LFT

15

Tumor markers

  • AFP (elevated in NSGCT ONLY)
  • Beta-HCG (elevated in NSGCT and SGCT)
  • LDH (elevated in NSGCT and SGCT)

16

Scrotal ultrasound in testicular cancer

  • Homogenous
  • Hypoechoic
  • Itratesticular mass

17

Investigations for staging

CXR

CT/MRI of abdomen

18

Boden and Gibbs 

Stage 1(A)

  • Confined to testis
  • NO spread to capsule nor spermatic cord

19

Boden and Gibbs 

Stage 2 (B) 

 

  • Clinical/radiological evidence of spread beyond testis but WITHIN REGIONAL LN

B<2cm

B2-5cm

B>5cm

20

Boden and Gibbs 

Stage 3 (C)

VIsceral disease ie above diaphragm

21

Incidenc of testicular tumors

  • <1% of malignancies in males; hughly curable regardless of stage
  • 95% are germ cell tumors
  • 5% sex cord stromal cells
    • bening mostly
    • maybe associated withwith hormonal syndromes

22

Intratubular germ cell neoplasia 

IGCN

  • In situ stage of germ cell neoplasia
  • Seen in 90-100% of testes adjacent to germ cell tumor
  • Less often in childhood yolk sac and teratomas

23

Germ Cell Tumors

  • Seminoma
  • Embryonal carcinoma
  • Yolk sac tumor
  • Choriocarcinoma

24

Sex cord stroma

  • Leydig cell tumor
  • Sertoli cell tumor

25

Mixed germ cell- gonadal stromal tumors

Gonadoblastoma

  • rare
  • associated with testicular dysgenesis
    • cryptorchidism
    • hypospadias
    • poor sperm quality

26

Seminoma 

Epidemiology 

  • Most common tumor in 25-29 yrs
  • Account for 50% of germ cell tumors
  • 1-2% bilateral
  • 15% are bilateral if both testes are undescended

 

NOTE: identical to ovarian dysgerminoma

27

Seminoma 

Origin

Arises from intratubular germ cell neoplasia

EXCEPT

Adult spermatocytic seminoma variant

28

Seminoma 

Genetics

  • Isochrome 12p
  • Express OCT3/4 and NANOG
  • 25% have KIT activating mutations

29

Seminoma 

Gross description

  • Bulky
  • Homogenous
  • Grey-white
  • Well circumscribed 
  • Lobulated, bulging surface
  • NO (usuallly)
    • hemorrhage
    • cystic changes
    • extensive necrosis
  • INASION
    • <10% invade tunica albuginea
    • rarely extend to epididymis, spermatic cord, scrotal sac

30

Seminoma 

Microscopic description

  • Sheets of uniform tumor cells
  • Divided into poorly demarcated lobules
    • by delicate fibrous septa 
    • Lobules contain lymphocytes and plasma cells
  • Cells are
    • large
    • round-polyhedral
    • distinct cell membranes
    • abundant clear/watery cytoplasm
    • large central nuclei
    • 1-2 irregular elongated nucleoli 
    • minimal mitotic figures