Testicular tumors are rare and are mostly germ cell tumors. Seminomas and non-seminomatous germ cell tumors are the main types. Risk factors include undescended testes. Staging involves tumor markers, imaging and pathology. Treatment depends on tumor type and stage but may include surgery, chemotherapy and radiation. Prognosis is generally good even for high stage disease, with survival rates over 90% for stage I seminoma and non-seminoma.

1. TESTICULAR TUMORS

2. EPIDEMIOLOGY
 Rare tumours
 Germ cell tumours – 90 – 95 %
 Non – germ cell tumours – 5 – 10 %
 more common in white
 More common in socio-economic classes
 Slightly more common on right side 1 – 2 % are
bilateral

3. RISK FACTORS
 Undescended testes

4. HISTOLOGICAL CLASSIFICATION
 Seminomas 35 %
 Non-Seminomatoos germ cell tumours
(NSGCT)
 Embryonal cell carcinoma 20 %
 Teratoma 5 %
 chorio carcinoma < 1 %
 Mixed cell type 40 %
 Carcinoma in situ

5. TUMORIGENIC MODEL FOR
GERM CELL TUMOURS
 DIAGRAM

6. PATHOLOGY
 Seminoma (3 Histological Types)
 Classic seminoma 85 %
 Common age of 4th decade
 Cut surface smooth similar surface
 Microscopic mono tonon’s sheets of large cells with clear
cytoplasm and densely staining nuclei
 Anaplastic Seminoma 5 – 10 %
 Higher degree of nuclear pleomorplism
 Diagnosis requires presence of 3 or more mitoses per high
power field.

7. PATHOLOGY (Contd.)
 Spermoaytic se,inoma 5 – 10 %
 Densely staining cytoplasm and round nuclei that contains
condensed chronatics
 Presents in older age > 50 years

8. EMBRYONAL CELL CARCINOMA
Two variants
 Adult type
 Infertile type (Yolk soe tomour)

9. EMBRYONAL CELL CARCINOMA (Contd.)
 Adult type
 Married pleomorplism
 Indistinct cellular borders
 Mitotic figures are complex
 Infertile type (Yolk Soe tumor)
 Most common testicular tumor of infants and
children
 Produce Alpha foctoprofin (AFP) abundance
 Vacuolated cytoplasm
 Embryoid bodies are commonly seen

10. TERATOMA
 Common in 15-25 year age group
 Contains more than one germ cell layer in
various stages of materaties and differentiates
 Grossly tumor is lobalotes and contains variable
size cysts filled with numerous materials
 Mature teratomas have elements resembling
benign shortness derived from ectoderm,
mesoderm or endoderm and in counterpart of
dysgeseninoma of ovary.

11. ?
 Chorio Carcinoma
 Microscopically syneytiotrophosphate and cyto
drophoblasis are seen
 Aggressire tumors with easily blood spread
 Mixed cer tumors
 Terato carcinoma (teratoma and embrynal cell)
 Terato seminoma carcinoma (tratoma and
saminoma)

12. ?
 Carcinoma in Situ (cis)
 5 % of cases testicular tumor have cis in contralateral
testis
 If microcallification in noted in other testis, then
biopsy is medicated
 Cis is treated by Radiothempy

13. SPREAD OF TUMOR
 Lymphatic spread
 Stepwise lymphatic spread
 Para aortic lymphatic in renal hilum area is the first
lymph nods
 For Rt side, pre caval pre aortic para
caval right common iliac right iliac
lymph nodes
 For Lt sided tumor, para aortic pre aortic
left common iliac and left external iliac lymph
nods

14. SPREAD OF TUMOR (Contd.)
 If epididymis or spermatic cord is involved, than
spread to distal external iliac and obtrerative lymph
node occur
 Important of serotum result in inguinal lymph node
metastasis
 Hamealogenous spread
 To viscera vicluaals
 Lung, liver, bone, kidney, adrenal got and spleen
 Charioeariuane as a rule has early haemotoguous
spread and involve un usual sites like spleen

15. CLINICAL STAGING
 Pic in book

16. CLINICAL FINDINGS
 Symptoms
 Painless enlargement of testis
 Importance oc patient awareness and self
examination
 Pain in only in 10 % cases
 Symptoms related to metastasis
 Back pain (retropintonial metastasis involving nerve roots)
 Cough or dyspnoea (pulmonary metastasis)
 Anorexia, nausea, vomiting (retroduodenal metastasis)
 Bone pain (skeletal metastasis)
 Lower, lirals (vena caval obstructions)
 Asymptromatic 10%

17. SIGNS
 Scrotal examination
 Testicular mass or difference enlargement
 Firm, non-tender
 Secondary hydrcode in some cases
 Abdominal examination
 Palpable retropintonial lymph node masses
 Supradanicolor lymphoduripathy
 Inguinal lymphaduipnthy
 Gynaecorrastia
 Signs of inferior rena carol obstructies

