urology

TESTICULAR TUMORS

DR.MOHAMMED ALSHAHWANI

Testicular tumors

99 Percent of testicular tumor is malignant
It is one of most common tumor in young adult
Mal descent testis predispose to malignancy
Despite that the testis is easily palpable organ,a testicular tumor often escapes detection until it has metastasised

Classification of testicular tumors

Sminoma (40 % ) age 35 to 45 years
Teratoma (32 % ) age 20 to 35 years
Combined seminoma and teratoma ( 14% )
Interstitial tumors (1.5 % )
Lymphoma (7% )
Other tumors (5.5% )


Seminoma derived from seminiferous tubule .it metastasized via lymphatics to retroperitoneal lymph nodes ,and metastasis via blood is un common
Teratoma arise from totipotent cell in the rete testis and often contain a variety of cell type

Interstitial tumor

Leydig cell tumor masculinises
prepubertal.secrete androgene,cause precaucious puberty
Sertoli cell tumor feminises
postpubertal,couse loss of lipido, gynecomastia,aspermia
both are usually benign and treated by simple orchidectomy

Staging of tumor

Stage 1 testes lession only,no spread

Stage2 nodes below the diaphragm only

Stage3 nodes above the diaphragm

Stage 4 pulmonary or hepatic metastasis

Presentation (sign and symptom)
painless enlargement discovered during ex.
(10 percent may be painful)
May present after trauma (10% )
Secodary retroperitoneal deposit may be palpable,
some time enlarged supraclavicular L N maybe the only sign of tumor
Occasionally the predominant symptom is that of metastasis ,abdominal or lumbere pain,mass in the epigastrium


Presentation ,cont.
Pulmonary metastesis usually silent but may cause chest pain or hemoptesis (teratoma)
Atypical cases may resemble epididymitis which not respond to antibiotic
On exa.testis enlarged.smoth ,firm and heavy
Mild secondary hydrocele may present

Investigation

ULS
For testes and abdomen
CT,MRI
For retroperitoneal LN metastasis
Chest XR
For pulmonary metastasis
Tumor marker HCG,AFP,LDH
For diagnosis and follow up after treatment

TREATMENT

for any testicular tumor first thing to do is inguinal radical orchidectomy
send for histopathology to know the tumor type ,and after staging of the tumor the treatment are

TREATMENT.cont,

For seminoma
Seminoma is radio sensetive ,stage 1 and 2 treated by radiotherapy of involved LN ,recently some give adjuvant chemotherapy (cisplatin)
For metastatic seminoma chemotherapy with cisplatin


treatment
teratoma
its insensetive to radiotherapy
for stage 1 after orchidectomy follow up with measurment of tumor marker and MRI of retroperitoneal LN .some give adguvent chemotherapy

treatment

For stage 2 to 4 teratoma
.chemotherapy with Cisplatin,Methotrexate ,Bleomycin and Venicrestin
retroperitoneal L N dissection some time neede dwhen reroperitoneal masses remain after chemotherapy.

Thank you