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