testicular tumors Flashcards
what are the basics of testicular tumors? where do they arise from? how are they diagnosed? how do they present?
arise from germ cells or sex cord stroma. presents as a firm, painless testicular mass that cannot be transilluminated. they are NOT biopsied due to risk of seeding the scrotum, but are rather removed via radial orchiectomy.
what are the most common types of testicular tumors? when does this type appear? risk factors? pathologic categorization?
germ cell tumors most common. occur btw ages of 15 and 40. risk factors are cryptorchidism and klinefelter syndrome. divided into seminoma (same as dysgerminoma) and nonseminoma. both are malignant.
seminoma vs. non-seminoma
seminoma: responds to radiotherapy, metastasizes late, and has an excellent prognosis
non-seminoma: variable response to therapy, metastasizes early
seminoma: histo, markers, presentation, prognosis, treatment
malignant tumor of large cells with clear cytoplasm and central nuclei. presents as a homogenous mass with no hemorrhage or necrosis.
rare cases produce beta-hCG. good prognosis.
tx: responds to radiotherapy
embryonal testicular carcinoma: definition, presentation, tumor markers
malignant tumor of immature primitive cells. may form glands (important!)
presents as a hemorrhage mass with necrosis.
aggressive with early hematogenous spread.
chemotherapy can cause differentiation.
may secrete alpha fetal protein (mixed especially) or beta hCG (pure)
yolk sac tumor: definition, presentation, histo
most common testicular cancer in kids.
AFP is produced.
may have shiller duval body (glomeruloid structure)
choriocarcinoma
malignant tumor of synctiotrophoblasts (make beta hCG) and cytotrophoblasts. spreads early by blood; has a small primary. beta-hCG is elevated, which may lead to hyperthyroidism (activates TSH receptors) or gynecomastia (activates FSH and LH receptors). No villus!
teratoma
MALIGNANT IN MALE adults. benign in kids.
may make AFP or beta-hCG.
mixed germ cell tumors: prognosis
most germ cell tumors are mixed. prognosis is based on the worst component.
leydig cell tumors
produce androgen. can cause precocious puberty in kids or gynecomastia in adults. characteristic reinke crystals on histology.
sertoli cell tumors
comprised of tubules and usually clinically silent.
lymphoma and testicular cancer
lymphoma is the most common cause of testicular mass in males > 60; often bilateral. usually diffuse large B-cell type
what can cause priapism?
painful sustained erection not associated with sexual stimulation or desire. may be caused by trauma, sickle cell disease (sicked RBCs get trapped in vascular channels), medications (anticoagulants), phosphodiesterase-5 inhibitors, antidepressants, alpha-blockers, cocaine.
