Testis

Dr. Raid Jastania

Objectives

• By the end of this session the student should be able to:

• List common causes of scrotal swelling

• Classify testicular tumors

• List the gross and microscopic features of germ cell tumors

Scrotum

• Scrotal enlargement– Hydrocele: accumulation of serous fluid in the

tunica vaginalis– Hematocele– Chylocele

• Squamous cell carcinoma and chimney sweeps

Cryptorchidism

• Undescended testis 0.7-0.8% of males• Descent occurs in the last 2 months of

intrauterine life• Risk factors:

– Hormonal abnormalities– Prematurity– Testicular abnormalities– Mechanical problems– Congenital syndormes

Cryptorchidism

• Right > left

• Can result in infertility

• Risk of malignancy : x4

• May result in atrophy

• Tubular atrophy, hyalinization

• Hyperplasia of leydig cells

• Intratubular germ cell neoplasia

Epididymitis, Orchitis

• Infections (acute, chronic, granulomatous)

• Follow UTI

• Associated with mumps in 20% of adults, rare in children

Granulomatous orchitis

Testicular torsion and infarction

Testicular Neoplasm

• Most common cause of painless, firm enlargement of the testis

• 2/100,000 male

• 15-35 year

• Classification– Germ cell tumors– Sex cord tumors

Germ cell tumors

– Seminoma Non-Seminoma

1. Teratoma

2. Embryonal carcinoma

3. Yolk sac tumor

4. Choriocarcinoma

– Mixed Germ cell tumors (60%)

• Risk factors:– Testicular abnormalities: undesceded testis,

testicular dysgenesis– Chromosomal syndromes: Klinefelter– Family history– White > Black– Intratubular germ cell neoplasia

• Genetic finding: Isochromosome 12

Case Presentation

• A 35-year-old healthy male with a past history of cryptorchidism repaired at age 5 presented with painless enlargement of the left testis. The mass was opaque on transillumination. A testicular ultrasound examination revealed the enlargement to be composed of soft tissue without a cystic component.

• Laboratory data included serum HCG of 90 mU/mL (ref. range < 5 mU/mL) and AFP of 7 ng/mL (ref. range 0-44 ng/mL).

• A radical left orchiectomy was performed.

• The left testicle was dominated by a 4.0-cm, pink-tan nodular mass. An abdominal CT scan revealed para-aortic lymphadenopathy; a chest x-ray was normal. Radiotherapy was given to the abdominal retroperitoneal region.

Seminoma

• Age 40-50 years• Large, soft, well-demarcated, homogenous

mass, gray-white (may show hemorrhage, necrosis)

• Large cells, round nuclei with porminent nucleoli

• Inflammatory cells• Malignant

Teratoma

• All ages• Firm mass, may contain cartilage• Types

– Mature– Immature– Teratoma with malignant transformation

• All are considered malignant except mature teratoma in children.

Embryonal carcinoma

• Age 20-30 years• Ill-defined mass with

hemorrhage and necrosis

• Large cells, large nuclei with glandular structures

• Malignant

Yolk Sac tumor• Children: 3 years• Large tumor, well

demarcated• Cuboidal cells forming

microcysts• Eosinophilic hyaline

globules• Schiller-Duvall bodies• Alpha feto protien

(AFP)• Malignant

Choriocarcinoma

• Age 20-30 years

• Small, hemorrhagic

• Cytotrophoblasts, Syncytiotrophobalsts

• hCG

• Malignant

Mixed Germ cell tumor

• 60%• Teratoma +

Embryonal carcinoma• Teratoma + Yolk sac

tumor

Clinical Issues• Stage I: tumor limited to testis• Stage II: Retroperitoneal lymph nodes• Stage III: beyond retroperitoneal lymph nodes

• Tumor markers• hCG• AFP

• Seminoma is radiosensitive

70 year old man with testicular mass