common testicular tumour- Seminoma of testis

academic purpose of teaching

1. TESTICULAR TUMOURS
DR.A.S.SHIVA SARAVANAN,BHMS,M.D,Ph.D(HOM)
PROFESSOR& HOD
DEPARTMENT OF SURGERY
VMHMC
SALEM

2. INTRODUCTION
They constitute 1 % of all malignant tumours in
the males and almost all are malignant (more
than 99%).
Classification :
WHO CLASSIFICATION

Seminoma

Spermatocytic

Anaplastic

Lymphocytic

3. Non – Seminomatous germ cell tumours
Teratoma
Embryonal cell carcinoma
Choriococarcinoma
Yolk sac tumour
Other classification :
1.SEMINOMA HAS THE MOST COMMON TUMOUR
INCIDENCE – 50%
TYPES
1. spematocytic type- good prognosis
2. lymphocytic
3.anaplastic

4. Teratoma
Incidence : 30 %
Combined :
10-20%
Interstitial cell tumours
a)Leydig cell tumour
it is prepubertal tumour
causes masculinisation
increased androgens

5. OTHER CLASSIFICATION
B) sertoli tumours
They are feminising tumours
Increased oestrogens
Post pubertal tumour
C) Lymphoma of testis : very rare

6. SEMINOMA OF TESTIS
Aetiology
Undescended testis , undoubtedly predisposes to
seminoma.
1 in 20 abdominal testis, 1 in 60 testis at the level of
deep ring and 1 in 80 inguinal testis are prone for
testicular tumours.
Trauma to the testis is a coincidence. This may not
precipitate a testicular tumour but brings to the
attention of the patient.

7. PATHOLOGY
Seminoma arises from the seminiferous tubules,
as the tumour grows, it compresses the (normal)
testicular tissue. The cut surface is smooth,
homogenous.
Microscopy : round to oval cells with prominent
nucleus. In few cases, lymphocytic infiltration can be
found.
Teratoma arises from rete testis. The tumour contains
totipotential cells and so can have ectodermal,
mesodermal and endodermal elements.

8. PATHOLOGY
Teratoma differentiated : the most benign form of
a malignant tumour- high orchidectomy
Malignant tumor intermediate : the cells are
mixture of differentiated and anaplastic cells.
Malignant teratoma anaplastic : highly
malignant tumour.
Malignant teratoma trophoblastic : secretes HCG
and it is similar to choriocarcinoma in a female.

9. CLINICAL FEATURES OF TESTICULAR
TUMOURS
Typical presentation
Age : teratoma 20-30 years,seminoma 30-40 years.
Testicular swelling : more often heaviness due to
tumour rather than hypertrophy or if it is infiltrated
with tumour but vas is never involved.
This is called sign of vas negative ( sign of vas
positive in TB epididymo-orchitis where there
is beading of pus).
Haemospermia : blood in the semen is rare
Infertility : not uncommon
Gynaecomastia is seen in about 10% of the
patients.

10. ATYPICAL PRESENTATION
1. hurricane variety is the most malignant
tumour. The tumour grows rapidly with
pulmonary metastasis (cannon ball) and death in
few days
2. mimicking acute epididymo-orchitis : this
variety presents as severe pain along with the
swelling of the testis, but does not respond to
antibiotics.

11. SYMPTOMS MAINLY DUE TO
METASTASES
Lymphatic spread
Para aortic node mass –distention of theabdomen.
Left supraclavicular node mass – swelling in the neck
Illiac node mass- swelling of the leg.
BLOOD SPREAD : extensive pulmonary secondaries
occur from amalignant teratoma.

12. STAGING OF TESTICULAR CANCER
Stage I : tumour confined to the testis only.
Stage II: tumour and lymph nodes below the diaphrgm
– size less than 2cm
Stage IIB : tumour and lymph nodes below the
diaphrgm –size more than 2cm
Stage III- tumour and lymph nodes above the
diaphrgm.
Stage IV- blood spread to lungs/liver/elsewhere.

13. INVESTIGATIONS
No biopsy should be done through scrotal
route,because if the scrotal skin is involved , the
spread occurs to inguinal lymph nodes opening up
one more channel of lymphatics.
Chest x-ray : to rule out cannon ball secondaries as in
teratoma
Ivp to see back pressure effect on the kidney due to
enlarged paraaortic nodes.
Abd.usg : to see enlarged lymph nodes, secondaries in
the liver,or to detect a tumour in an undescended
testis.

14. INVESTIGATION
24 hours urine sample for HCG
Normal levels – less than 100 IU
More than 1000IV is diagnostic of choriocarcinoma
Hence it is the tumour marker of choriocarcinoma.

15. MANAGEMENT
High orchidectomy in case of fully developoed
carcinoma
chevasu’s procedure