I really tried to explain testicular tumors so the readers will learn many things from my presentation

2. Dr.Mirwice haqmal
Urologist and dean of medical research
center
Kabul Afghanistan

3. Testosterone
4x3x2,5
TUnica albuginea testis Fascia
mediastinum Fascia
testis

4. Plexus celiacus plexus testicularis

5. Mono orchidid An orchidid
Cryptorchidism
Epididymis

6. testicular Artery
Internal spermatic Arteries
Spermatic vein Pampiniform
Spermatic vein IVC Spermatic vein
Mediastinal lymph nodes

7. Seminiferous Convoluted -
tubules
Efferent duct Mediastinum testis
Epididymis
Seminiferous
Seminiferous
Sertoli -
-
Leydig Stroma

10. 1- Germ cell 2- Non-Germ cell tumors 3- Secondary tumors
tumors of the of the testis of
testis the testis

12. -
Seminoma Germ cell Tumors -
Non seminoma
Leydig cell , Sertoli cell , Non germ cell tumors -
Gonadoblastoma
Combination chemotherapy

13. -
-
( Denmark , Norway and Sweden and some Scandinavian
time Faroe, Finland, Iceland, Island and Greenland)

14. -
Cryptorchidism

15. Seminoma Germ cell tumors
Cryptorchidism -
Seminoma Cryptorchidism

16. Intra
abdominal testes)
Cryptorchid
-

17. Germ cell tumors
Germ cell tumors
Teratoma Nonseminoma - Seminoma -
Mixed cell Type Embryonal cell carcinoma Choriocarcinoma
Carcinoma in situ

18. Seminoma ( 35%) Choriocarcinom Carcinoma in Embryonal cell Mixed cell Type
a ( 1%) situ Teratoma (5%)
carcinoma (20%) (40%)

19. Totipotential germ cell
Differentiation
Totipotential germ cell
Embryonal carcinoma( Totipotential tumor cell ) Seminoma
Undergo farther differentiation
yolk sac tumor Choriocarcinoma Teratoma
Yolk sac Choriocarcinoma Tumor Markers
AFP Alpha-fetoprotien tumor
Chorionic gonadotropin Choriocarcinoma

20. Normal Spermatocyte
Totipotential germ cell Siminoma
Embryonal carcinoma ( Totipotential tumor ?
cell)
Extra embryonic differentiation
Intra
embryonic
Trophoblastic differentiation
Yolk sac pathways
pathway
Choriocarcinoma Yalksac tumor Teratoma

21. G.C.T Choriocarcinoma
L4 T1
Right Right common iliac Paracaval Preaortic Precaval
external iliac lymph nodes
Para aortic
Left external iliac Left common iliac Preaortic

22. Crossover
obturator External iliac
Tunica albuginea
Choriocarcinoma

23. Staging
Gibb Boden
Stage A
Stage B
Retro peritoneal Stage C
Sub Stage B
Stage BB1
Stage BB2
Stage BB3

24. Stage I
Stage II
Stage III
Sub Stage II
Stage II A
Stage II B

25. TNM classification
Table 23–1. TNM Classification of Tumors
of the Testis. M—Distant metastasis
T—Primary tumor MX: Cannot be assessed
TX: Cannot be assessed M0: No distant metastasis
T0: No evidence of primary tumor M1: Distant metastasis present in nonregional lymph
Tis: Intratubular cancer (CIS) nodes or lungs
T1: Limited to testis and epididymis, no M2: Nonpulmonary visceral metastases
vascular invasion
T2: Invades beyond tunica albuginea or has
vascular
invasion
T3: Invades spermatic cord
T4: Invades scrotum S—Serum tumor markers
SX: Markers not available
S0: Marker levels within nordehydrogenase (LDH)
N—Regional lymph nodes <1.5 × normal
NX: Cannot be assessed and hCG <5000 mIU/mL and AFP mal limits
N0: No regional lymph node metastasis
S1: Lactic acid <1000 ng/
N1: Lymph node metastasis ≤2 cm, or
multiple nodes, mL
none more than 2 cm. and <6 nodes positive S2: LDH 1.5–10 × normal or hCG 5000–50,000 mIU/
N2: nodal mass >2 cm and ≤5 cm. or ≥6 nodes mL or AFP 1000–10,000 ng/mL
positive S3: LDH >10 × normal or hCG >50,000 mIU/mL or
N3: Nodal mass >5 cm. AFP >10,000 ng/mL
Source: American Joint Committee on Cancer: TNM Classification—Genitourinary Sites, 1996.

