Testicular tumors

1. Testicular
Tumors

2. Testicular Tumors
• Testicular cancer represents 1% of all
cancers in men.

3. Testicular Tumors
Classification:
1. Germ cell tumors (GCTs): (95%) of primary testicular tumors.
a. Seminomas (45%).
b. Non-seminomas (50%): mixed GCTs (40%), Teratomas and teratocarcinomas
(30%) Embryonal cell carcinoma (20%). Choriocarcinoma (1%). Yolk sac
tumors
2. Gonadal Stromal Tumors: Leydig cell tumors and Sertoli cell tumor.
3. Secondary Tumors: Lymphoma, leukemia, and melanoma are the
most common malignancies that metastasize to the testicle.

4. Testicular Tumors
Age:
• First Decade → Yolk Sac Tumors – Teratomas.
• Second & Third Decade → Teratoma & Choriocarcinoma.
• Forth And Fifth Decade → Seminoma.

5. Testicular Tumors
Tumors Markers:
• Alpha Fetoprotein → All Yolk Sac Tumors – 75% Of Embryonal
Carcinoma.
• Human Chorionic Gonadotrophin (hCG) → All
Choriocarcinoma - 60% Embryonal Carcinoma.

6. Testicular Tumors
Spread:
• Lymphatic Spread.
• Hematogenous Spread.
• Local.

7. Testicular Tumors
Clinical:
• Asymptomatic.
• Mass.
• Metastasis.
• Hormonal disturbance.

8. Imaging

9. Testicular Tumors
Plain X-Ray:
• Metastasis.

10. Testicular Tumors
CT:
• Staging

11. Testicular Tumors
MRI:
• Homogeneously hypointense on T2-weighted
images. Larger tumors may be more heterogeneous.

12. Testicular Tumors
US:
• Hypoechoic relative to
the surrounding
parenchyma.

13. Testicular Tumors
US:
• Seminomas are well defined within the tunica
albuginea and homogeneously hypoechoic

14. Testicular Tumors
US:
• Nonseminomatous lesions are more often cystic with
interspersed areas of calcification.

15. Testicular Tumors
US:
• Embryonal cell cancers are heterogeneous.
• The borders of the tumor are less distinct.
• More aggressive in behavior.
• The tunica albuginea may be invaded.

16. Testicular Tumors
US:
• Embryonal cell cancers.

17. Testicular Tumors
US:
Yolk Sac Tumor:
• Imaging findings are
nonspecific,especially in children,
in whom the only finding may be
testicular enlargement without a
defined mass.

18. Testicular Tumors
US:
Teratoma:
• Well-circumscribed complex
masses.
• Cysts are a common feature and
may be anechoic or complex,
depending on the cyst contents (ie,
serous, mucoid, or keratinous fluid)

19. Testicular Tumors
US:
• Choriocarcinomas are often
heterogeneous with multiple
internal calcifications present.

20. Testicular Tumors
US:
• Leydig and Sertoli cell, are
generally well defined and
hypoechoic.
• Calcifications are frequently
described.

21. Testicular Tumors
US:
• Testicular lymphoma generally
appears as discrete hypoechoic
lesions, which may completely
infiltrate the testicle &
epididymis.

22. Testicular Tumors
“Burned-out" Germ Cell Tumor
• The patient may present with
widespread metastases even
though the primary tumor has
involuted.

23. Testicular Tumors
“Burned-out" Germ Cell Tumor
• The pathogenesis of this
phenomenon may be that the
high metabolic rate of the tumor
causes it to rapidly outgrow its
blood supply.

24. Testicular Tumors
“Burned-out" Germ Cell Tumor
• These tumors are clinically
occult, with the testis being
normal to small upon
palpation.

25. Testicular Tumors
“Burned-out" Germ Cell Tumor
• US plays a vital role in the search
for the primary regressed tumor.
• These primary tumors have a
variable appearance. They are
generally small and can be
hypoechoic, hyperechoic, or
merely an area of focal
calcification.