pathology of testicular tumours.

2. CLINICAL PATHOLOGY
The foundation of clinical medicine.
Shashidhar Venkatesh Murthy
A/Prof & Head of Pathology
College of Medicine & Dentistry
MGS4: Male Genital: Testes Tumors
CPC : Term4 Week4 - MGS 4/6
System : Male Genital System.
Topic : 1: Overview 2: STD 3: Orchitis 4: Tumours 5: Penis 6: GLS

3. 3
Testes Tumors: Features:
 Commonest tumour of young males, painless swelling.
 Etiology: Idiopathic, Undescended testes (10%, 10 times)
 Classification:
 95% Germ cell Tumours,
 Seminoma 45% - good prognosis.
 Non seminoma (NSGT) 45% - poor prognosis.
Embryonal ca, Teratoma, Chriocarcinoma,
Mixed - common
 5% Sertoli / Leydig cell tumours.
 Clinical features:
 Adults 20-40y – Seminoma.
 Children <10y – NSGT- Yolksac tum.
 Painless, dragging, unilateral, solid.
 Metastases – Para aortic LN*.

4. 4
Seminoma:
 Commonest Germ cell tumour, 20-40y.
 Firm, grey, smooth, painless,
 Many subtypes: classical*, spermatocytic etc..
 Microscopy: uniform clear cells + lymphocytes.
 Mixed seminoma  Seminoma + Teratoma, embryonal carcinoma or
choriocarcinoma (βhCG 10%). Etc.

5. 5
Seminoma Testes:
Lymphocytes
Clear cells

6. 6
Seminoma Testes:
Lymphocytes
Clear tumour cells

8. 8
NSGT: Embryonal Ca
 Clinical: painless swelling, hemorrhagic,
malignant, poor prognosis, metastases.
 Germ cell tumor – embryonic cells.
 Gross: Hemorrhagic, necrotic tumor.
 Adults: Embryonal Ca.
 Children: Yolksac tumor.
 Tumor Marker: AFP (α feto protein)
 Microscopy: Pleomorphic cells, embryoid
structures. Pink AFP globules in cells.

9. 9
NSGT: Teratoma / Teratocarcinoma
 > 1 tissue type (mature / immature)
 Teratoma + other germ cell tum (Embryonal ca)
 Common, 10-30y, aggressive, poor prognosis.
 Both βhCG & AFP +ve - if mixed.

10. 10
Testes Tumors: summary
 Germ cell Tumours (95%)
 Gonadal: Seminoma
Non Seminoma Germ Cell tum (NSGT)
 Embryonic: Embryonal ca.
 Extraembryonic: Yolk sac tum, Choriocarcinoma.
 Somatic: Teratoma
 Mixed: (40%)
Tumor – Incidence Age Tumor Marker
Seminoma 50% 40-50y 10% βhCG
Embryonal ca. 20-30y Negative (pure)
Yolk sac tumour < 3y 90% AFP
Choriocarcinoma 20-30y 100% βhCG
Teratoma (Pure) All ages Negative
Mixed 15% 15-30y 90% βhCG & AFP