1. Testicular tumors and STDs Dr. Basu MD

2. Our topic A. Classification of testicular tumor. B. Seminoma C. Embryonal carcinoma D. Yolk sac tumor E. Choriocarcinoma F. Teratoma G. Diagnosis of these tumors

3. What you should know about a Testicular tumor Age Age Gross and microscopy Gross and microscopy Markers Markers Clinical Presentation Clinical Presentation

4. Classification of testicular tumor. 1.Tumor arising from the Germ cells 2.Tumor arising from Leydig cells( produce endocrine abnormality). 3.Tumor arising from Sertoli cells.

5. Tumor arising from the Germ cells 1. Tumors with one histological pattern A. Seminoma B. Embryonal carcinoma C. Yolk sac tumor D. Choriocarcinoma E. Teratoma 2. Tumor with more than one histological pattern 3. Miscellaneous

6. Seminoma Vs Non seminomatous tumor of testis Seminoma Embryonal carcinoma, Yolk sac tumor, choriocarcinoma RadiosensitiveNot Late metastasis Early Good prognosis Bad

7. Tumors and the diagnostic points Classic Seminoma Seminoma cells. Lymphocyte in stroma. Cells are positive for PAS Embryonal Carcinoma Primitive cells. Both AFP and beta hcG elevated Choriocarcinoma Malignant trophoblast. Elevated beta hcG Yolk sac tumor Schillar Duval body – glomeruloid body Elevated AFP

8. Teratoma Pure Teratoma Tissues of all three germ-cell layer. No specific marker Teratoma + foci of choriocarcinoma Tissues of all three germ-cell layer + malignant trophoblast Increased beta-hcG Teratoma + foci of Embryonal carcinoma Tissues of all three germ-cell layer + Embryonal carcinoma Increased AFP & hcG

9. Seminoma [Classic] 1. Most common types of testicular neoplasm. 2. Age : 15 to 34 years 3. Note: Some Seminoma may contain trophoblastic content. Some Seminoma may contain trophoblastic content. In these type of Seminoma Beta-HCG will be mildly elevated. In these type of Seminoma Beta-HCG will be mildly elevated.

10. Variant of Seminoma Variant : Spermatocytic Seminoma In this case metastasis is rare, common in old people. In this case metastasis is rare, common in old people. Three types of cell are seen Three types of cell are seen 1. large multinucleated cells, 2. medium size cells and 3. small cells that reminiscent of spermatocytes

11. Seminoma Gross Features : large, soft, homogenous, grey-white

12. Seminoma : Microscopy 1.Seminoma cells ([ PAS positive] : Large cells with distinct border, round nuclei and prominent nucleoli. 2.Lymphocytes, plasma cell in stroma.

13. Seminoma counterpart in Ovary DYSGERMINOMA

14. Embryonal carcinoma Age : 20-30 years. Features : 1. Often multiple metastasis is present at the time of diagnosis. 2. Often it contain other foci of Yolk sac tumor, teratoma and Chorio- carcinoma. 3. So both AFP and beta hcG will be elevated ( non specific)

15. Embryonal carcinoma Features : Red to tan to brown areas, including prominent hemorrhage and necrosis.

16. Sheets of primitive looking blue cells.

17. Embryonal carcinoma and Teratoma [ Teratocarcinoma] Features : Chondroid white areas (teratoma) in a Embryonal carcinoma.

18. Solid cystic mass in Ultra sound- Teratocarcinoma

19. Teratoma in testis Age = all ages Age = all ages Almost always malignant ( unlike ovary – where it is usually benign) Almost always malignant ( unlike ovary – where it is usually benign)

20. Yolk sac tumor [ endodermal sinus tumor] Age : 3 years Age : 3 years Histology : Presence of Schiller – Duvall body ( glomeruloid body) Histology : Presence of Schiller – Duvall body ( glomeruloid body) Specific Marker = AFP Specific Marker = AFP

21. Schillar Duval body – glomeruloid structure in yolk sac tumor ; locate it

22. Choriocarcinoma Age = 20 -30 Age = 20 -30 Pure Chorio carcinoma is rare in testis. Pure Chorio carcinoma is rare in testis. It is always mixed with Teratoma, or other tumor even with Seminoma. It is always mixed with Teratoma, or other tumor even with Seminoma. Histology : Malignant cyto and syncytiotrophoblast without villous formation. Histology : Malignant cyto and syncytiotrophoblast without villous formation. Specific Marker = beta hcG Specific Marker = beta hcG

23. Mixed tumor Add…………. Add………….

24. Leydig cell tumor : Clinical features Small( 1-3 cm), nodular, circumscribed tumor, yellowish in colour Bilateral gyenecomastia and testicular enlargement force the patient to seek medical assistance.

