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HYDROCELE &
TESTICULAR TUMORS
Dr. SIZAN THAPA
MBBS, MD
Objectives
• Hydrocele
– Definition
– Causes
– Clinical Features
• Testicular tumors
– Classification
– Etiology
– Histogenesis
– Common tumor markers
HYDROCELE
Defination
• Abnormal collection of serous fluid in tunica
vaginalis (between visceral and parietal layers
of tunica vaginalis)
• May be acute or chronic, congenital or
acquired
• Presents as swelling of scrotum or groin area
• Common in men over the age of 40.
Causes
• Exact cause is unknown
• May be associated with:
– Trauma
– Systemic edema: cardiac failure, renal disease
– Inflammation of testis and epididymis
• Gonorrhoea,
• Syphilis
• Tuberculosis
– Cancers/tumors of testicle or kidney
• Cause of fluid accumulation:
– Defective absorption of fluid by tunica vaginalis:
may be due to damage to endothelial wall by
low-grade infection
– Interference with drainage of fluid by lymphatic
vessels of cord
– Excessive production of fluid
– Communication with peritoneal cavity
• Mild Pain
• Swelling of scrotum
• Redness of scrotum
• Feeling of pressure at base of penis may be present
• Testicular torsion
• Infertility
Clinical Features
TESTICULAR TUMORS
Classification
Broadly divided into 3 main groups:
• Germ cell tumor
– Majority of testicular tumors ~ 95% arise from
germ cells or their precursors in seminiferous
tubules
• Sex- cord stromal tumors
– < 5% originate from sex cord- stromal
components
• Mixed forms
WHO Classification of Testicular
Tumors
A. Germ cell tumors derived from Germ cell neoplasia in
situ
• Non-invasive : Germ cell neoplasia in situ (GCNIS)
• Tumors of single histologic type (pure forms)
– Seminoma
– Non-seminomatous germ cell tumors
• Embryonal carcinoma
• Choriocarcinoma
• Yolk sac tumors, postpubertal type
• Teratoma, postpubertal type
• Teratoma with somatic type malignancy
• Non- seminomatous germ cell tumors of more than one
histologic type:
B. Germ cell tumors unrelated to germ cell neoplasia in situ
• Spermatocytic tumor
• Teratoma, prepubertal type
• Yolk sac tumor, prepubertal type
• Mixed teratoma and yolk sac tumor, prepubertal type
C. Sex- cord stromal tumors
• Leydig cell tumor
• Sertoli cell tumor
• Granulosa cell tumor
D. Tumors with both germ cell and sex-cord stromal
elements
• Gonadoblastoma
Germ cell tumors
Categorised into 2 main groups:
• Seminomatous
– Composed of cells that resemble primordial
germ cells or early gonocytes
• Non- seminomatous
– Composed of undifferentiated cells resembling
embryonic stem cells (as in embryonal
carcinoma) or may differentiated along other
cell lines giving rise to yolk sac tumors,
choriocarcinomas and teratomas
Etiologic factors
• Environmental factors
– Associated with testicular dysgenesis syndrome:
cryptorchidism, hypospadias, impaired
testicular development and poor sperm quality
• Increased by inutero exposure to pesticides
and non-steroidal estrogens
- Associated with cryptorchidism-seen in approx
10% of testicular GCTs
• Risk asscociated with higher temperature to
which undescended testis in groin or
abdomen is exposed
- Klinefelter syndrome: associated with
mediastinal GCTs but not testicular tumors
• Genetic factors
– Risk increases in first-degree family members
– Susceptibility genes include genes encoding
ligand for receptor tyrosine kinase KIT and
BAK , which are inducers of apoptosis
Histogenesis
• Cell of origin: Primordial
germ cell/gonocytes with
acquired defect in
differentiation into
spermatogonia
• Activating mutation in KIT
receptor kinase that
stimulates proliferation
• Precursor lesion: Germ cell
neoplasia in situ (GCNIS) :
found in all types of GCTs
except spermatocytic tumors
and unusual types that arise
in infancy
• Lesional cells retain
expression of transcription
factors OCT3/4 and
NANOGimportant in
maintenance of pluripotent
stem cells
• Progression to full blown
germ cell tumors associated
with reduplication of short
arm of chromosome 12
(isochromosome 12p)
TUMOR MARKERS
• Polypeptide hormones and enzymes secreted by
tumors that can be detected in blood
• Helps in detection but not diagnostic of cancers
• Evaluation of serum tumor markers helps in:
– Initial evaluation of testicular mass
– Staging of testicular GCTs: persistent increase on
hCG or AFP after orchidectomy indicates
metastatic spread
– In assessing tumor burden
– In monitoring the response to therapy
Common tumor markers
• Chorionic gonadotropin (hCG):
Choriocarcinoma, Seminoma
• Alpha-fetoprotein (AFP):
Yolk sac tumor, Embryonal carcinoma
• Lactate dehydrogenase (LDH):
Seminoma
• Human placental lactogen (HPL):
Choriocarcinoma
• Placental alkaline phosphatase:
Seminoma
Hydrocele and tumors of testis Introduction.pptx

