1. Testis
Dr. Raid Jastania

2. 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

3. Scrotum Scrotal enlargement Squamous cell carcinoma and chimney sweeps
Hydrocele: accumulation of serous fluid in the tunica vaginalis
Hematocele
Chylocele
Squamous cell carcinoma and chimney sweeps

4. 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

5. 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

6. Epididymitis, Orchitis
Infections (acute, chronic, granulomatous)
Follow UTI
Associated with mumps in 20% of adults, rare in children

7. Granulomatous orchitis

8. Testicular torsion and infarction

9. 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

11. Germ cell tumors
Seminoma Non-Seminoma
1. Teratoma
2. Embryonal carcinoma
3. Yolk sac tumor
4. Choriocarcinoma
Mixed Germ cell tumors (60%)

12. Genetic finding: Isochromosome 12
Risk factors:
Testicular abnormalities: undesceded testis, testicular dysgenesis
Chromosomal syndromes: Klinefelter
Family history
White > Black
Intratubular germ cell neoplasia
Genetic finding: Isochromosome 12

13. Case Presentation

14. 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.

15. The left testicle was dominated by a 4. 0-cm, pink-tan nodular mass
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.

17. Seminoma
Age years
Large, soft, well-demarcated, homogenous mass, gray-white (may show hemorrhage, necrosis)
Large cells, round nuclei with porminent nucleoli
Inflammatory cells
Malignant

21. Teratoma All ages Firm mass, may contain cartilage Types
Mature
Immature
Teratoma with malignant transformation
All are considered malignant except mature teratoma in children.

24. Embryonal carcinoma Age 20-30 years
Ill-defined mass with hemorrhage and necrosis
Large cells, large nuclei with glandular structures
Malignant

26. 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

29. Choriocarcinoma Age 20-30 years Small, hemorrhagic
Cytotrophoblasts, Syncytiotrophobalsts
hCG
Malignant

32. Mixed Germ cell tumor 60% Teratoma + Embryonal carcinoma
Teratoma + Yolk sac tumor

34. 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

35. 70 year old man with testicular mass