This document summarizes testicular tumors. It discusses that testicular cancer is the most common solid tumor in young men aged 15-40. The majority (95%) are germ cell tumors, with seminomas comprising 40% of cases. Diagnosis involves imaging of the testes and tumor markers. Orchiectomy is essential for diagnosis and staging. Treatment depends on the tumor type but may involve chemotherapy, radiotherapy, or surveillance. Prognosis is generally good even for metastatic disease, with cure rates as high as 99% with proper management.

1. TESTICULAR TUMORS
BY RESIDENT AHMED MOHAMED TAWFIK
SURGICAL ONCOLOGY UNIT

2. INCIDENCE
• In spite of being a rare cancer 1-1.5% of all malignancies in men it is the most
common type of SOLID malignancy in men aged between 15 to 40
• Benign forms mostly affect children 2-4
• Older patients are more liable to secondary types (Lymphoma) > 60
• Race plays a role as it affects young white men more than African Americans
(Black)
• Still it is one of the most curable cancers up to 99% with proper managment

3. PRESIDPAING FACTORS
• Personal history (prior history of germ cell tumor (GCT),contralateral tumor ,intratubular
germ cell neoplasia (testicular intraepithelial neoplasia [TIN])
• Family history
• Klinefelter’s syndrome
• Cryptorchidism
• Hypotrophic testicle
• Trauma ( co-incidental?)
• Hormonal (exposure to environmental estrogen)

4. CLASSIFICATION
GCT 95% NGCT. Secondary tumors 5%
>Seminoma 40% (sex cord stromal. Lymphoma
>Non Seminoma 60% tumors) 2-3%
1.Embryonal Carcinoma 20%. Sertoli cell tumor
2.Teratoma 25-35%. Leydig cell tumor
3.Choriocarcinoma 1%
4.Yolk Sac Tumor
5.Mixed Germ Cell Tumor

7. GERM CELL TUMORS (GCT)
• They have a more favorable out come
• Sensitive to both Chemo and radiotherapy
• Well differentiated with rapid growth rate
• More in young patients ( no co-morbidities )

8. SEMINOMA
• 40% >> commonest variety of all testicular tumors
• 4th to 5th decade
• Mostly Painless testicular mass
• May present with heaviness and may mimic epidedymorchitis or sudden pain and
swelling due to hemorrhage and mimic torsion
• Mostly Unilateral
• Rt > lt side

9. DIAGNOSIS AND STAGING
Imaging
• US examination of both testes should always be performed and has
a sensitivity to detect a testicular mass of almost 100%
• metastatic work up CXR and CT , abdominal CT as 30% of patients
present with metastatic symptoms

10. DIAGNOSIS AND STAGING
Labs
• Tumor markers >> AFP and β-HCG
• AFP mostly is not elevated in seminomas unlike β-HCG which is elevated in 30%
of patients
• Labs >> LDH (less specific than AFP and β-HCG )
• AFP , LDH and β-HCG have established roles in diagnosis and staging,
determining prognosis and assessment of treatment outcome

11. DIAGNOSIS AND STAGING
Biopsy of the contralateral testis
• There is no reason for a standard contralateral biopsy, unless when dealing with
high-risk patients for contralateral TIN (testicular volume <12 ml, history of
cryptorchidism and age <40 years)

13. ORCHIDECTOMY IS ESSENTIAL IN CLASSIFICATION
OF TESTICULAR MASS

15. STAGING

16. MANAGEMENT OF TESTICULAR MASS
• Cryopreservation and hormonal analyses *
Every patient of fertile age should be offered sperm banking prior to any therapeutic
intervention that may compromise fertility
preferably before orchiectomy
But also in any case before adjuvant chemotherapy or radiotherapy

17. INGUINAL ORCHIDECTOMY
• All patients with suspected testicular mass should undergo radical
inguinal orchidectomy with division of the spermatic cord at the level
of the internal inguinal ring.
• Scrotal violation should be avoided.
• There is no need for testicular biopsy to confirm the diagnosis

18. ORGAN-SPARING SURGERY
• may be considered for synchronous bilateral tumors <2 cm or in a
tumor in a mono- testis with sufficient preoperative testosterone
levels .
• In patients presenting with life-threatening advanced disease,
chemotherapy can be started immediately and orchiectomy may be
delayed until clinical stabilization has occurred

19. STAGING

20. ROLE OF CHEMO AND RADIOTHERAPY

21. FOLLOW-UP OF PATIENTS WITH TESTICULAR
TUMOURS
• According to the existing literature and guidelines, dif- ferent follow-up schedules have
been proposed. The primary objective of ideal follow-up should be early detec- tion of
relapse and monitoring of the contralateral testis

22. CLASSIFICATION
GCT 95% NGCT. Secondary tumors 5%
>Seminoma 40% (sex cord stromal. Lymphoma
>Non Seminoma 60% tumors) 2-3%
1.Embryonal Carcinoma 20%. Sertoli cell tumor
2.Teratoma 25-35%. Leydig cell tumor
3.Choriocarcinoma 1%
4.Yolk Sac Tumor
5.Mixed Germ Cell Tumor

23. EMBRYONAL CARCINOMA
• undifferentiated malignant cells resembling primitive epithelial cells from early-
stage embryos
• These cells are found in about 20% of testicular tumors, but pure embryonal
carcinomas occur only 3% to 4% of the time
• Painful testicular tumor
• Associated with elevated AFP +/- elevated β-HCG levels

24. TERATOMA
• Different tissues from various germinal layers
• 25-35%
• More in children
• Mostly Benign

25. CHORIOCARCINOMA
• Associated with Gynecomastia and hyperthyroidism ??why??
• Formed of Syncytiotrophoblast and Cytotrophoblast
• Markedly Increased hCG
• 1%

26. YOLK SAC TUMORS
• More in children
• Increased AFP level

27. NGCT
• Leydig cell tumor
• Sertoli cell tumor

28. LEYDIG CELL TUMOR
• Leydig cells are the primary source of testosterone or androgens in males
• Causes precocious pubetry and gynecomastia

29. SERTOLI CELL TUMOR
• Sertoli cells secrete MIF > suppress the paramesonephric duct
• help in supporting, protecting and provide nutrition to
spermatogenic cells

30. LYMPHOMA
• Secondary metastatic cancer
• It is the most common testicular tumor in men > 60
• Mostly bilateral (metastatic)
• Diffuse large B cell subtype (NHL)

31. •Thank you