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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
Cryptorchidism/undescended testis increases the risk of cancer ..-... times
Cryptorchidism/undescended testis increases the risk of cancer **4 – 8** times
26
Can Genitic abnormalities cause testicular cancer?
Yes - Klinefelter’s syndrome (47XXY) & Down’s syndrome (trisomy 21)
27
Do First degree relatives of those with testicular cancer have a higher risk than the general population?
Yes
28
Exposure to oestrogens (diethylstilbestrol) in utero → cryptorchidism→ ... the risk of testicular cancer
Exposure to oestrogens (diethylstilbestrol) in utero → cryptorchidism→ **increases** the risk of testicular cancer
29
Atrophic Undescended Testis: -\> ... risk of testicular cancer
Atrophic Undescended Testis: -\> **Increased** risk of testicular cancer
30
_Classification of Testicular Tumours_ * Either classified as ... cell tumours or ... .../ ... tumours
Either classified as **germ** cell tumours or **sex cord/stromal** tumours
31
_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
* 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)
32
_Seminomatous tumours (Germ Cell tumours)_ * 2 types: * ... seminoma * ... seminoma
* **Classical** seminoma * **Spermatocytic** seminoma
33
_Non-seminomatous tumours - (Germ Cell Tumours)_ * _4 types:_ * E.. carcinoma * ... ... tumour * C... * T...
* **Embryonal** carcinoma * **Yolk** sac tumour * **Choriocarcinoma** * **Teratoma**
34
Sex cord/ stromal tumours account for less than ...% of testicular tumours
**less than 5**% (leydig cell tumours, sertoli cell tumours)
35
_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
* 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
36
More than ...% of cancers of the testis arise in germ cells
More than **90**% of cancers of the testis arise in germ cells
37
Germ cells produce the ...
Germ cells produce the **sperm**
38
Germ cell tumours are divided into ... and non-...
Germ cell tumours are divided into **seminomas** and non-**seminomatous**
39
Mixed germ cell tumours consists of ... and non-... components
Mixed germ cell tumours consists of **seminoma** and non-**seminomatous** components
40
Germ cell carcinoma in ... or intra-tubular germ cell ... is the precursor lesion
Germ cell carcinoma in **situ** or intra-tubular germ cell **neoplasia** is the precursor lesion
41
Seminomas tend to grow and spread more ... than non-seminomatous tumours
Seminomas tend to grow and spread more **slowly** than non-seminomatous tumours
42
_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
* 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
43
_Classical Seminoma:_ * Constitutes more than ....% of seminomas * Affect men between ... and ... years of age * Tumours markers can be ... or ...
* Constitutes more than **95**% of seminomas * Affect men between **25** and **45** years of age * Tumours markers can be **normal** or **raised**
44
What sub-type of seminomas affect men between 25 and 45?
Classical seminoma
45
What sub-type of seminoma constitutes more than 95% of seminomas?
Classical seminoma
46
In a classical seminoma, tumour markers can be ...
Tumours markers can be **normal** or **raised**
47
_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
* 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
What sub-type of seminomas affect older men?
Spermatocytic Seminoma/tumour
49
What sub-type of seminomas grow more slowly? and are less likely to spread to other parts of the body?
Spermatocytic seminomas/tumour
50
_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...
* 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
Non-seminomatous germ cell tumours usually occur in men of what age?
late teens and early 30's
52
_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
* 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
Embryonal Carcinoma is present in about ...% of all tumours, but ... embryonal carcinoma occurs in only 3% to 4% of cases
Embryonal Carcinoma is present in about **40**% of all tumours, but **pure** embryonal carcinoma occurs in only 3% to 4% of cases
54
Embryonal Carcinoma tend to grow ... and ... ... the testis
Embryonal Carcinoma tend to grow **rapidly** and **spread outside** the testis
55
_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 ...
* 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
What is the most common form of testicular cancer in children?
Yolk sac carcinoma/tumour (germ cell - non-seminomatous)
57
What type of testicular cancer has better prognosis in children than adults? (germ cell...)
Yolk sac carcinoma/tumour (germ cell - non-seminomatous)
58
_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 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
Is Choriocarcinoma a common testicular cancer in adults?
No - very rare and fast-growing testicular cancer
60
Do pure choriocarcinoma spread to other parts outside of the testis?
Yes - Pure choriocarcinoma tends to spread **rapidly** to other parts of the body, including the **lungs, bones, and brain**
61
Choriocarcinomas are usually present in what type of germ cell tumour ?
mixed germ cell tumour - with associated haemorrhage
62
_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.
* **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
_Teratoma - Testis_ * Derived from 3 germ cell layers of the embryo * –... (innermost layer) * –... (middle layer) * –... (outer layer)
* Derived from 3 germ cell layers of the embryo * –**Endoderm** (innermost layer) * –**Mesoderm** (middle layer) * –**Ectoderm** (outer layer)
64
Are pure teratomas of the testicles common or rare?