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Hydrocele and tumors of testis Introduction.pptx

  • 1. HYDROCELE & TESTICULAR TUMORS Dr. SIZAN THAPA MBBS, MD
  • 2. Objectives • Hydrocele – Definition – Causes – Clinical Features • Testicular tumors – Classification – Etiology – Histogenesis – Common tumor markers
  • 4. Defination • Abnormal collection of serous fluid in tunica vaginalis (between visceral and parietal layers of tunica vaginalis) • May be acute or chronic, congenital or acquired • Presents as swelling of scrotum or groin area • Common in men over the age of 40.
  • 5.
  • 6. Causes • Exact cause is unknown • May be associated with: – Trauma – Systemic edema: cardiac failure, renal disease – Inflammation of testis and epididymis • Gonorrhoea, • Syphilis • Tuberculosis – Cancers/tumors of testicle or kidney
  • 7. • Cause of fluid accumulation: – Defective absorption of fluid by tunica vaginalis: may be due to damage to endothelial wall by low-grade infection – Interference with drainage of fluid by lymphatic vessels of cord – Excessive production of fluid – Communication with peritoneal cavity
  • 8. • Mild Pain • Swelling of scrotum • Redness of scrotum • Feeling of pressure at base of penis may be present • Testicular torsion • Infertility Clinical Features
  • 10. Classification Broadly divided into 3 main groups: • Germ cell tumor – Majority of testicular tumors ~ 95% arise from germ cells or their precursors in seminiferous tubules • Sex- cord stromal tumors – < 5% originate from sex cord- stromal components • Mixed forms
  • 11. WHO Classification of Testicular Tumors A. Germ cell tumors derived from Germ cell neoplasia in situ • Non-invasive : Germ cell neoplasia in situ (GCNIS) • Tumors of single histologic type (pure forms) – Seminoma – Non-seminomatous germ cell tumors • Embryonal carcinoma • Choriocarcinoma • Yolk sac tumors, postpubertal type • Teratoma, postpubertal type • Teratoma with somatic type malignancy • Non- seminomatous germ cell tumors of more than one histologic type:
  • 12. B. Germ cell tumors unrelated to germ cell neoplasia in situ • Spermatocytic tumor • Teratoma, prepubertal type • Yolk sac tumor, prepubertal type • Mixed teratoma and yolk sac tumor, prepubertal type C. Sex- cord stromal tumors • Leydig cell tumor • Sertoli cell tumor • Granulosa cell tumor D. Tumors with both germ cell and sex-cord stromal elements • Gonadoblastoma
  • 13. Germ cell tumors Categorised into 2 main groups: • Seminomatous – Composed of cells that resemble primordial germ cells or early gonocytes • Non- seminomatous – Composed of undifferentiated cells resembling embryonic stem cells (as in embryonal carcinoma) or may differentiated along other cell lines giving rise to yolk sac tumors, choriocarcinomas and teratomas
  • 14.
  • 15.
  • 16. Etiologic factors • Environmental factors – Associated with testicular dysgenesis syndrome: cryptorchidism, hypospadias, impaired testicular development and poor sperm quality • Increased by inutero exposure to pesticides and non-steroidal estrogens
  • 17. - Associated with cryptorchidism-seen in approx 10% of testicular GCTs • Risk asscociated with higher temperature to which undescended testis in groin or abdomen is exposed - Klinefelter syndrome: associated with mediastinal GCTs but not testicular tumors
  • 18. • Genetic factors – Risk increases in first-degree family members – Susceptibility genes include genes encoding ligand for receptor tyrosine kinase KIT and BAK , which are inducers of apoptosis
  • 19. Histogenesis • Cell of origin: Primordial germ cell/gonocytes with acquired defect in differentiation into spermatogonia • Activating mutation in KIT receptor kinase that stimulates proliferation • Precursor lesion: Germ cell neoplasia in situ (GCNIS) : found in all types of GCTs except spermatocytic tumors and unusual types that arise in infancy
  • 20. • Lesional cells retain expression of transcription factors OCT3/4 and NANOGimportant in maintenance of pluripotent stem cells • Progression to full blown germ cell tumors associated with reduplication of short arm of chromosome 12 (isochromosome 12p)
  • 21.
  • 22. TUMOR MARKERS • Polypeptide hormones and enzymes secreted by tumors that can be detected in blood • Helps in detection but not diagnostic of cancers • Evaluation of serum tumor markers helps in: – Initial evaluation of testicular mass – Staging of testicular GCTs: persistent increase on hCG or AFP after orchidectomy indicates metastatic spread – In assessing tumor burden – In monitoring the response to therapy
  • 23. Common tumor markers • Chorionic gonadotropin (hCG): Choriocarcinoma, Seminoma • Alpha-fetoprotein (AFP): Yolk sac tumor, Embryonal carcinoma • Lactate dehydrogenase (LDH): Seminoma • Human placental lactogen (HPL): Choriocarcinoma • Placental alkaline phosphatase: Seminoma

Editor's Notes

  1. Hypospadis: congenital disorder where urethral opening is underside of penis Klinefelter syndrome: associated with excess of X chromosome 47XXY