testiculartumours-main-2-250317014509-23bccf05.pptx

TEST

1. TESTICULAR TUMOURS

2. Testicular descent A – 4 TH WEEK B- 8-9 WEEK C – 7 TH MONTH

3. CLASSIFICATION OF TESTICULAR TUMOURS Typ ical / Classical (85%) Anaplastic (5-10%) Spermatocytic (2-12%) Embryonal cell carcinoma Yolk sac tumour Teratoma choriocarcinoma

4. GERM CELL TUMORS: NON SEMINOMATOUS TUMOUR AGE GROUP – 30 YEARS. RADIORESISTANT BETA HCG , ALPHA FETO PROTEIN AND LDH RAISED BAD PROGNOSIS M/c tumor in young males (20-40 years) most of them arise from germ cells 80% of testicular cancer can be cured occurs b/l in 1-2%

5. SEMINOMA 4-5th decade of life soft tan to white diffuse or multinodular sheet like arrangement of cells, polygonal nuclei,clear cytoplasm lymphocytic infiltrates seen in 20% Syncytiotrophoblastic element in 15% - Bhcg production positive for CD117 and PLAP radiosensitive

6. SEX CORD TUMORS: derived from syncytiotrophoblast grow rapidly- hurricane tumor raised BHCG haematogenous spread metastasis to brain,lungs,bone CHORIOCARCINOMA

7. EMBRYONAL CELL CARCINOMA: Derived from primitive embryonal epithelial cells Most undifferentiated of NSGCT Totipotent -can differentiate into other NSGCT gross:tan yellow with areas of haemorrhage and necrosis raised AFP and BHCG poor prognosis

8. endodermal sinus tumors m/c in mediastinal and pediatric GCTs schiller duval bodies ,cytoplasmic and extracellular eosinophilic hyaline globules raised AFP YOLK SAC TUMOR

9. TERATOMA well or incompletely differentiated elements of atleast 2 of 3 germ cell layers well differentiated-mature incompletely differentiated-immature resistant to chemotherapy surgical resection needed can de-differentiate to rhabdomyosarcoma, adenocarcinoma, or primitive neuroectodermal tumor

10. CLINICAL FEATURES Testicular swelling-painless, progressive increase in size Vague scrotal discomfort or heaviness. Metastasis palpable mass-retroperitneal metastasis, flank pain-ureteral obstruction,back pain-psoas muscle, lower extremity swelling -compression of IVC dyspnea, chest pain, cough, or hemoptysis. Gynecomastia- Leydig cell tumors Infertility-rare presentation

11. INVESTIGATIONS ULTRASOUND BOTH SCROTUM CECT abdomen and pelvis IMPORTANCE OF TUMOUR MARKERS TUMOUR MARKERS ARE ESTIMATED BEFORE SURGERY AFTER SURGERY AFTER THE COMPLETION OF TREATMENT. DURING SURVEILLANCE

12. TUMOUR MARKERS

13. CHEVASSU’S MANOUVRE Inguinal incision made Soft vascular clamp applied at deep inguinal ring Testis delivered out Testis cut open Frozen section done IF POSITIVE IF NEGATIVE HIGH INGUINAL ORCHIDECTOMY IS PERFORMED TESTIS IS LEFT BACK IN SCROTUM

14. METASTASIS WITH LYMPH NODE MASS WITH 2cm in greater dimensions - N1 2 cm to 5 cm in greater dimensions - N2 Involvement of multiple nodes or nodes - N3 more than 5cm in greater dimension. N STAGING T STAGING

15. MANAGEMENT OF TESTICULAR TUMOURS CLINICAL DIAGNOSIS HIGH INGUINAL ORCHIDECTOMY TUMOUR MARKER ESTIMATION AFTER 4 WEEKS due to half life of tumour markers NO’S IN TESTICULAR TUMOUR

16. MANAGEMENT OF SEMINOMA: