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Year 2 Medicine > Pathology of the Testis > Flashcards

Pathology of the Testis Flashcards

1
Q

‘Normal Testis’ with associated epididymal cyst

A

*

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2
Q

Acute Epididymo-orchitis - Benign

  • Most cases of acute epididymo-orchitis occur in men aged … - … years
  • Associated with sexually transmitted diseases such as … trachomatis and Neisseria …
  • In older men over 40 years the most common cause is … infection
  • The inflammation is initially confined to the … and later spreads to the testis
A
  • Most cases of acute epididymo-orchitis occur in men aged 20 – 39 years
  • Associated with sexually transmitted diseases such as Chlamydia trachomatis and Neisseria gonorrhoea
  • In older men over 40 years the most common cause is E.coli infection
  • The inflammation is initially confined to the epididymis and later spreads to the testis
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3
Q

What is Acute Epididymo-orchitis?

A

Acute epididymo -orchitis is a clinical syndrome consisting of pain, swelling and inflammation of the epididymis +/- testes usually caused by local extension of infection from the urethra (sexually transmitted) or the bladder (urinary)

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4
Q

Presentation, Management of Acute Epididymo-orchitis

  • Pain and swollen epididymis due to inflammation with a predominance of n…
  • Culture and sensitivity of … secretions to identify causative bacteria
  • Raised … (CRP)
  • Ultrasound scan to differentiate epididymo-orchitis from …
  • Treat with …, pain relief and supportive care (scrotal elevation)
  • If not resolved may require … care
  • May heal with scarring leading to …
A
  • Pain and swollen epididymis due to inflammation with a predominance of neutrophils
  • Culture and sensitivity of urethral secretions to identify causative bacteria
  • Raised C-Reactive Protein (CRP)
  • Ultrasound scan to differentiate epididymo-orchitis from torsion
  • Treat with antibiotics, pain relief and supportive care (scrotal elevation)
  • If not resolved may require inpatient care
  • May heal with scarring leading to sterility
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5
Q

In older men over 40 years with Acute Epididymo-orchitis the most common cause is … infection

A

E.coli infection

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6
Q

Most cases of acute epididymo-orchitis occur in men aged … - … years

A

Most cases of acute epididymo-orchitis occur in men aged 20 – 39 years

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7
Q

Acute Epididymo-orchitis is associated with …

A

sexually transmitted diseases such as Chlamydia trachomatis and Neisseria gonorrhoea

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8
Q

Presentation of Acute Epididymo-orchitis

  • Pain and swollen … due to … with a predominance of n…
A

Pain and swollen epididymis due to inflammation with a predominance of neutrophils

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9
Q

Acute Epididymo-orchitis may heal with … leading to s…

A

Acute Epididymo-orchitis may heal with scarring leading to sterility

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10
Q

Management of Acute Epididymo-orchitis

  • Treat with …, … relief and supportive care (scrotal elevation)
  • If not resolved may require … care
A
  • Treat with antibiotics, pain relief and supportive care (scrotal elevation)
  • If not resolved may require inpatient care
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11
Q

Illustrative Case of Epididymo-orchitis

  • Pathology showed:
A
  • Excision included adherent scrotal skin
  • Testis was covered in fibrous adhesions
  • The cut surface was necrotic
  • Histology showed abscess formation
  • Died years later due to complications of diabetes mellitus
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12
Q

Torsion - Testis

  • Manage as a urological …
  • Torsion occurs due to twisting of the … cord which cuts off the … drainage of the testis
  • If untreated leads to … of the testis
  • Presents with … onset of testicular pain which may or may not be related to …
  • If ‘untwisted’ within … hours there is a chance that the testis will remain viable
  • The … testis should be fixed to the … (orchidopexy) to risk reduce risk of torsion
A
  • Manage as a urological emergency
  • Torsion occurs due to twisting of the spermatic cord which cuts off the venous drainage of the testis
  • If untreated leads to infarction of the testis
  • Presents with sudden onset of testicular pain which may or may not be related to trauma
  • If ‘untwisted’ within 6 hours there is a chance that the testis will remain viable
  • The contralateral testis should be fixed to the scrotum (orchidopexy) to risk reduce risk of torsion
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13
Q

Testicular torsion should be treated as a …

A

urological emergency

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14
Q

Testicular torsion occurs due to twisting of the …. … which cuts of the … … of the testis

A

Torsion occurs due to twisting of the spermatic cord which cuts off the venous drainage of the testis

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15
Q

In testicular torsion - if ‘untwisted’ within … hours - testis may remain viable

A

within 6 hours

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16
Q

Illustrative Case of Torsion

A
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17
Q

Hydrocoele is the … of … around the testis surrounded by the … …

A

Hydrocoele is the collection of fluid around the testis surrounded by the tunica vaginalis

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18
Q

Epidemiology of Testicular Cancer

  • Most common solid malignant tumour in men …-… years of age
  • Incidence of testicular cancer … in caucasian men than black men
  • Testicular cancer accounts for less …% of all new cancers in the UK with …% increase since the early 1990s
    • (Cancer Research UK)
A
  • Most common solid malignant tumour in men 30-34 years of age
  • Incidence of testicular cancer higher in caucasian men than black men
  • Testicular cancer accounts for less 1% of all new cancers in the UK with 28% increase since the early 1990s
    • (Cancer Research UK)
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19
Q

Incidence of testicular cancer is … in caucasian men than black men

A

Incidence of testicular cancer higher in caucasian men than black men

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20
Q

Testicular cancer accounts for less …% of all new cancers in the UK with …% increase since the early 1990s (Cancer Research UK)

A

Testicular cancer accounts for less 1% of all new cancers in the UK with 28% increase since the early 1990s (Cancer Research UK)

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21
Q

Torsion in a younger man (18years old)

A
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22
Q

Testicular Cancer is the … common solid malignant tumour in men ages 30-34 years of age

A

Testicular Cancer is the most common solid malignant tumour in men ages 30-34 years of age

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23
Q

Causes of Testicular Cancer

  1. Cryptorchidism/… testis increases the risk of cancer 4-8 times
  2. History of previous …
  3. Genetic abnormality: … syndrome (47XXY) & … syndrome (trisomy 21)
  4. FH of testicular cancer – … degree relatives have a higher risk than the general population
  5. Men with … problems are more likely to develop testicular cancer
  6. Exposure to … (diethylstilbestrol) in utero → cryptorchidism→ increases the risk of testicular cancer
A
  1. Cryptorchidism/undescended testis increases the risk of cancer 4 – 8 times
  2. History of previous testicular cancer
  3. Genetic abnormality: Klinefelter’s syndrome (47XXY) & Down’s syndrome (trisomy 21)
  4. FH of testicular cancer – First degree relatives have a higher risk than the general population
  5. Men with infertility problems are more likely to develop testicular cancer
  6. Exposure to oestrogens (diethylstilbestrol) in utero → cryptorchidism→ increases the risk of testicular cancer
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24
Q

Men with infertility problems are … likely to develop testicular cancer

A

Men with infertility problems are more likely to develop testicular cancer

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25
Q

Cryptorchidism/undescended testis increases the risk of cancer ..-… times

A

Cryptorchidism/undescended testis increases the risk of cancer 4 – 8 times

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26
Q

Can Genitic abnormalities cause testicular cancer?

A

Yes - Klinefelter’s syndrome (47XXY) & Down’s syndrome (trisomy 21)

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27
Q

Do First degree relatives of those with testicular cancer have a higher risk than the general population?

A

Yes

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28
Q

Exposure to oestrogens (diethylstilbestrol) in utero → cryptorchidism→ … the risk of testicular cancer

A

Exposure to oestrogens (diethylstilbestrol) in utero → cryptorchidism→ increases the risk of testicular cancer

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29
Q

Atrophic Undescended Testis: -> … risk of testicular cancer

A

Atrophic Undescended Testis: -> Increased risk of testicular cancer

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30
Q

Classification of Testicular Tumours

  • Either classified as … cell tumours or … …/ … tumours
A

Either classified as germ cell tumours or sex cord/stromal tumours

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31
Q

Classification of Testicular Tumours

  • Germ Cell tumour can be further divided into … tumours (… types) or non-… tumours (… types)
  • Sex cord/stromal tumours can be further classified into … cell tumour or … cell tumour
A
  • Germ Cell tumour can be further divided into seminonmatous tumours (2 types) or non-seminomatous tumours (4 types)
  • Sex cord/stromal tumours can be further classified into leydig cell tumour or sertoli cell tumour (both - less than 5% of testicular tumours)
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32
Q

