FN: Testicular Tumours

Question 1

Epi

Answer 1

• Commonest male malignancies from 15-44 yrs

- Whites > blacks =5:1

Question 2

Presentation

Answer 2

1. Painless testicular lump -often noticed after trauma
2. Haematospermia
3. secondary hydrocele
4. Mets: SOB from lung mets
5. Abdomass: para-aortic lymphadenopathy
6. Hormones: gynaecomastia
7. Contralateral tumour in 5%

Question 3

RF

Answer 3

1. Undescended testis -10% occur in undescended testes
2. Infant hernia
3. Infertility

Question 4

Pathology

Answer 4

1. Germ cell
2. Sex-cord Stromal
3. Lymphoma/Leukaemia

Question 5

Germ cell tumour

Answer 5

1. Pure seminomas

2. Non-seminomas (inc.mixed)

Question 6

Sex-cord Stromal

Answer 6

1. Leydig cell

2. Sertoli cell

Question 7

Lymphoma/Leukaemia

Answer 7

1. NHL

2. ALL

Question 8

Pure Seminomas

Answer 8

• Commonest single subtype
• 30-40 yrs
• Raised Beta HCG in 15%
• raised placental ALP in some
• Very radiosensitive

Question 9

Non-seminomas (inc. mixed)

Answer 9

1. Mixed
2. Teratoma
3. Yolk sac
4. Choriocarcinoma

Question 10

Mixed

Answer 10

Commonest NSGCT

Question 11

Teratoma

Answer 11

• Arise from all 3 germ layer
• Common and benign in children
• Rare and malignant in adults: 15-30 yrs
• Secrete beta HCG and/or AFP
• chemosensitive

Question 12

Yolk sac

Answer 12

Commonest testicular tumour in children

Question 13

Choriocarcinoma

Answer 13

Very high beta HCG

Question 14

Leydig cell

Answer 14

Mostly benign

May secrete androgens or oestrogens

Question 15

Sertoli cell

Answer 15

• mostly benign

- May secrete oestrogens

Question 16

NHL

Answer 16

Commonest malignant testicular mass >60 yrs

Question 17

ALL

Answer 17

Commonest malignant testicular mass

Question 18

Staging: Royal Marsden Classification

Answer 18

1. Disease only in testis
2. Para-aortic ndes involved (below diaphragm)
3. Supra- and infra- diaphragmatic LNs involved
4. Extra-lymphatic spread: lungs, liver

Question 19

Investigations

Answer 19

1. Tumour marker
2. Scrotum US
3. Staging

Question 20

Tumour markers

Answer 20

1. Useful for monitoring
2. Raised AFP anf hCG in 90% of teratomas
3. Raised hCG in seminomas
4. Normal AFP in pure seminomas

Question 21

Staging done with

Answer 21

CXR

CT

Question 22

NEVER

Answer 22

Percutaneous biopsy should not be performed as it may - seeding along needle tract

Question 23

Management

Answer 23

If both testes are abnormal, semen can be cryopreserved

Question 24

Seminomas Mx stage 1-2

Answer 24

Inguinal orchidectomy + radiotherapy

- groin incision allows cord clamping to prevent seeding

Question 25

Seminomas Mx stage 3-4

Answer 25

Inguinal orchidectomy + radiotherapy
- groin incision allows cord clamping to prevent seeding

With Chemo )BEP_

Question 26

Chemo used in seminomas

Answer 26

Bleomycin
Etoposide
CisPlatin

Question 27

Non-seminomas/Teratomas Mx

Answer 27

stage 1: Inguinal orchidectomy + surveillance
Stage 2: Orchidectomy + chemo + para-aortic LN dissection
Stage 3: Orchidectomy + chemo

Question 28

Close/f/up to detect relapse

Answer 28

• Typically w/i 18-24mo

- Repeat CT scanning and tumour markers

Question 29

Prognosis

Answer 29

• Stage 1: 98% 5yrs
  Stage 2: 85% 5yrs
  Stage 3: 60% 5 yrs