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

2. 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

3. 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

4. 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

5. Classification of testicular tumours
Diagram scanned from Gillenwater

6. Seminoma 42% of all testis tumours
Tend to appear later than other tumours (mean 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.

7. 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

8. 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

9. 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