Hydrocele is the accumulation of fluid in the tunica vaginalis of the scrotum. It is the most common cause of scrotal enlargement. There are two main types - congenital and acquired. Complications include rupture, infection, and atrophy of the testis. The fluid can accumulate due to excessive production, defective absorption, or lymphatic drainage interference. Testicular tumors are most common in males ages 15-35. The majority are malignant germ cell tumors originating from seminomas or non-seminomas such as embryonal carcinoma, yolk sac tumor, choriocarcinoma, and teratoma. Each tumor type exhibits different characteristics such as age of occurrence

1. Hydrocele

2. Hydrocele
 Is the accumulation of fluid in the tunica vaginalis of
the scrotum.
 Most common cause of scrotal enlargement.

3. Hydrocele
 Types –
Congenital Acquired
Primary (Idiopathic)
Secondary (Inflammatory/Malignant)
 Complications:
Rupture, Infection,Atrophy of the testis.

4. Hydrocele
Causes:
 Excessive production of fluid within the sac, e.g.
secondary hydrocele (e.g. Epididymo-orchitis, torsion of
testis, malignant tumor of the testis).
 Defective absorption of fluid. Explanation for most
primary hydroceles (Idiopathic).
 Interference with lymphatic drainage of scrotal
structures.
 Connection with a hernia of the peritoneal cavity in the
congenital variety.

5. Transillumination test

6. Other fluid accumulations:
 Hematocele: Contains blood
 Spermatocele: Contains sperm

7. Testicular tumors
 Most testicular tumors are malignant and of germ cell
origin(95%).
 Most common malignancy between ages 15-35 years.
 Most germinal tumors highly aggressive whereas most
non-germinal tumors are generally benign.
 Seminomas are highly radiosensitive, non-
seminomatous are not radiosensitive.

8. Testicular tumors (Classification)
Germcelltumors
Seminomatous tumors
Seminoma
Spermatocytic seminoma
Non-seminomatous tumors
Embryonal carcinoma
Yolk sac (endodermal sinus) tumor
Choriocarcinoma
Teratoma
Sex Cord-Stromal Tumors
Leydig cell tumor
Sertoli cell tumor
Granulosa cell tumor
MixedGermcell-Sex cord-
stromaltumors
Gonadoblastoma
Unclassified
Others:
Lymphoma: Non-Hodgkin’s type

9. Predisposing factors of testicular tumors
A. Idiopathic
B. Cryptorchidism(Undescended testis): Most
common cause.
C. Testicular dysgenesis (Disorder of
testicular development) : Testicular
feminization syndrome (AKA Androgen
insensitivity syndrome), Klinefelter
syndrome (XXY).
D. Genetic factors E.g. H/O disease in Father
and brother, Some ethnic groups (e.g. black
five times more prone than the caucasians)
E. Others: Peutz-Jeghers syndrome (Sertoli-
Leydig cell tumor), Inguinal hernia, Mumps
orchitis.

10. Seminoma
 Most frequent testicular cancers.
 Age – 30-35 years.
 Greatest association with cryptorchid testes.
 The tumor cells stain positively for placental alkaline
phosphatase.

11. Seminoma
 Most common Germ cell tumor of testis (40% cases)
 Is identical to dysgerminoma of ovary.
 Approx. 10% are positive for b-hCG (because of
trophoblastic tissue within the tumor)
 Spread – via lymphatics (para aortic) to retroperitoneal,
mediastinal and supraclavicular lymph nodes.
Hematogeneous later (lungs)
 Are highly radiosensitive.
 Prognosis: Excellent

12. Morphology of seminoma
Gross:
Moderate size, bulky,
solid, homogeneous,
lobulated and light
yellow.
C/s: Usually devoid of
hemorrhage and
necrosis.

