Testicular tumor

Question 2

Stem1.A 32-year-old male presented with Rt groin lump; firm non tender for a month O/E testicle not palpable in scrotum. US. 6cm partially cystic & solid mass at internal ring extending into abdomen & local soft tissue. No other pathology seen.
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Q1. Deferential diagnosis?

Answer 2

Groin lump  Inguinal LN / Femoral art aneurysm / Hematoma / Lipoma /Inguinal hernia / Teratoma / Testicular Tumor

Question 3

Orchidectomy & bone biopsy from a suspicious region done & pathology report came as follows: Testicular teratoma with involved margins, local tissue, lymphatic & skeletal invasion.
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Q2. Discus this pathology report with the family in simple lines.

Answer 3

Testicular Tumor but not totally removed and It’s spreading locally breaching bone and lymphatic glands. and pt might need another surgery and chemotherapy

Question 4

Q3. To where dose teratoma initially spread?

Answer 4

By Hematogenous route / Intially to Para-aortic LNs

Question 5

Q4. Types of testicular tumors according to age groups?

Answer 5

20-30 Teratoma
30-40 Seminoma
>60 Lymphoma
– Other classification: Germ (Seminoma and Non-Sem) and Non-Germ Cell tumor

Question 6

Q6.What tissue section Immunohistochemical marker confirm diagnosis of choriocarcinoma?

Answer 6

Beta-HCG

Question 6

Q5. What’s choriocarcinoma?

Answer 6

Malignant Teratomtous neoplasm with placental differentiation

Question 7

Q7.Other type of malignancy at this age?

Answer 7

Seminomas

Question 8

Q8.What’s alpha fetoprotein?

Answer 8

It’s a ptn produced by yolk sac of the fetus may indicate yolk sac differentiated teratomas because of that it could be an indicator for teratomas tumors

Question 9

Q9. Mention another non germ tumour with high a. fetoprotein?

Answer 9

HCC

Question 10

Q10.What’s the value of LDH in testicular cancer?

Answer 10

It reflects tumor load and rate of growth of testicular cancer and response to ttt

Question 11

Q11. Post-Op he developed haematoma. What are the stages of haematoma resolutions?

Answer 11

First of one week –> lysis of hematoma by macrophages
Two week following –> growth of fibroblast

Question 12

Q12. After few month he developed small pneumothorax. Cause?

Answer 12

Lung mets from Test. Canc.

Question 13

Q13. Define metastasis?

Answer 13

Growth and survival of cells from a site distant form their primary origin

Question 14

Stem 2: A 69 year old male presented with bilateral groin lumps; firm non tender for a month Gray scale and color Doppler ultrasound findings include diffuse testicular infiltration, enlargement with hypervascularity or multifocal areas of hypoechoic, solid and hypervascular nodules within testes . Orchidectomy done & testicles found White tan pink & fleshy.

Pathology report . Malignant cells are pleomorphic and non-cohesive with large irregular nuclei and prominent nuclcoli with vascular invasion and sclerosis of seminiferous tubules. No intratubular germ cell neoplasia. The neoplastic cells typically express CD20

Q14. On the light of the pathology report given what’s the diagnosis?

Answer 14

Testicular lymphoma

Question 15

Q15. Talk about other classification of testicular tumours & give an example for each.

Answer 15

Germ Cell
-Seminoma (Classical, Spermatocystic, anaplastic)
-Non-Seminomatous (Yolk sac, Choriocarcinoma, Teratoma, Embryonal)
Non-Germ Cell
-Sex cord Stromal ( Leydig , Sertoli)
-Others (Lymphoma, Mets)

Question 16

Q16. Describe the microscopic morphology of testicular teratoma Vs seminoma?

Answer 16

Teratoma Various diff. types of cells and could originate from any primitive tissue.
Seminoma Sheets of uniform cell divided into lobules by delicate fibrous septa, call are large and rounded nucleus and prominent nucleoli

Question 17

He presented with PE a year later & found to have large mass at the region of para-aortic LNs compressing renal vessels. Debulking surgery done , but tumour can’t be totally resected.

Q17. Frozen section showed thyroid tissue. Why?

Answer 17

As teratoma could be differentiated from any type of tissue in the body.

Question 18

Q18. Explain finding in adenocarcinoma.

Answer 18

Epithelial differentiation and subsequent malig. Transformation of epithelial differentiated lineage

Question 19

Q19. What’s the composition of PE?

Answer 19

Platelets / Fibrin / circulating cells

Question 20

Q20. Which clotting factor allowing polymerization of fibrin? Explain coagulation cascade.

Answer 20

Int. Path; Enodthelial injury – > activate F12– >F11 – > F9 – F10 –Thromboplastin into thrombin – Fibrinogen to fibrin and formation of clot.
Ext. Path; tissue injury – > sctivste F7 – > F10 in presence of F5/Ca+

Question 21

Q21.What cause PE in this patient? Explain.

Answer 21

• Tumor affecting locally on blood vess or systemically on clotting factors (Alteration)
• Venous stasis as effect of the mass on blood vessel
  -Hypercoagulability status in malignancy also

Question 22

Q22. Where could a Beta-hcg found in a normal male?

Answer 22

In the seminal fluid in very minimal amount