Testicular tumours

Question 1

What is the simplest way to differentiate clinically between a testicular mass and hydrocele?

Answer 1

• Tumour cannot be transilluminated

- Hydrocele can be transilluminated

Question 2

Why are testicular tumors not biopsied?

Answer 2

• Risk of seeding scrotum

- Majority are malignant

Question 3

What percentage of testicular tumours are germ cell tumours?

Answer 3

> 95%

Question 4

What are risk factors for developing germ cell tumors of testes?

Answer 4

• Cryptorchidism

- Klinefelter syndrome

Question 5

How can germ cell tumours of the testes be divided?

Answer 5

Into seminoma and nonseminoma

Question 6

What is the most common testicular cancer in older males?

Answer 6

Primary testicular lymphoma

Question 7

What type of germ cell tumour has placental components?

Answer 7

Choriocarcinoma (large increase in hCG)

Question 8

What do seminomas respond well to?

Answer 8

Radiotherapy - excellent prognosis and metastasizes late

Question 9

Seminoma looks like what on histology?

Answer 9

• Large cells w. clear cytoplasm and central nuclei

- Fried egg appearance (like dysgerminoma of ovary)

Question 10

Does seminoma produce Beta-hCG?

Answer 10

rarely

Question 11

Are seminomas hemogenous?

Answer 11

Yes

Question 12

Do seminomas have hemorrhage or necrosis?

Answer 12

No

Question 13

What type of testicular tumour may have early hematogenous spread?

Answer 13

Embryonal carcinoma

Question 14

What kind of mass is embryonal carcinoma?

Answer 14

Hemorrhagic

Question 15

What percentage of testicular tumors are sex cord stromal tumors?

Answer 15

5% - mostly benign

- Develop from embryonic sex cord (develop into Sertoli and Leydig cells)

Question 16

What kind of germ cell tumour causes an increase in placental ALP?

Answer 16

Seminoma

Question 17

What are the levels of PALP, AFP and B-hCG in an embryonal carcinoma?

Answer 17

• PALP normal
• AFP (only increased if mixed tumor)
• B-hCG increased

Question 18

Are embryonal carcinomas usually mixed?

Answer 18

Yes - hence they will usually present with increased AFP

Question 19

In what kind of people are teratomas more likely to be malignant?

Answer 19

Adult males

Question 20

What can a yolk sac tumor also be known as?

Answer 20

Endodermal sinus tumor

Question 21

Is a yolk sac tumor aggressive?

Answer 21

Yes - malignant

Question 22

What is the most common testicular tumor in children? <3 years old?

Answer 22

Yolk sac tumor

Question 23

What can be seen on histology in yolk sac tumors?

Answer 23

Schiller-Duval bodies

- Resemble primitive glomeruli

Question 24

What causes choriocarcinoma to often have features of hyperthyroidism and gynecomastia?

Answer 24

• Increase in B-hCG

- alpha-subunit of hCG is identical to alpha-subunit of LH, FSH, TSH

Question 25

What do Leydig cells look like?

Answer 25

Golden brown color; contains Reinke crystals (eosinophilic cytoplasmic inclusions)

Question 26

What are possible symptoms of a Leydig cell tumour?

Answer 26

Produce androgens or estrogens

- Precocious puberty, gynaecomastia

Question 27

What else can a Sertoli or Leydig cell tumor be called?

Answer 27

Androblastoma (arises from sex cord stroma)

Question 28

What is a primary testicular lymphoma typically?

Answer 28

Diffuse large B-cell lymphoma - malignant and aggressive

Question 29

What other tumors other than choriocarcinoma may have an increase in B-hCG?

Answer 29

• Embryonal carcinoma

- Seminoma and yolk sac tumor (less so)

Question 30

What tumors may have a raised AFP?

Answer 30

• Yolk sac
• Teratoma (less so)
• Embryonal carcinoma (when mixed)