18. LABORATORY FINDINGS
 Anemia
 Deranged LFT (liver metastasis)
 Azotomia (ureteric obstructs)
 Tumor Markers
 AFP (appha focta proteins)
 BhCG (human chorinomic gonadotrophins)
 LDH (Latic dehydrogenase)
 AFP is elerrted in non-seminarratous germs cees
tumours. It is never elevated in seminones

19. LABORATORY FINDINGS
 BHCG and LDH are also elevated in non-
seminomas but in 7 % of cases BHCG is elevated in
seminomas as well
 BHCG is diagnostic of chorio carcinomas

20. RADIOLOGICAL STUDIES
 Scrotal ultrasound
 X-ray chest
 CT scan abdomen and pelvis
 Pocdal lymphangioeymphy (raroly used)

21. DIFFERENTIAL DIAGNOSIS
 Epididymoordutis
 hydorcode
 Spermathocode
 Hematocode
 Granulomatovs orchitas
 varicocode

22. Treatment
 inguinal exploration with cross-clamping of the
spermatic cord and delivery of the testis into the
field is the mainstay of exploration followed by
radical orchiectomy.
 scrotal approaches and open testicular biopsies
should be avoided
 Further treatment depends on histology of
tumor and its clinical stage

23. LOW STAGE SEMINOMA (I, II-A)
 Highly radiosensitive
 95 % of stage I seminoma are cured by radical
ordriectomy amd retroperyomal irradiaties
 Chemotherapy is reserved for patients who
relapse following irradiation.
 High stage seminoma (II-B, III)
 Chemotherapy is the primary form of treatment
 Cisplatius + Etoposide + bleomycin
 90 % of patients with stage III disease achieves
complete response with chemotherapy
 Residual retroperitonial masses sometimes requires
retropentoneal lymphadeneatomy

24. LOW STAGE NON-SEMINOMATOUS
GERM CELL TUMORS
Options are: -
 Radical ordicetomy + Surveillance
Indications
 Stage I only
 Tumor markers should normalize after ordiectomy
 Radiological imaging does not slow any evidence of
metastasis
 Reliable patient

25. LOW STAGE NON-SEMINOMATOUS
GERM CELL TUMORS (Contd.)
 Servallance includes monthly follow up for 2
years and 2 monthly for 3rd year.
 At each visit tumor markers and added and CT
scan every 3 – 4 months CXR

26. ?
 Radical ordiotomy and Retroparitomal lymph
node disseere (RPLAND)
 Commonly diva in USA
 Node positive patients then require chemotherapy
 Significant morbioitmy
 Infertility due to sympathetic nerves disruption
 Modified RPLAND

27. HIGH STAGE NON SEMINOMAIOUS
GERM CELL TUMORS
 With with bulky retropevitomal disease
primary cis-plalium based combination
chemotherapy
 Retropevitomal lymphadeveetomy for residval
masses
 Maligiant toratoma is irresponsive to
chemotherapy
 Complieaharis of uiclvale sepsis, nemopathy
reveal toxicity

28. FOLLOW UP
 3 monthly 2 years
 Then every 6 month x 3 years
 Then yearly
 At each visit
 Examination of remaining tests
 Abdominal examination
 Lymph nodes examination
 Tumor
 Chest X-ray
 Abdominal ultrasound

29. PROGNOSIS
Survival rates are
 Seminoma
 Stage I - 98%
 Stage II - 92 %
 High Stages - 35 – 75 %
 Non Seminomas
 Stage I - 96 – 100 %
 Stage II - 90 %
 High Stages - 55 – 80 %

30. Non-Germ Cell Testicular Tumors
 5 – 6 % of all testicals tumors
 3 types
 Leydig cell tumor
 Sertoli cell tumor
 Gonadoblastomas

31. LEYDIG CELL TUMORS
 Most common non-germ cell testicular tumor
 1 – 3 % of all testicular tumors
 5 – 10 % are bilateral
 Cut surface is small, yellow well circumscribed
lesion, without haemorhages or necrosis
 Microscopically fusifrue shaped cytoplasmic
indusion bodies (reinke crystnis) are
pathognomoic

32. LEYDIG CELL TUMORS (contd.)
 Prepubcobl children present with virilization
 Benign tumor
 Gynaeienastia 20 – 25 % adults
 serum and arivary 17–Ketostoroial
 Radical ordriectomy

33. SERTOLI CELL TUMORS
 Exceedingly rare tumors
 Approximately 10 % are malignant
 Testicular mass is the most common
preseabitron
 Virilization in children and gynaecomasia in
adults
 Radical ordncotomy
 R PLAND if malignant

34. GONADO BLASTOMAS
 Exclusively seen in patients coslt some forms of
gonadal dysgenesis
 Microscopically all 3 cell types are seen (sertoli
cell, interstitial cells, germ cells)
 50 % case are bilateral
 Bilateral orshicatomy is indicated

35. Secondary Tumor of The Testis
 Lymphome
 Leureaeuic (Acute lymphocytic
)
 Metastatic tumors (CA Prostate, CA lmag, GI
cancers, malignant melanoma, CA kidney)

37. THANK YOU