Testicuolar tumours

1. Testicular Tumours
Part 1
Vinod Jain
02.09.2014

2. 2
Testicular Tumours
• Classification
• Incidence
• Etiology
• Spread of tumour
• Clinical Staging
• Clinical features
• Differential Diagnosis
• Investigations
• Treatment
• Follow up schedule

3. Classification
Secondary Tumour Para testicular
neoplasm
Germ Cell
tumour
Non Germ
Cell tumour
Lymphona Leukaemia Metastatic
Seminoma
(SGCT)
Non Semimomatous
(NSGCT)
Leydig cell Tm Sertoli Cell
Tm
Gonadoblastoma Adeno CA of rete tests
Terratoma Embryonal CA Chorio CA Yolk sac
Tumour
Mixed Tumour
Primary Tumour

4. Metastatic testicular Tumour
In decreasing order
Prostate
Lung
Gut
Melanoma
Kidney

5. Incidence
• Age – most common solid tumor of men
between 20-30 years
• Race – White : Black = 4:1 in U.S.
• Side – Right > Left
• Socio-economic status – high : low = 2:1
• Geographical
• Highest in Scandinavia, Germany, Switzerland
• Intermediate – USA & UK
• Low – Africa and Asia

6. Age wise incidence of
testicular tumour
Tumour Type Age group (years)
1. Seminoma 35-40
2. Pure Terratoma Pediatric age group
3. Embryonal CA 25-30
4. Chorio CA 25-35
5. Yolk sac Tumour infancy & child hood
6. Mixed terrato CA 25-30
7. Lymphoma > 50

7. Etiology
• Congenital – 3-14 times common in
undescended testes
• Abnormal germ cell morphology
• Elevated temperature
• Interference with blood supply
• Gonadal dysgenesis
• Endocrine dysfunction
• Acquired
• Trauma – co incidence

8. Spread of Tumour
• Local
• Lymphatic –
– Right inter aortocaval at L2  precaval  preaortic 
Right common iliac  Right ext. iliac
– Left  Paraortic at renal hilium  preaortic  common iliac
 Left ext. iliac
(Cross metastasis more common in right side tumour)

9. Spread of Tumour
• Blood (Distant metastases in decreasing
order
Lung
Liver
Brain
Bone
Kidney
Adrenal
GIT
Spleen

10. Clinical Staging
(Boden and Gibbs – 1971)
• Stage I (A) – confined to testis with no spread
through capsule or spermatic cord
• Stage II (B) – Clinical or radiological evidence
of spread beyond testis but with in regional
L.N.
• B1 -<2cm
• B2 -2-5cm
• B3 - >5cm
• Stage III (C) - Disseminated above diaphragm
/ visceral disease

11. Clinical features
A. Presentations
• Gradually increasing lump / hardness in testis
• Abnormal sensitivity – numbness / heaviness
/ Pain
• Loss of sexual activity
• Dull ache in lower abdomen / groin
• Haemospermia
• General weakness
• Metastatic presentations (Contd.)

12. Clinical features (Contd.)
- Metastatic presentations
• Cough and Dyspnoea
• Anorexia
• Nausea / Vomiting (retro duodenal LN)
• Neck mass
• Swelling lower extremity (IVC obstruction)
• Back pain (retroperitoneal L. N.)
• Gynaecomastia
• Bone pains
• Unilateral limb swelling (L.N metastasis)
B. Signs
• Local

13. Differential Diagnosis
• Epidedymo-orchitis
• Testicular haematoma
• Spermatocele
• Hydrocele
• Testicular Torsion

14. Investigations
• Haematological – Hb%, Bl. urea/S. creatinine,
LFT
• Tumour markers – AFP, HCG, LDH
• Scrotal Ultrasound – Usually homogenous,
hypoechoic, intra testicular mass
• X-ray chest
• CT / MRI – abdomen

15. Tumour markers
NSGCT SGCT
• AFP  N
• HCG  
• LDH  
(Advanced) (Advanced)

16. Let us revise
• Classification
• Incidence
• Etiology
• Spread of tumour
• Clinical Staging
• Clinical features
• Differential Diagnosis
• Investigations
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