1. Testicular Tumours Part 1
Vinod Jain

2. Testicular Tumours Classification Incidence Etiology Spread of tumour
Clinical Staging
Clinical features
Differential Diagnosis
Investigations
Treatment
Follow up schedule

3. Classification Primary Tumour Secondary Tumour Para testicular
neoplasm
Lymphona
Leukaemia
Metastatic
Germ Cell
tumour
Non Germ
Cell tumour
Seminoma
(SGCT)
Non Semimomatous
(NSGCT)
Leydig cell Tm
Sertoli Cell Tm
Gonadoblastoma
Adeno CA of rete tests
Terratoma
Embryonal CA
Chorio CA
Yolk sac
Tumour
Mixed Tumour

4. Metastatic testicular Tumour
In decreasing order Prostate Lung Gut Melanoma Kidney

5. Incidence Age – most common solid tumor of men between 20-30 years
Race – White : Black = 4:1 in U.S.
Side – Right > Left
Socio-economic status – high : low = 2:1
Geographical
Highest in Scandinavia, Germany, Switzerland
Intermediate – USA & UK
Low – Africa and Asia

6. Age wise incidence of testicular tumour
Tumour Type Age group (years)
Seminoma
Pure Terratoma Pediatric age group
Embryonal CA
Chorio CA
Yolk sac Tumour infancy & child hood
Mixed terrato CA
Lymphoma > 50

7. Etiology Congenital – 3-14 times common in undescended testes
Abnormal germ cell morphology
Elevated temperature
Interference with blood supply
Gonadal dysgenesis
Endocrine dysfunction
Acquired
Trauma – co incidence
Endocrine – sex hormone fluctuation
Infection – Mumps induced atrophy/ non-specific infections

8. (Cross metastasis more common in right side tumour)
Spread of Tumour
Local
Lymphatic –
Right inter aortocaval at L2  precaval  preaortic  Right common iliac  Right ext. iliac
Left  Paraortic at renal hilium  preaortic  common iliac  Left ext. iliac
(Cross metastasis more common in right side tumour)

9. Spread of Tumour Blood (Distant metastases in decreasing order Lung
Liver
Brain
Bone
Kidney
Adrenal
GIT
Spleen

10. Clinical Staging (Boden and Gibbs – 1971)
Stage I (A) – confined to testis with no spread through capsule or spermatic cord
Stage II (B) – Clinical or radiological evidence of spread beyond testis but with in regional L.N.
B1 -<2cm
B2 -2-5cm
B3 - >5cm
Stage III (C) - Disseminated above diaphragm / visceral disease

11. Clinical features A. Presentations
Gradually increasing lump / hardness in testis
Abnormal sensitivity – numbness / heaviness / Pain
Loss of sexual activity
Dull ache in lower abdomen / groin
Haemospermia
General weakness
Metastatic presentations (Contd.)

12. Clinical features (Contd.)
- Metastatic presentations
Cough and Dyspnoea
Anorexia
Nausea / Vomiting (retro duodenal LN)
Neck mass
Swelling lower extremity (IVC obstruction)
Back pain (retroperitoneal L. N.)
Gynaecomastia
Bone pains
Unilateral limb swelling (L.N metastasis)
B. Signs
Local
Systemic

13. Differential Diagnosis
Epidedymo-orchitis
Testicular haematoma
Spermatocele
Hydrocele
Testicular Torsion

14. Investigations Haematological – Hb%, Bl. urea/S. creatinine, LFT
Tumour markers – AFP, HCG, LDH
Scrotal Ultrasound – Usually homogenous, hypoechoic, intra testicular mass
X-ray chest
CT / MRI – abdomen

15. Tumour markers NSGCT SGCT AFP  N HCG   LDH  
(Advanced) (Advanced)

16. Let us revise Classification Incidence Etiology Spread of tumour
Clinical Staging
Clinical features
Differential Diagnosis
Investigations
Treatment
Follow up schedule