Presentation for MBBS student. Short notes on Hydrocele, and Introduction of Testicular tumors, Etiopathogenesis, including the WHO classification of Testicular tumors, 5th Edition, 2022.

1. HYDROCELE &
TESTICULAR TUMORS
Dr. SIZAN THAPA
MBBS, MD

2. Objectives
• Hydrocele
– Definition
– Causes
– Clinical Features
• Testicular tumors
– Classification
– Etiology
– Histogenesis
– Common tumor markers

3. HYDROCELE

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.

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

9. TESTICULAR TUMORS

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

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)

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