Lecture 25: Testes and Penis pathology

Question 1

What do we think if we see a scrotal mass? what are the options

Answer 1

Question 2

Epididymitis

Answer 2

Inflammation of epididymis due to tuberculosis

Question 3

Haematocoele

Answer 3

Blood collection within scrotum

Question 4

Clinical presentation of testicular tumours

Answer 4

1. Enlargement or irregularity of testis: usually painless
2. May be with metastatic disease: neglected or smal primary tumour
3. Hormonal effects: gynaecomastia

Testis needs to be removed, through inguinal approach, (through scrotum → tumour cells in wound → cancer in inguinal nodes)

Question 5

Testicular Germ cell tumours

Answer 5

Predominating tumour of the testis (really no epithelial tumours)

*there are some ovarian germ cell tumours.

6/100 000

2% male malignancy but commonest solid tumour

Question 6

Types of Testicular germ cell tumours

Answer 6

Seminoma 40%

NSGCT 60%

1. Embryonal carcinoma:
2. Teratoma: mixture of tissues
3. Choriocarcinoma: chorion/placenta
4. Yolk sac Tumour

Question 7

Origin and sites of germ cell Neoplasms

Answer 7

Origin: Totipotent cells

Sites: testis and ovary, midline site (mediastinum, pineal gland, sacrococcygeal)

Question 8

Age incidence of types

Answer 8

NSGCT: slightly younger
Seminoma: slightly older

None >60years

Question 9

Genetic factors of testicular tumours

Answer 9

Genetic:

• Low incidence in africans/black american
• Slight increase in family members
• cryptorchidism: undescended testes

**no known environmental factors

Question 10

Predisposing conditions that can cause the pathogenesis of Testicular tumours

Answer 10

• 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.

Question 11

Genetic changes in testicular tumours

Answer 11

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

Question 12

Differentiation of testicular tumours

Answer 12

Question 13

Embryonic differentiation: NSGCT

Answer 13

Question 14

Macroscopic appearance of Testicular tumours

Answer 14

Easily seen, expands testis and replaces normal tissue.
Confined within Tunica Albuginea

Seminoma: homogenous cream with granular necrosis

Teratoma: Variegated: cartilage cysts, cream/grey necrotic areas

Choriocarcinoma: haemorrhagic

Yolk sac tumours: grey gelantinous

Question 15

This is?

Answer 15

Teratoma: Lots of variation, cysts, cartilage etc

Question 16

This is?

Answer 16

Seminoma, relatively homogenous, grey/white

Question 17

this is

Answer 17

Left: seminoma

Right: embryonal carcinoma

Question 18

How do you get a diagnosis?

Answer 18

Clinical examination

Ultrasound

Inguinal orchidectomy

Pathological exam

Question 19

STaging is done by?

Answer 19

Chest xray

CT scan

serum markers

Question 20

How do the tumours spread

Answer 20

Local invasion is extremely rare.

Lymphatic spread: common iliac and para-aortic

Haematogenous: lung, liver and other

Question 21

Tumour markers

Answer 21

HCG: in choriocarcinomas, malignant teratomas or some seminomas

AFP: (produced by liver and yolk sac) yolk sac tumours, malignant teratomas

Seminomas usually have no markers

will be v v high with tumours!!

Question 22

Management post testis removal

Answer 22

Seminoma: removal + radiation (>95%)

NSGCT: removal + surveillance + chemo (>90%)

Very high cure rates!!!

Question 23

Squamous cell carcinoma of the penis

Answer 23

• Elderly men
• HPV found in CIS, invasive carcinoma
• Circumsion has a protective effect
• Most common site: coronal sulcus and glans penis
• Spreads commonly to inguinal nodes (high mortality)