Testicular neoplasia

Question 1

What are the RFx for testicular tumours?

Answer 1

• Cryptorchidism
• Atrophy
• HIV infection
• Family Hx

Question 2

Which testicle has higher incidence of neoplasia?

Answer 2

Right testicle has slightly higher incidence of testicular neoplasia; corresponds to slightly higher incidence of right cryptorchidism

Question 3

Increased risk of neoplasia conferred by cryptorchidism?

Answer 3

10-40x increased risk

Question 4

From which cells does primary testicular neoplasia arise?

Answer 4

• 95% germ cell tumours (all are malignant)

- 5% are non-germ cell tumours (usually benign)

Question 5

What are the types of primary germ cell tumours?

Answer 5

• Seminoma (35%) –> classic, anaplastic, spermatohytic
• NSGCT
• ->embryonal cell carcinoma (20%)
• ->teratoma (5%)
• -> choriocarcinoma (mixed cell type (4050

Question 6

Origins of secondary testicular neoplasia?

Answer 6

-Lymphoma or mets (e.g. lung, prostate, GI)

Question 7

CFx testicular neoplasia?

Answer 7

• PAINLESS testicular enlargement (painful if intratesticular haemorrhage or infarction)
• Dull, heavy ache in lower abdo, anal area or scrotum
• Supraclavicular and inguinal lymphadenopathy
• Abdo mass (retroperitoneal LN mets)

Question 8

What are the methods of spread of testicular neoplasia?

Answer 8

• LOCAL: spread follows lymphatics:
• ->Right: medial, paracaval, anterior and lateral nodes
• -> Left: left lateral and anterior paraaortic nodes
• CROSS OVER: mets from R>L common, no reports of L>R.
• HAEMATOGENOUS: most commonly to lung, liver, bone, kidney.

Question 9

Dx of testicular neoplasia?

Answer 9

Radical inguinal orchidectomy

Question 10

Testicular neoplasia tumour markers?

Answer 10

-BhCG and AFP +ve in 85% non seminomatous tumours

BhCH +ve in 7% seminomas, AFP never elevated w/ seminoma

Question 11

Ix in testicular neoplasia?

Answer 11

• Tumour markers (BhCH + AFP)
• Testicular U/S: hypoechoic area within tunica albuginea = high suspicion of neoplasia
• Dx by ochidectomy

Question 12

Mx of testicular neoplasia?

Answer 12

• orchidectomy through inguinal canal for all stages
• Consider sperm banking
• adjuvant therapies

Question 13

How does orchiopexy alter the risk of testicular neoplasia?

Answer 13

Surgical descent (orchiopexy) of undescended testis does not reduce risk of malignany=> reduces risk of infertility and allows for detection of testicular tumours by self exam.

Question 14

Why is testicular Bx or trans-scrotal orchidectomy contraindicated in ?testicular neoplasia?

Answer 14

Testis and scrotum have different lymphatic drainage, therefore trans-scrotal approach should be avoided.

Question 15

How is testicular neoplasia staged? (categories of staging)

Answer 15

• Clinical (Stage I - III)

- Pathologic (TNM)

Question 16

Clinical staging of testicular neoplasia Ix?

Answer 16

• CXR (lung mets)
• Markers: BhCH, AFP, LDH
• CT A/P (retroperitoneal lymphadenopathy)

Question 17

Clinical stages of testicular neoplasia?

Answer 17

Stage 1: disease limited to testis, epididymis or spermatic cord
Stage 2: disease limited to the retroperitoneal nodes
Stage 3: disease metastatic to supra diaphragmatic nodal or visceral sites

Question 18

Prognosis testicular neoplasia?

Answer 18

• 99% cured with stage I and II disease

- 70-80% complete remission with advance disease

Question 19

Pathologic stages of testicular neoplasia?

Answer 19

• T1: confined to testis and epididymis, no vascular / lymphatic invasion
• T2: extends beyond tunica albuginea or vascular / lymphatic invasion
• T3: invovles spermatic cord
• T4: invades scrotum
• T4a: invades spermatic cord
• T4b: invades scrotal wall