Seminomatous tumours (Germ Cell tumours)

  • 2 types:
    • … seminoma
    • … seminoma
A
  • Classical seminoma
  • Spermatocytic seminoma
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33
Q

Non-seminomatous tumours - (Germ Cell Tumours)

  • 4 types:
    • E.. carcinoma
    • … … tumour
    • C…
    • T…
A
  • Embryonal carcinoma
  • Yolk sac tumour
  • Choriocarcinoma
  • Teratoma
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34
Q

Sex cord/ stromal tumours account for less than …% of testicular tumours

A

less than 5% (leydig cell tumours, sertoli cell tumours)

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35
Q

Germ Cell Tumours

  • More than …% of cancers of the testis arise in germ cells
  • Germ cells produce the …
  • Germ cell tumours are divided into … and non-…
    • Mixed germ cell tumours consists of … and non-… components
  • Germ cell carcinoma in … or intra-tubular germ cell n… is the precursor lesion
A
  • More than 90% of cancers of the testis arise in germ cells
  • Germ cells produce the sperm
  • Germ cell tumours are divided into seminomas and non-seminomatous
    • Mixed germ cell tumours consists of seminoma and non-seminomatous components
  • Germ cell carcinoma in situ or intra-tubular germ cell neoplasia is the precursor lesion
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36
Q

More than …% of cancers of the testis arise in germ cells

A

More than 90% of cancers of the testis arise in germ cells

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37
Q

Germ cells produce the …

A

Germ cells produce the sperm

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38
Q

Germ cell tumours are divided into … and non-…

A

Germ cell tumours are divided into seminomas and non-seminomatous

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39
Q

Mixed germ cell tumours consists of … and non-… components

A

Mixed germ cell tumours consists of seminoma and non-seminomatous components

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40
Q

Germ cell carcinoma in … or intra-tubular germ cell … is the precursor lesion

A

Germ cell carcinoma in situ or intra-tubular germ cell neoplasia is the precursor lesion

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41
Q

Seminomas tend to grow and spread more … than non-seminomatous tumours

A

Seminomas tend to grow and spread more slowly than non-seminomatous tumours

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42
Q

Seminomas

  • There are two main sub-types: classical seminoma and spermatocytic seminoma/tumour
    • Classical Seminoma:
      • Constitutes more than …% of seminomas
      • Affect men between 25 and 45 years of age
      • Tumours markers can be normal or raised
    • Spermatocytic Seminoma/Tumour:
      • … tumour; affects older men; average age of 65yrs
      • Grow more … than classical seminomas and are … likely to spread to other parts of the body
A
  • There are two main sub-types: classical seminoma and spermatocytic seminoma/tumour
    • Classical Seminoma:
      • Constitutes more than 95% of seminomas
      • Affect men between 25 and 45 years of age
      • Tumours markers can be normal or raised
    • Spermatocytic Seminoma/Tumour:
      • Rare tumour; affects older men; average age of 65yrs
      • Grow more slowly than classical seminomas and are less likely to spread to other parts of the body
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43
Q

Classical Seminoma:

  • Constitutes more than ….% of seminomas
  • Affect men between … and … years of age
  • Tumours markers can be … or …
A
  • Constitutes more than 95% of seminomas
  • Affect men between 25 and 45 years of age
  • Tumours markers can be normal or raised
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44
Q

What sub-type of seminomas affect men between 25 and 45?

A

Classical seminoma

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45
Q

What sub-type of seminoma constitutes more than 95% of seminomas?

A

Classical seminoma

46
Q

In a classical seminoma, tumour markers can be …

A

Tumours markers can be normal or raised

47
Q

Spermatocytic Seminoma/Tumour:

  • Rare tumour; affects … men; average age of …yrs
  • Grow more … than classical seminomas and are … likely to spread to other parts of the body
A
  • Rare tumour; affects older men; average age of 65yrs
  • Grow more slowly than classical seminomas and are less likely to spread to other parts of the body
48
Q

What sub-type of seminomas affect older men?

A

Spermatocytic Seminoma/tumour

49
Q

What sub-type of seminomas grow more slowly? and are less likely to spread to other parts of the body?