27. -
Orchidectomy
Infarction

28. Retroperitoneal metastasis involving nerve roots
Pulmonary metastasis
Skeletal metastases Retro duodenal metastasis
Venacaval obstruction

29. Transillumination
Supra clavicular
Leydig Sertoli Germ cell tumors Gynecomastia
-
Hemoptysis

30. markers
LDH hCG AFP
Daltons Alpha-fetoprotien
-
NSGCTs
Seminoma

31. Table 23–2. Incidence of Elevated Tumor
Markers by Histologic Type in Testis Cancer.
hCG (%) AFP (%)
Seminoma 7 0
Teratoma 25 38
Teratocarcinoma 57 64
Embryonal 60 70
Choriocarcinoma 100 0

32. Human Chorionic gonadotropin
TSH Follicle-stimulating hormone FSH LH Luteinizing hormone
hCG
NSGCTs beta-hCG

33. Lactic acid dehydrogenase ( LDH)
NSGCTs
Seminoma
Gamma-glutamyl Placental alkaline phosphatase (PLAP)
transpeptidase (GGT)

34. -
-
CT scan CT scan -
- CT scan
Chest – x-ray

35. Urethral discharge Epididymitis -
Epididymoorchitis -
Hydrocele -
Transillumination
Spermatocele -
Hematocele -
Granlomatous orchitis -
Vasdeferens
Varicocele
Epidermoid cyst -
Tunica albuginea
Inguinal
Orchidectomy
Teratoma

36. Orchiedectomy
Scrotal approach

37. A. LOW-STAGE SEMINOMA
B. HIGH-STAGE SEMINOMA
C. LOW-STAGE NONSEMINOMATOUS GERM CELL TUMORS
D. HIGH-STAGE NONSEMINOMATOUS GERM CELL TUMORS

38. Low-Stage seminoma
Stage I Seminomas Seminoma
- cGy Retroperitoneal Orchiectomy
Retroperitoneal
Relapse irradiation

39. HIGH-STAGE SEMINOMA
AFP Seminoma Bulky Seminoma
1- (PEB) cisplatin, etoposide, and bleomycin
2- vinblastine, cyclophosphamide, dactinomycin, bleomycin, and cisplatin
(VAB-6);
3- cisplatin and etoposide
4- All seminomas receive low-risk Chemotherapy regimens, which currently
consist of cisplatin and etoposide(4 cycles) or 3 cycles of PEB
Complete response

40. LOW-STAGE NONSEMINOMATOUS GERM CELL TUMORS
Retro peritoneal lymph node dissection Stage 1
Midline Thoracoabdominal
Bifurcation of common iliac vessels
N2 N1
RPLND Orchiedectomy Stage I

41. HIGH-STAGE NONSEMINOMATOUS CELL TUMORS
GERM
Metastatic NSGCT Bulky retroperitoneal
Orchiedectomy Chemotherapy
Imaging
Embyonal cell carcinoma
Teratoma
, Salvage Chemotherapy
cisplatin, etoposide, bleomycin ifosfamide

42. CT scan
RPLND
HIGH-STAGE NONSEMINOMATOUS GERM CELL TUMORS
Renal
toxicity
Mediastinal primary tumor -
Non pulmonary visceral Metastasis -
S3 Marker level -

43. Follow-Up care
Follow-Up -
-
-
LDH hCG AFP -
Chest and Abdominal x-ray Visit -

44. 1- For seminoma treated by orchiectomy and radiotherapy, the 5-year disease-
free survival rate is 98% for stage I and 92–94% for stage II-A in several recent
series.
2- Higher stage disease treated by orchiectomy and primary chemotherapy has
a 5-year disease-free survival rate of 35–75%.
3- Survival in patients with NSGCTs treated by orchiectomy and RPLND for
stage I disease ranges from 96 to100%.
4- For low-volume stage II disease treated with chemotherapy plus surgery,
greater than 90% 5-year disease free survival rates are attainable.
5- Patients with bulky retroperitoneal or disseminated disease treated with
primary
chemotherapy followed by surgery have a 5-year disease free survival rate of
55–80%.

46. Leyding cell Sertoli cell Gonadoblastomas
Tumors Tumors

47. Leydig Cell Tumors
- NGCT
- -
-
Cryptorchiedism GCT

48. Virilization -
- -
Gynecomastia
-
17-Ketosteroids -

49. 1-Radical orchiectomy is the initial treatment for Leydig cell tumors.
2- Clinical staging is similar to that for germ cell tumors.
3- levels of the 17-ketosteroids can be helpful in distinguishing between
benign and malignant lesions. Elevations of 10–30 times normal are typical of
malignancy.
4- RPLND is recommended for malignant lesions.
5- Prognosis is excellent for benign lesions, while it remains poor for patients
with disseminated disease.

50. Sertoli Cell Tumors
-

51. 1- Radical orchiectomy is the initial procedure of
choice.
2- In cases of malignancy, RPLND is indicated.
3- roles of chemotherapy and radiotherapy remain
unclear.

52. Gonadoblastomas
1- Radical orchiectomy is the primary treatment of choice.
2- In the presence of gonadal dysgenesis ( Infertility ) , a contralateral
gonadectomy is recommended because the tumor tends to be bilateral in 50%
of cases. in this setting Prognosis is excellent.

54. Lymphom Leukemic infiltration of Metastatic
a testis Tumors

55. References:
1- Smith general urology , 15th , 16th and 17th editions.
2- Internet.
3- cambell walsh urology , 8th and 9th editions.