Pure teratomas of the testicles are **rare**
65
Teratoma Testis - Most teratomas are components of ... germ cell tumours
Teratoma Testis - Most teratomas are components of **mixed** germ cell tumours
66
Teratoma Testis - no increase in ...
Teratoma Testis - no increase in **tumour markers**
67
What Germ Cell Testicular tumour has no increase in tumour markers?
Teratoma (a non-seminomatous germ cell tumour)
68
What are the two types of teratoma? (testis)
mature teratoma and immature teratoma
69
_Mature teratoma_ * Tumours are formed by cells similar to ... tissues * They ... spread, can usually be cured with ..., but may ... after treatment
* Tumours are formed by cells similar to **adult** tissues * They **rarely** spread, can usually be cured with **surgery**, but may **recur** after treatment
70
_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.
* 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
Which type of teratoma is more likely to invade nearby tissue, metastasise outside the testis and recur after treatment? (mature or immature?)
Immature teratoma
72
Dermoid cyst/mature cystic teratoma of the ovary is ..., testicular teratomas are always ...
Dermoid cyst/mature cystic teratoma of the ovary is **benign**, testicular teratomas are always **malignant**
73
Are testicular teratomas always malignant?
Yes
74
_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
* 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
Any painless swelling or nodule in the testis is ... until proved otherwise
Any painless swelling or nodule in the testis is **cancer** until proved otherwise
76
* 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
* **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
_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
* **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
_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 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
A CT scan is used for testicular cancer imaging to assess what?
CT scan: chest, abdomen and pelvis to assess for **metastases** in the lymph nodes, liver and lungs
80
An MRI is done of the ... and ... if ... is suspected (testicular cancer)
An MRI is done of the **brain** and **bone** if **metastasis** is suspected (testicular cancer)
81
... scan is used for recurrent disease after treatment lesions appear ‘hot’ when there is viable cancer (testicular cancer)
**PET** scan for recurrent disease after treatment lesions appear ‘hot’ when there is viable cancer
82
Testicular tumours produce ... ... (TMs) not normally present in the blood
Testicular tumours produce **tumour markers** (TMs) not normally present in the blood
83
Positive Tumour Markers aid in making a diagnosis of cancer in the presence of a ... mass
Positive TMs aid in making a diagnosis of cancer in the presence of a **testicular** mass
84
_Tumour Markers in Testicular Cancer_ * Different tumours secrete specific TMs * ...-... (AFP) - yolk sac tumour, embryonal carcinoma * ... ... ... (HCG) - Choriocarcinoma, embryonal carcinoma, seminoma * ... .... (LDH) - seminoma
* 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
Alpha-fetoprotein (AFP) (tumour marker) is secreted in ... and ... tumours
Alpha-fetoprotein (AFP) (tumour marker) is secreted in **yolk sac tumour, embryonal carcinoma**
86
Human chorionic gonadotropin (HCG) is secreted in 3 types of testicular tumour...
Human chorionic gonadotropin (HCG) is secreted in 3 types of testicular tumour - **Choriocarcinoma, embryonal carcinoma, seminoma**
87
Lactate dehydrogenase (LDH) (tumour marker) is secreted in what testicular tumour?
Lactate dehydrogenase (LDH) - seminoma
88
All TMs are raised in a ... germ cell tumour
All TMs are raised in a **mixed** germ cell tumour
89
What is used for follow-up of patients after therapy (testicular cancer?)
**Tumour Markers** used for follow-up of patients after therapy
90
_Case Report: Seminoma_
*
91
What tumour marker is secreted by seminomas?
Lactate dehydrogenase
92
_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
* 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
_Microscopic Appearance of Seminoma_
94
Early Seminoma vs Advanced Seminoma
95
_Case Report: Teratoma_
96
_Macroscopic Appearance - Early Teratoma_
97
_Microscopic Appearance - Early Teratoma_
98
_Case Report: Mixed Germ Cell Tumour_
* 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
_MIXED GERM CELL TUMOUR: Lt testis and part of residual right testis_
100
_Mixed Germ Cell Tumour_
101
The slides show mixed germ cell tumour containing ...
* Choriocarcinoma (A) - raised HCG * Seminoma (B) * Embryonal carcinoma (C) - raised AFP
102
_Choriocarcinoma in a Mixed Germ Cell Tumour_
103
_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
* 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
Prognosis of testicular cancer depends on the type - what type has a good prognosis?
seminoma
105
What staging system is used for testicular tumours?
TNM stage = Tumour , Node, Metastasis
106
TNM stage = ...,...,...
TNM stage = **Tumour , Node, Metastasis**
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_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)
* 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)**
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_Staging of Testicular Cancer TNM_
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_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
* 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
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What is complete pathologic response to chemotherapy?
When there is no tumour found in the removed testis on pathological examination (after a testicular cancer and chemo)
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_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
* 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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