A

Spermatocytic seminomas/tumour

50
Q

Non-seminomatous Germ Cell Tumours (GCTs)

  • These germ cell tumours usually occur in men in their … or …
  • Four main types of non-seminomatous germ cell tumours
    • – … carcinoma
    • – … sac carcinoma/tumour
    • – …carcinoma
      • Tera…
A
  • These germ cell tumours usually occur in men in their late teens and early 30s
  • Four main types of non-seminomatous germ cell tumours
    • – Embryonal carcinoma
    • – Yolk sac carcinoma/tumour
    • – Choriocarcinoma
      • Teratoma
51
Q

Non-seminomatous germ cell tumours usually occur in men of what age?

A

late teens and early 30’s

52
Q

Embryonal Carcinoma

  • Present in about …% of testicular tumours
    • Pure embryonal carcinoma occurs in only …% to …% of cases
  • Microscopically, looks like tissues of very early …
  • Tends to grow … and … … the testis
A
  • Present in about 40% of testicular tumours
  • Pure embryonal carcinoma occurs in only 3% to 4% of cases
  • Microscopically, looks like tissues of very early embryos
  • Tends to grow rapidly and spread outside the testis
53
Q

Embryonal Carcinoma is present in about …% of all tumours, but … embryonal carcinoma occurs in only 3% to 4% of cases

A

Embryonal Carcinoma is present in about 40% of all tumours, but pure embryonal carcinoma occurs in only 3% to 4% of cases

54
Q

Embryonal Carcinoma tend to grow … and … … the testis

A

Embryonal Carcinoma tend to grow rapidly and spread outside the testis

55
Q

Yolk sac carcinoma/tumour

  • The cells look like the yolk sac of an early embryo
  • The most common form of testicular cancer in …
  • Pure yolk sac tumours are rare in …
  • Have better prognosis in … than …
A
  • The cells look like the yolk sac of an early embryo
  • The most common form of testicular cancer in children
  • Pure yolk sac tumours are rare in adults
  • Have better prognosis in children than adults
56
Q

What is the most common form of testicular cancer in children?

A

Yolk sac carcinoma/tumour (germ cell - non-seminomatous)

57
Q

What type of testicular cancer has better prognosis in children than adults? (germ cell…)

A

Yolk sac carcinoma/tumour (germ cell - non-seminomatous)

58
Q

Choriocarcinoma

  • A very … and …-growing testicular cancer in adults
  • … choriocarcinoma tends to spread rapidly to other parts of the body, including the lungs, bones, and brain
  • Usually present in … germ cell tumours with associated …
A
  • A very rare and fast-growing testicular cancer in adults
  • Pure choriocarcinoma tends to spread rapidly to other parts of the body, including the lungs, bones, and brain
  • Usually present in mixed germ cell tumours with associated haemorrhage
59
Q

Is Choriocarcinoma a common testicular cancer in adults?

A

No - very rare and fast-growing testicular cancer

60
Q

Do pure choriocarcinoma spread to other parts outside of the testis?

A

Yes - Pure choriocarcinoma tends to spread rapidly to other parts of the body, including the lungs, bones, and brain

61
Q

Choriocarcinomas are usually present in what type of germ cell tumour ?

A

mixed germ cell tumour - with associated haemorrhage

62
Q

Teratoma

  • … teratomas
    • Tumours are formed by cells similar to adult tissues
    • They … spread, can usually be cured with surgery, but may recur after treatment
  • … teratomas
    • Are less well-developed cancers with cells that resemble those of an early embryo
    • … likely than a … teratoma to invade nearby tissues, metastasise outside the testis and recur years after treatment.
A
  • Mature teratomas
    • Tumours are formed by cells similar to adult tissues
    • They rarely spread, can usually be cured with surgery, but may recur after treatment
  • Immature teratomas
    • Are less well-developed cancers with cells that resemble those of an early embryo
    • More likely than a mature teratoma to invade nearby tissues, metastasise outside the testis and recur years after treatment.
  • (N.B. Dermoid cyst/mature cystic teratoma of the ovary is benign; testicular teratomas are always malignant)
63
Q

Teratoma - Testis

  • Derived from 3 germ cell layers of the embryo
    • –… (innermost layer)
    • –… (middle layer)
    • –… (outer layer)
A
  • Derived from 3 germ cell layers of the embryo
    • –Endoderm (innermost layer)
    • –Mesoderm (middle layer)
    • –Ectoderm (outer layer)
64
Q

Are pure teratomas of the testicles common or rare?

