Testicular Teratoma (8)

Question 1

What is cryptorchidism?

Answer 1

Cryptorchidism is a complete or partial failure of the intra-abdominal testes to descend into the scrotal sac and is associated with testicular dysfunction and an increased risk of testicular cancer.

Question 2

What are the etiology/risk factors of cryptorchidism?

Answer 2

1. Family history
2. Low birth weight
3. Premature birth
4. High abdominal pressure (gastroschisis)
5. Down syndrome.

Question 3

Does undescended testis contribute to an increased risk of testicular cancer?

Answer 3

The cryptorchid testis carries a 3 to 5-fold higher risk for testicular cancer

Question 4

What are the other complications of cryptorchidism?

Answer 4

1. Infertility
2. Inguinal hernia
3. Testicular torsion.

Question 5

What is the management for testicular teratoma?

Answer 5

1. CT abdomen and pelvis → staging
2. Discuss in MDT
3. Orchiectomy
4. Chemotherapy
5. If nodal disease → RPLND (Retroperitoneal Lymph Node Dissection).

Question 6

What is the role of orchiopexy?

Answer 6

Reduces risk of infertility and cancer

Question 7

What are the types of germ cell tumors?

Answer 7

• eminomatous tumors: Seminoma, Spermatocytic seminoma
• Nonseminomatous tumors: Embryonal carcinoma, Yolk sac tumor, Choriocarcinoma
• Teratoma
• Sex Cord-Stromal tumors: Leydig cell tumor, Sertoli cell tumor.

Question 8

Pathology report provided
- This is cancer in the testis
- Incomplete resection
- Lymphatic spread.

Where does teratoma spread first?
Where does teratoma spread next?

Answer 8

First To the para-aortic lymph nodes.

Then Locoregional.

Question 9

What are the serological markers/blood tests for testicular cancer?

Answer 9

Biologic markers include B-HCG, AFP, Lactate dehydrogenase.

Question 10

What are the other conditions where HCG is elevated?

Answer 10

Pregnancy.

Question 11

What is the value of serum tumour markers?

Answer 11

• In the evaluation of testicular masses
• Staging of testicular germ cell tumors
• Assessing tumor burden
• Monitoring the response to therapy.

Question 12

What are the stages of hematoma resolution?

Answer 12

1. Inflammatory Phase (Days 1-3)
   
   • Attracting neutrophils and macrophages to the site.
2. Organization Phase (Days 4-7)
   
   • Macrophages begin to clear the hematoma.
   • Fibroblasts start to proliferate within the hematoma.
   • Granulation tissue (a type of vascular connective tissue) forms.
3. Reparative Phase (Week 2)
   
   • Collagen deposition.
   • Hematoma size decreases.
4. Maturation Phase (Weeks 3-4 and onwards)
   
   • The hematoma is gradually replaced by this scar tissue.
   • The hematoma color fades to a pale or yellowish hue

Question 13

What is the cause of small pneumothorax developed after a few months?

Answer 13

Lung metastasis.

Question 14

What is metastasis?

Answer 14

Survival and growth of cells at a site distant from their primary origin.

Question 15

Why does the patient have PE?

Answer 15

Venous stasis, hypercoagulable state due to cancer

Question 16

Why hypercoagulable state?

Answer 16

Tumor cells produce and secrete procoagulant/fibrinolytic substance which activates the coagulation cascade and stimulates the tissue factor production by host cell.

Question 17

What is Virchow’s triad

Answer 17

Question 18

Which part of Virchow’s triad is missing here?

Answer 18

Endothelial injury.

Question 19

What is choriocarcinoma and what is its tumor marker?

Answer 19

Choriocarcinoma is a highly malignant form of testicular tumor. Histologically, the tumors contain two cell types, syncytiotrophoblast and cytotrophoblast. The tumor marker is B-HCG.

Question 20

What is the cell origin of seminoma?

Answer 20

Most testicular germ cell tumors originate from a precursor lesion called intratubular germ cell neoplasia (ITGCN).

Question 21

Why does the histopathology for teratoma show papillary thyroid tissue and GIT adenocarcinoma?

Answer 21

Teratoma has the 3 germ cell lines (mesoderm, endoderm, ectoderm) could develop into any type of tissue