Testicular Tumours

Question 1

Risk Factors

Answer 1

1. Cryptocorchidism
2. HIV Infection
3. Gonadal Dysgenesis

Question 2

Clinical Presentation

Answer 2

1. Asymptomatic enlarging testicular mass/ dull ache in one testes in young man (15 - 35)
2. 10% have painful testes (due to infarct or hemorrhage)
3. May even present as back pain (if para-aortic nodes infiltrated with metastases

-PE-
1. Inseparable from testis, distinct from superfdicial inguinal ring (cant get above mass)
2. Hard, nodular, irregular, non. tender
3. Non transilluminable

Question 3

DDx

Answer 3

Chronic infection with scarring (orchitis/ TB)
Long standing hydrocele with calcification

Question 4

Investigations

Answer 4

1. No role for perc biopsy - risk of seeding/changing lymphatic drainage
2. U/S scrotum - seminoma is a hypoechoic intratesticular mass; nonseminoma = inhomogenous lesion
3. Tumour markers - LDH (assess tumour burden), AFP, B-HCG
4. Staging
   - CT TAP
   – Styage 1 = testes lesion, nil nodes
   - Stage 2 = Nodes below diaphragm
   - Stage 3 = Nodes above diaphragm
   - Stage 4 = Pulmonary and Hepatic Mets

Question 6

Classification of tumour

Answer 6

1. Germ cell tumours
2. Sex cord stroma tumours
3. Secondary Testicular Tumour (lymphoma, leukemia)

Question 7

According to examples, age, releavnt tumour markers, early treatment, disseminated treatment, prognosis, distinguish the types of germ cell tumours.

Answer 7

Question 8

What is a paraneoplastic presentation of testicular tumours and why?

Answer 8

Hyperthyroidism. Tumour marker HCG has a structure similar to TSH

Question 9

What surgery can be performed for testicular tumouyrs?

Answer 9

Radical Orchidectomy via Inguinal Apporach +/- Retroperitoneal LN dissection with combination chemotherapy
- no violation of scrrotal skin as risk of altering the lymphatic drainage of testis
- Intra-op, perform early clumping of testicular artery & vein within the spermatic cord before testis is mobilised out of the scrotum to prevent intraoperative seeding of tumour up testicular vein

Question 10

What are the types of nonseminomatous germ cell tumours

Answer 10

1. Embryonal Carcinoma - immature primitive cells ; presenting with bulky mass with hemorrhager and necrosis, AFP elevated
2. Choriocarcinoma: a/w widespread mets at diagnosis; in males 15-20; present as small tumour that has extensive hemorrhage and necrosis, gynaecomastai and ss of hyperthyroid
3. Yolk Sac Tumours: AFP elevated, in children
4. Teratoma
5. Mixed Germ Cell Tumour (worst prognosis)

Question 11

What are types of sex cord stroma tumours

Answer 11

1. Leydig cell tumour: p/w gynaecomastia in adults; in children with precocious puberty (due to excessive androgen and estrogen pdtn) characterised by golden brown testicular tumour, large uniform cellls with indistincct cell borders; and pale-staining rod-shaped inclusion known as crystals of Reinke
2. Sertoli cell tumour : a/w gynaecomastia
3. Granuolsa cell tumour