A

Pure teratomas of the testicles are rare

65
Q

Teratoma Testis - Most teratomas are components of … germ cell tumours

A

Teratoma Testis - Most teratomas are components of mixed germ cell tumours

66
Q

Teratoma Testis - no increase in …

A

Teratoma Testis - no increase in tumour markers

67
Q

What Germ Cell Testicular tumour has no increase in tumour markers?

A

Teratoma (a non-seminomatous germ cell tumour)

68
Q

What are the two types of teratoma? (testis)

A

mature teratoma and immature teratoma

69
Q

Mature teratoma

  • Tumours are formed by cells similar to … tissues
  • They … spread, can usually be cured with …, but may … after treatment
A
  • Tumours are formed by cells similar to adult tissues
  • They rarely spread, can usually be cured with surgery, but may recur after treatment
70
Q

Immature teratomas

  • Are … well-developed cancers with cells that resemble those of an early …
  • … likely than a mature teratoma to invade nearby tissues, metastasise outside the testis and recur years after treatment.
A
  • Are less well-developed cancers with cells that resemble those of an early embryo
  • More likely than a mature teratoma to invade nearby tissues, metastasise outside the testis and recur years after treatment.
71
Q

Which type of teratoma is more likely to invade nearby tissue, metastasise outside the testis and recur after treatment? (mature or immature?)

A

Immature teratoma

72
Q

Dermoid cyst/mature cystic teratoma of the ovary is …, testicular teratomas are always …

A

Dermoid cyst/mature cystic teratoma of the ovary is benign, testicular teratomas are always malignant

73
Q

Are testicular teratomas always malignant?

A

Yes

74
Q

Clinical Presentation of Testicular Cancer

  • Any … swelling or nodule in the testis is cancer until proved otherwise
  • Mass or nodule not separate from the testis
  • … ache or … sensation in the lower abdomen
  • … cancer + … may present with:
    • Back pain due to enlarged para-aortic L nodes
    • Supraclavicular lymphadenopathy
    • Cough, chest pain, haemoptysis and shortness of breath due to metastases to the lungs
    • Marked gynaecomastia in patients with tumours secreting beta HCG as in choriocarcinoma
A
  • Any painless swelling or nodule in the testis is cancer until proved otherwise
  • Mass or nodule not separate from the testis
  • Dull ache or heavy sensation in the lower abdomen
  • Advanced cancer + mets may present with:
    • Back pain due to enlarged para-aortic L nodes
    • Supraclavicular lymphadenopathy
    • Cough, chest pain, haemoptysis and shortness of breath due to metastases to the lungs
    • Marked gynaecomastia in patients with tumours secreting beta HCG as in choriocarcinoma
75
Q

Any painless swelling or nodule in the testis is … until proved otherwise

A

Any painless swelling or nodule in the testis is cancer until proved otherwise

76
Q
  • Advanced Testicular cancer + mets may present with:
    • … pain due to enlarged para-aortic L nodes
    • Supraclavicular …
    • Cough, … pain, haemoptysis and shortness of breath due to metastases to the …
    • Marked … in patients with tumours secreting beta HCG as in choriocarcinoma
A
  • Back pain due to enlarged para-aortic L nodes
  • Supraclavicular lymphadenopathy
  • Cough, chest pain, haemoptysis and shortness of breath due to metastases to the lungs
  • Marked gynaecomastia in patients with tumours secreting beta HCG as in choriocarcinoma
77
Q

Imaging in Testicular Cancer

  • … scan will distinguish between:
    • A tumour in the testis and external to the testis
    • A complex cyst, most likely malignant and a simple cyst, most likely benign
    • A solid tumour and a cyst
  • … scan: chest, abdomen and pelvis to assess for metastases in the lymph nodes, liver and lungs
  • … of brain and bone if metastases suspected
  • … scan for recurrent disease after treatment lesions appear ‘hot’ when there is viable cancer
A
  • Ultrasound scan (USS) will distinguish between:
    • A tumour in the testis and external to the testis
    • A complex cyst, most likely malignant and a simple cyst, most likely benign
    • A solid tumour and a cyst
  • CT scan: chest, abdomen and pelvis to assess for metastases in the lymph nodes, liver and lungs
  • MRI of brain and bone if metastases suspected
  • PET scan for recurrent disease after treatment lesions appear ‘hot’ when there is viable cancer
78
Q