25. Quiz : name the markers Yolk sac tumor Choriocarcinoma Teratoma + Yolk sac tumor Teratoma + choriocarcinoma Teratoma + Embryonal carcinoma AFP hcG AFP hcG AFP and hcG

26. Testicular tumor; clinical features 1. Painless swelling 2. Seminoma usually confined to testis. 3. Other non-seminomatous tumor widely metastasize. 4. Metastasis occur by both hematgenous and lymphatic route.

27. Rest your eyes : Time for Sexually transmitted disease

28. At a glance- STDs PathogensDiseases Diagnostic points HPV ( 6,11) Condylomata acuminata Koilocyte in the squamous epithelial cells. Chlamydiae Trachomatis Urethritis, Urethritis, Epididymitis. Epididymitis. Lymphogranulo ma Venereum. Lymphogranulo ma Venereum. Granuloma and Neutrophils Granuloma and Neutrophils Mucopurulent urethral discharge. Mucopurulent urethral discharge. Culture negative Culture negative

29. STDs PathogensDiseases Diagnostic points Neisseria Gonorrhoeae Epididymitis,salpingitis Mucopurulent discharge. Culture positive. Hemophilus ducreyi Chancroids (soft chancre) Tender ulcer, exudates present at ulcer base.

30. Syphilis ; Treponema pallidum Primary syphilis Hard chancre Negative serological tests Painless ulcer, clean moist base of the ulcer. Positive for treponoma pallidum in scrap smear

31. Secondary syphilis Generalized lymphadenopathy. Generalized lymphadenopathy. Maculopapular rash. Maculopapular rash. Condylomata lata Condylomata lata Serological testes positive Strongly Positive both Anti treponomal antibody test and Anti treponomal antibody test and Nontrepomomal test Nontrepomomal test

32. Syphilis Tertiary syphilis Cardiovascular disease. Neurosyphilis ( general paresis) ( general paresis) Development of gumma in bone, skin, mucus membrane. Positive anti treponomal antibody test. Negative – Nontrepomomal antibody test

33. STDs Calymmatobact erium donovani Granuloma Inguinale Ulcerative papular lesions on the external genitalia. Genital herpes simplex Painful erythematous vesicles Presence of cowdry type A inclusion

34. Condylomata acuminata ( HPV infection type 6,11) : Genital Warts

35. Gonorrhea ; clinical features Male : Epididymitis, may involve prostate. Male : Epididymitis, may involve prostate. Female : salpingitis, infertility Female : salpingitis, infertility Infants ( during delivery) : Purulent infection of the eye : Ophthalmia neonatorum). Infants ( during delivery) : Purulent infection of the eye : Ophthalmia neonatorum).

36. Lymphogranuloma Venereum, LGV lymphadenopathy. Mixed Granulomatous and neutrophilic inflammation.

37. Diagnosis - LGV Demonstration of organism in Biopsy section / exudates- in active lesion. Demonstration of organism in Biopsy section / exudates- in active lesion. ELISA performed on serum. ELISA performed on serum.

38. “Soft chancre” –Chancroid in Hemophilus ducreyi infection. Ulcer contain yellowish exudates.

39. Syphilis ( Primary- Painless clear base ulcer, no exudates) ; hard chancre

40. Syphilis ( secondary – maculopapular rash) Histology shows plasma cells and lymphocytes

41. Syphilis - Secondary :: Syphilis - Secondary :: Condylomata lata - This broad base, elevated lesion seen in the moist areas.

42. Cause of false positive VDRL test 1.SLE 2.Lepromatous leprosy 3.Pregnancy 4.Antiphospholipid syndrome

43. Granuloma Inguinale ; ulcerated papular lesion Calymmatobacterium donovani

44. Genital herpes simplex : Painful erythematous vesicles Etiology : HSV type 2 and 1

45. Gonorrhea Neisseria gonorrhea Syphilis Treponema pallidum Genital Herpes Herpes simplex, Type2 (mostly), occasionally HSV-1 Genital Warts Human papilloma virus (HPV) Granuloma Inguinale Calymmatobacterium donovani Chlamydial Infections Chlamydia trachomatis Lymphogranuloma Venereum C. trachomatis Chancroid Haemophilus ducreyi

46. Best of luck