11. Testicular tumours

Question 1

name the 3 main types of testicular tumours - are they malignant or benign

Answer 1

1. sex cord-stromal tumours (5%) - benign, most often Sertoli or Leydig cell tumours
2. germ cell tumours (95%) - usually malignant
3. lymphomas

Question 2

name the different types of germ cell tumours

Answer 2

1. SEMINOMAS (originates in germinal epithelium of seminiferous tubules)
2. NON-SEMINOMATOUS GERM CELL TUMOURS, often a mix of:
   - yolk sac tumours
   - embryonal carcinomas
   - choriocarcinomas
   - teratomas

Question 3

which condition increases risk of testicular germ cell tumours - how should this be managed

Answer 3

CRYPTORCHIDISM - failure of testicular descent into scrotum

Orchiopexy (surgical placement of testes into scrotum) should be performed before puberty

Question 4

which tumour cell markers may indicate germ cell tumours

Answer 4

1. AFP (alpha fetoprotein): produced by NSGCTs, esp. yolk sac tumours
2. hCG (beta-human chorionic gonadotropin): produced by mixed NSGCTs and choriocarcinomas, and by 10% seminomas

Question 5

how whould testicular tumours be treated

Answer 5

Radical orchiectomy (removal of testis) +/-

• seminoma: radiotherapy
• NSGCTs: aggressive chemotherapy

Question 6

what is the prognosis for germ cell tumours

Answer 6

Seminomas: good - metastasise late in disease and often don’t spread further than iliac and paraortic lymph nodes

NSGCTs: less good - tend to metastasise early via both lymphatics and BVs