Ultrasound scan of testis (testicular cancer imaging) will distinguish between:

  • A tumour in the testis and … to the testis
  • A complex cyst, most likely … and a simple cyst, most likely …
  • A … tumour and a cyst
A
  • A tumour in the testis and external to the testis
  • A complex cyst, most likely malignant and a simple cyst, most likely benign
  • A solid tumour and a cyst
79
Q

A CT scan is used for testicular cancer imaging to assess what?

A

CT scan: chest, abdomen and pelvis to assess for metastases in the lymph nodes, liver and lungs

80
Q

An MRI is done of the … and … if … is suspected (testicular cancer)

A

An MRI is done of the brain and bone if metastasis is suspected (testicular cancer)

81
Q

… scan is used for recurrent disease after treatment lesions appear ‘hot’ when there is viable cancer (testicular cancer)

A

PET scan for recurrent disease after treatment lesions appear ‘hot’ when there is viable cancer

82
Q

Testicular tumours produce … … (TMs) not normally present in the blood

A

Testicular tumours produce tumour markers (TMs) not normally present in the blood

83
Q

Positive Tumour Markers aid in making a diagnosis of cancer in the presence of a … mass

A

Positive TMs aid in making a diagnosis of cancer in the presence of a testicular mass

84
Q

Tumour Markers in Testicular Cancer

  • Different tumours secrete specific TMs
    • …-… (AFP) - yolk sac tumour, embryonal carcinoma
    • … … … (HCG) - Choriocarcinoma, embryonal carcinoma, seminoma
    • … …. (LDH) - seminoma
A
  • Different tumours secrete specific TMs
    • Alpha-fetoprotein (AFP) - Yolk sac tumour, embryonal carcinoma
    • Human chorionic gonadotropin (HCG) - Choriocarcinoma, embryonal carcinoma, seminoma
    • Lactate dehydrogenase (LDH) - seminoma
85
Q

Alpha-fetoprotein (AFP) (tumour marker) is secreted in … and … tumours

A

Alpha-fetoprotein (AFP) (tumour marker) is secreted in yolk sac tumour, embryonal carcinoma

86
Q

Human chorionic gonadotropin (HCG) is secreted in 3 types of testicular tumour…

A

Human chorionic gonadotropin (HCG) is secreted in 3 types of testicular tumour - Choriocarcinoma, embryonal carcinoma, seminoma

87
Q

Lactate dehydrogenase (LDH) (tumour marker) is secreted in what testicular tumour?

A

Lactate dehydrogenase (LDH) - seminoma

88
Q

All TMs are raised in a … germ cell tumour

A

All TMs are raised in a mixed germ cell tumour

89
Q

What is used for follow-up of patients after therapy (testicular cancer?)

A

Tumour Markers used for follow-up of patients after therapy

90
Q

Case Report: Seminoma

A

*

91
Q

What tumour marker is secreted by seminomas?

A

Lactate dehydrogenase

92
Q

Macroscopic appearance - seminoma

  • He had right … (surgical removal of one or both testicles)
  • Testis had lobulated tumour with a ‘potato-like’ appearance
  • No … or necrosis
  • No normal residual testicular tissue
A
  • He had right orchidectomy (surgical removal of one or both testicles)
  • Testis had lobulated tumour with a ‘potato-like’ appearance
  • No haemorrhage or necrosis
  • No normal residual testicular tissue
93
Q

Microscopic Appearance of Seminoma

A
94
Q

Early Seminoma vs Advanced Seminoma

A
95
Q

Case Report: Teratoma

A
96
Q

Macroscopic Appearance - Early Teratoma

A
97
Q

Microscopic Appearance - Early Teratoma

A
98
Q

Case Report: Mixed Germ Cell Tumour

A
  • A & E doctor thought it was an infected abscess
  • Incisional and drainage of right testis
  • 60 x 50 x 20 mm of tissue removed
  • Histology: Undifferentiated carcinoma
  • Tumour markers:
    • Alpha fetoprotein = 29,124 ( 0-6)
    • Beta HCG = 6.6 ( <2.6)
  • Subsequent orchidectomy:
    • Bilateral testicular tumours fused together
    • Right testis tissue partly removed
  • Previously opened mass
  • 180 x 100 x 75 mm weighing 805grams
  • Cavity 140 x 80 x 40 mm
  • Prominent vessels on the surface
  • No normal testicular tissue
  • Left tumour intact; right tumour partly removed
99
Q

