Mr C Dawson Consultant Urologist Edith Cavell Hospital Peterborough Testicular Tumours Mr C Dawson Consultant Urologist Edith Cavell Hospital Peterborough

Incidence of Testicular tumours 1-2% of all tumours in men The most common tumour in men aged 20-35, excluding leukaemia Incidence of approx 2 cases / year/ 100,000 men in population Higher incidence in caucasians Right side > left side Incidence is increasing Right sided disparity may be due to incidence of Cryptorchidism Gillenwater chapter 39

Aetiology of testicular tumours [Chemical] [viral] Trauma to testicle Atrophy of testicle Cryptorchidism Not much known about chemical or viral causes Trauma history has been reported in 8-25% of all cases. Probably not the cause, but may draw attention to the problem Atrophy - one study showed that in 1.5% of patients with tumour the tumour developed in an atrophic testis. Cause of atrophy not always apparent Cryptorchidism Association first noted in 1851 Risk of subsequent tumour formation not reduced by orchidopexy Contralateral testis also has increased risk, even if it was normally descended at birth. In 20% of cases of cryptorchidism the tumour develops in the contralateral testis. Therefore perform orchidopexy performed between age 1-2 yrs. Needs follow up and patient should probably be taught self-examination

Classification of Testicular tumours Primary Germ cell (97%) Seminoma Non-seminoma Embryonal carcinoma Teratoma Choriocarcinoma Yolk sac tumours Non Germ cell tumours (3%) Secondary (Metastasis) - 0.9% of all: Prostate, bronchus, pancreas, melanoma, bladder TCC, Thyroid Ca

Classification of testicular tumours Diagram scanned from Gillenwater

Seminoma 42% of all testis tumours Tend to appear later than other tumours (mean 31-41 yrs) More common than NSGCT in undescended testis Picture is #1300 from Atlas of Urology by Lloyd Davis, Parkhouse et al - showing slightly lobulated tumour with a fairly homogenous appearance.

Non-seminoma germ cell tumours (NSGCT) Embryonal carcinoma 76% Teratoma 5% Choriocarcinoma 1% Approx 25% are mixed types commonly embryonal carcinoma and teratoma (aka “teratocarcinoma) - 64 % also contain seminoma Embryonal carcinoma and seminoma (5%) Yolk sac tumours - does not occur on its own in adults Yolk sac tumour originally described as a rare tumour of infancy Yolk sac elements are found in 38% of adult testis tumours and in 10% the yolk sac element is the dominant feature Not described as a pure adult tumour Gillenwater

NSGCT Teratoma Yolk-sac Tumour Pictures from Atlas of Urology from Lloyd-Davies, Parkhouse et al Teratoma - shows haemorrhagic mass at one pole. Yolk sac tumour - tends to occur in infants. Cut surface shows a well circumscribed yellowish tumour. Yolk-sac elements may be found in adult teratomas and tend to be associated with a poorer prognosis: like trophoblastic elements, they represent extra-embryonic development of a teratoma

Symptoms and Signs Swelling Fullness or heaviness in scrotum Occasionally pain Rarely - symptoms of metastatic disease Haemoptysis Supraclavicular mass (lymph node) Abdominal mass Occasionally, systemic endocrine effects, e.g. gynaecomastia