13. Morphology of seminoma
M/E:
A. Sheets of uniform cells
divided into poorly
demarcated lobules by
delicate septa of fibrous
tissue.
B. The tumor cells have
abundant clear cytoplasm,
sharply outlined cell
membrane, large central
nucleus and prominent
nucleoli.
C. The stroma is infiltrated by
lymphocytes and plasma
cells.
B&C
A

14. Spermatocytic seminoma
 Occurs in older men (>65years) and pursues a benign
course.
 Is a distinctive tumor (although related by name to
seminoma)
 In some medium sized cells, chromatin is similar to
that seen in meiotic phase of non-neoplastic
spermatocytes (justifying the term spermatocytic
seminoma)

15. Spermatocytic seminoma
Gross :
Large tumor, soft,
gelatinous appearance.

16. Spermatocytic seminoma
M/E :
Three cell populations-
a) Medium sized cells
predominantly, have
round nucleus and
eosinophilic
cytoplasm.
b) Smaller cells with
narrow rim of
cytoplasm.
c) Bizarre giant cells.

18. Embryonal carcinoma
 Are usually mixed with other germ cell tumors.
 When combined with teratomas are called
teratocarcinomas.
 Age group- 20-25 years
 Increased AFP (Alpha feto protein) and/or hCG in
90% of cases.
 Prognosis: Intermediate, less radiosensitive than
seminomas.

19. Embryonal carcinoma
Gross:
 Bulky tumor
Variegated
c/s: Areas of
hemorrhage and
necrosis

20. Embryonal carcinoma
M/E:
Sheets, alveolar or
tubular pattern.
Anaplastic with
hyperchromatic nuclei
and prominent nucleoli.

22. Yolk Sac Tumor(Endodermal sinus tumor)
 Most common testicular tumor in children <4 years.
 Increased AFP (a-fetoprotein) in all cases.
 Prognosis – Good.

23. Yolk Sac Tumor(Endodermal sinus tumor)
Gross-
Non-encapsulated,
homogeneous, yellow-
white, mucinous
appearance.

24. Yolk Sac Tumor(Endodermal sinus tumor)
M/E-
Intermingling of both
epithelial and
mesenchymal elements.
Perivascular Schiller-
Duval bodies resemble
primitive glomeruli.
Presence of microcystic
and papillary formation
are also seen.

25. Choriocarcinoma
 Age – 20-30 years.
 Most commonly mixed with other tumor types.
 Contains trophoblastic tissue (syncytiotrophoblast and
cytotrophoblast)
 Tumor marker – hCG increased in all cases
 May produce gynecomastia (hCG is an LH analogue)
 Prognosis – Poor; Most aggressive

26. Choriocarcinoma
Gross:
Small tumor
c/s: Usually
hemorrhagic and partially
necrotic.

27. Choriocarcinoma
M/E:
Intermingling of
cytotrophoblastic and
syncytiotrophoblastic cells.

28. Teratoma
 Affects males of all ages.
 Contains derivatives form ectoderm, endoderm and
mesoderm.
 Mixed with embryonal carcinoma (Teratocarcinoma).
 Increased AFP and/or hCG in 50% of cases.
 Prognosis: Good. Usually benign in children and
malignant in adults (Usually squamous cell carcinoma)

29. Teratoma
Gross:
Predominantly cystic and
multiloculated.
Foci of cartilage and bone
may be present.

30. Teratoma
M/E:(Mature/Immature)
All types of tissue can be
seen.
Most commonly neural
tissue, cartilage and various
types of epithelium.(e.g.
GIT,Resp, skin etc.)
When present with tissue
immaturity (e.g.primitive
glands) are known as immature
teratoma.
Cartilage
Glands

31. Common sites of teratomas
• Ovaries
• Testes
• Anterior mediastinum
• Pineal gland

32. Clinical findings of testicular tumors:
 Unilateral painless enlargement of the testis

33. Common tumor markers of testicular
tumors
 Uses: 1) Evaluate tumor mass.
2) Stage germ cell mass.
3) Assess tumor burden.
4) Monitor the response of a germ cell tumor to
therapy.
1. a-fetoprotein (AFP): Yolk sac (endodermal sinus) tumor.
2. Human chorionic gonadotropin (hCG): Choriocarcinoma
3. Lactate dehydrogenase: Non-specific
Degree of elevation correlates
with tumor mass.

34. References:
• Robbins and Cotran
• Ackerman
• Goldjan