MIXED GERM CELL TUMOUR: Lt testis and part of residual right testis

A
100
Q

Mixed Germ Cell Tumour

A
101
Q

The slides show mixed germ cell tumour containing …

A
  • Choriocarcinoma (A) - raised HCG
  • Seminoma (B)
  • Embryonal carcinoma (C) - raised AFP
102
Q

Choriocarcinoma in a Mixed Germ Cell Tumour

A
103
Q

Prognostic Factors - Testicular Cancer

  • Type of tumour e.g. … has a good prognosis
  • TNM stage = … , …, …
  • Size of tumour (… stage)
  • Extension outside the testis (… stage)
  • Presence of vascular invasion – enables spread to LN and other organs
  • Lymph node metastasis ( … stage)
  • Distant metastases to liver or lung (… stage)
  • High levels of tumour markers in the blood indicates high tumour load
A
  • Type of tumour e.g. seminona has a good prognosis
  • TNM stage = Tumour , Node, Metastasis
  • Size of tumour (T stage)
  • Extension outside the testis (T stage)
  • Presence of vascular invasion – enables spread to LN and other organs
  • Lymph node metastasis ( N stage)
  • Distant metastases to liver or lung ( M stage)
  • High levels of tumour markers in the blood indicates high tumour load
104
Q

Prognosis of testicular cancer depends on the type - what type has a good prognosis?

A

seminoma

105
Q

What staging system is used for testicular tumours?

A

TNM stage = Tumour , Node, Metastasis

106
Q

TNM stage = …,…,…

A

TNM stage = Tumour , Node, Metastasis

107
Q

TNM (Tumour , Node, Metastasis) staging - Testis

  • Size of tumour (… stage)
  • Extension outside the testis (… stage)
  • Presence of vascular invasion – enables spread to LN and other organs
  • Lymph node metastasis (… stage)
  • Distant metastases to liver or lung (… stage)
A
  • Size of tumour (T stage)
  • Extension outside the testis (T stage)
  • Presence of vascular invasion – enables spread to LN and other organs
  • Lymph node metastasis (N stage)
  • Distant metastases to liver or lung (M stage)
108
Q

Staging of Testicular Cancer TNM

A
109
Q

Treatment - Testicular Cancer

  • Radical … with isolated testicular mass followed by adjuvant …
  • If metastases are present at the time of presentation patients receive neo-adjuvant chemotherapy then orchidectomy
  • There maybe no tumour in the removed testis on pathological examination which is termed .. .. response to chemotherapy
  • Patients are offered … … prior to orchidectomy
  • Patients are offered a … after orchidectomy
A
  • Radical orchidectomy with isolated testicular mass followed by adjuvant chemotherapy
  • If metastases are present at the time of presentation patients receive neo-adjuvant chemotherapy then orchidectomy
  • There maybe no tumour in the removed testis on pathological examination which is termed complete pathologic response to chemotherapy
  • Patients are offered sperm banking prior to orchidectomy
  • Patients are offered a prosthesis after orchidectomy
110
Q

What is complete pathologic response to chemotherapy?

A

When there is no tumour found in the removed testis on pathological examination (after a testicular cancer and chemo)

111
Q

Take Home Message - Pathology of the Testis

  • Distinguish between acute …-orchitis and …
  • Painless testicular lump is … until proved otherwise
  • Testicular tumours classified as … cell and non-… cell
  • … is the most common germ cell tumour
  • … … important for diagnosis and monitoring testicular cancers
A
  • Distinguish between acute epididymo-orchitis and torsion
  • Painless testicular lump is cancer until proved otherwise
  • Testicular tumours classified as germ cell and non-germ cell
  • Seminoma is the most common germ cell tumour
  • Tumour markers important for diagnosis and monitoring testicular cancers

Year 2 Medicine (162 decks)

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