TESTICULAR TUMOURS

   

Etiology-

• Cryptoorchidism (MC)
• Poor sperm quality

Clinical features-

• Hyperploidy is a feature of germ cell tumor of testis.
• Isochromosome of short arm of chromosome 12 asi(12p) is found.
• Tumour markers- HCG ↑(non germ cell tumor), AFP ↑ (yolk sac tumor)
• Testicular germ cell tumors are always malignant.
• Painless enlargement of testis.
• Non seminatous germ cell tumor are more aggressive and radioresistant.

Staging-

• Stage I: Tumour confined to the testis only.

• Stage IIA: Tumour and lymph nodes below the diaphragm size less than 2 cm.

• Stage IIB: Tumour and lymph nodes below the diaphragm size more than 2 cm.

• Stage III: Tumour and lymph nodes above the diaphragm.

• Stage IV: Blood spread to lungs/liver/elsewhere

SEMINOMA

• MC type of germ cell tumors
• Begins in the seminiferous tubules in the mediastinum of testis and lower pole.
• Seen in 4^th decade (30 – 40 years)
• Seminomas are radiosensitive.

Microscopically-

• Cells are large polyheadral containing abundant clear cytoplasm.
• Tumor markers- PLAP, LDH, β- hCG

Types-

1. Typical seminoma- MC type

• Syncytiotrophoblastic type producing ↑ β-hCG.

2. Spermatocytic seminoma

• Seen in elderly person (6^th decade)
• Slow growing tumor with no metastasis
• Have excellent prognosis
• Treatment- Orchidectomy is done

3. Anaplastic seminoma

• High mitotic index/ anaplasia
• It spreads fast, so poor prognosis
• Treatment- Orchidetomy + radiotherapy

Treatment-

a) Stage I- IIA (low stage)

• Radiotherapy

b) Stage IIB, III, IV-

• Radical orchidectomy + Chemotherapy
• If lymph node mass is 3cm in size ven after chemotherapy – Retroperitoneal lymph node dissection

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