Testicular Tumours

Part 1

Vinod Jain

02.09.2014
 Testicular Tumours
• Classification
• Incidence
• Etiology
• Spread of tumour
• Clinical Staging
• Clinical features
• Differential Diagnosis
• Investigations
• Treatment
• Follow up schedule

2
 Classification

Primary Tumour Secondary Tumour Para testicular

neoplasm

Germ Cell Non Germ Lymphona Leukaemia Metastatic

tumour Cell tumour

Seminoma Non Semimomatous Leydig cell Tm Sertoli Cell Gonadoblastoma Adeno CA of rete tests
(SGCT) (NSGCT) Tm

Terratoma Embryonal CA Chorio CA Yolk sac Mixed Tumour

Tumour
 Metastatic testicular Tumour
In decreasing order
Prostate
Lung
Gut
Melanoma
Kidney
 Incidence
• Age – most common solid tumor of men
between 20-30 years
• Race – White : Black = 4:1 in U.S.
• Side – Right > Left
• Socio-economic status – high : low = 2:1
• Geographical
• Highest in Scandinavia, Germany, Switzerland
• Intermediate – USA & UK
• Low – Africa and Asia
 Age wise incidence of
testicular tumour
Tumour Type Age group (years)
1. Seminoma 35-40
2. Pure Terratoma Pediatric age group
3. Embryonal CA 25-30
4. Chorio CA 25-35
5. Yolk sac Tumour infancy & child hood
6. Mixed terrato CA 25-30
7. Lymphoma > 50
 Etiology
• Congenital – 3-14 times common in
undescended testes
• Abnormal germ cell morphology
• Elevated temperature
• Interference with blood supply
• Gonadal dysgenesis
• Endocrine dysfunction
• Acquired
• Trauma – co incidence
 Spread of Tumour
• Local
• Lymphatic –

– Right inter aortocaval at L2  precaval  preaortic 

Right common iliac  Right ext. iliac

– Left  Paraortic at renal hilium  preaortic  common iliac

 Left ext. iliac

(Cross metastasis more common in right side tumour)

 Spread of Tumour
• Blood (Distant metastases in decreasing
order
Lung
Liver
Brain
Bone
Kidney
Adrenal
GIT
Spleen
 Clinical Staging
(Boden and Gibbs – 1971)
• Stage I (A) – confined to testis with no spread
through capsule or spermatic cord
• Stage II (B) – Clinical or radiological evidence
of spread beyond testis but with in regional
L.N.
• B1 -<2cm
• B2 -2-5cm
• B3 - >5cm
• Stage III (C) - Disseminated above diaphragm
/ visceral disease
 Clinical features
A. Presentations
• Gradually increasing lump / hardness in testis
• Abnormal sensitivity – numbness / heaviness
/ Pain
• Loss of sexual activity
• Dull ache in lower abdomen / groin
• Haemospermia
• General weakness
• Metastatic presentations (Contd.)
 Clinical features (Contd.)
- Metastatic presentations
• Cough and Dyspnoea
• Anorexia
• Nausea / Vomiting (retro duodenal LN)
• Neck mass
• Swelling lower extremity (IVC obstruction)
• Back pain (retroperitoneal L. N.)
• Gynaecomastia
• Bone pains
• Unilateral limb swelling (L.N metastasis)
B. Signs
• Local
 Differential Diagnosis
• Epidedymo-orchitis
• Testicular haematoma
• Spermatocele
• Hydrocele
• Testicular Torsion
 Investigations
• Haematological – Hb%, Bl. urea/S. creatinine,
LFT
• Tumour markers – AFP, HCG, LDH
• Scrotal Ultrasound – Usually homogenous,
hypoechoic, intra testicular mass
• X-ray chest
• CT / MRI – abdomen
 Tumour markers
NSGCT SGCT
• AFP  N
• HCG  
• LDH  
(Advanced) (Advanced)
 Let us revise
• Classification
• Incidence
• Etiology
• Spread of tumour
• Clinical Staging
• Clinical features
• Differential Diagnosis
• Investigations
----------------------------------------------------------------