Testicular tumours Flashcards
What is the simplest way to differentiate clinically between a testicular mass and hydrocele?
- Tumour cannot be transilluminated
- Hydrocele can be transilluminated
Why are testicular tumors not biopsied?
- Risk of seeding scrotum
- Majority are malignant
What percentage of testicular tumours are germ cell tumours?
> 95%
What are risk factors for developing germ cell tumors of testes?
- Cryptorchidism
- Klinefelter syndrome
How can germ cell tumours of the testes be divided?
Into seminoma and nonseminoma
What is the most common testicular cancer in older males?
Primary testicular lymphoma
What type of germ cell tumour has placental components?
Choriocarcinoma (large increase in hCG)
What do seminomas respond well to?
Radiotherapy - excellent prognosis and metastasizes late
Seminoma looks like what on histology?
- Large cells w. clear cytoplasm and central nuclei
- Fried egg appearance (like dysgerminoma of ovary)
Does seminoma produce Beta-hCG?
rarely
Are seminomas hemogenous?
Yes
Do seminomas have hemorrhage or necrosis?
No
What type of testicular tumour may have early hematogenous spread?
Embryonal carcinoma
What kind of mass is embryonal carcinoma?
Hemorrhagic
What percentage of testicular tumors are sex cord stromal tumors?
5% - mostly benign
- Develop from embryonic sex cord (develop into Sertoli and Leydig cells)
What kind of germ cell tumour causes an increase in placental ALP?
Seminoma
What are the levels of PALP, AFP and B-hCG in an embryonal carcinoma?
- PALP normal
- AFP (only increased if mixed tumor)
- B-hCG increased
Are embryonal carcinomas usually mixed?
Yes - hence they will usually present with increased AFP
In what kind of people are teratomas more likely to be malignant?
Adult males
What can a yolk sac tumor also be known as?
Endodermal sinus tumor
Is a yolk sac tumor aggressive?
Yes - malignant
What is the most common testicular tumor in children? <3 years old?
Yolk sac tumor
What can be seen on histology in yolk sac tumors?
Schiller-Duval bodies
- Resemble primitive glomeruli
What causes choriocarcinoma to often have features of hyperthyroidism and gynecomastia?
- Increase in B-hCG
- alpha-subunit of hCG is identical to alpha-subunit of LH, FSH, TSH
What do Leydig cells look like?
Golden brown color; contains Reinke crystals (eosinophilic cytoplasmic inclusions)
What are possible symptoms of a Leydig cell tumour?
Produce androgens or estrogens
- Precocious puberty, gynaecomastia
What else can a Sertoli or Leydig cell tumor be called?
Androblastoma (arises from sex cord stroma)
What is a primary testicular lymphoma typically?
Diffuse large B-cell lymphoma - malignant and aggressive
What other tumors other than choriocarcinoma may have an increase in B-hCG?
- Embryonal carcinoma
- Seminoma and yolk sac tumor (less so)
What tumors may have a raised AFP?
- Yolk sac
- Teratoma (less so)
- Embryonal carcinoma (when mixed)
