Testicular

Tumors

Testicular Tumors

• Testicular cancer represents 1% of all

cancers in men.

Testicular Tumors

Classification:

1. Germ cell tumors (GCTs): (95%) of primary testicular tumors.

a. Seminomas (45%).

b. Non-seminomas (50%): mixed GCTs (40%), Teratomas and teratocarcinomas

(30%) Embryonal cell carcinoma (20%). Choriocarcinoma (1%). Yolk sac

tumors

2. Gonadal Stromal Tumors: Leydig cell tumors and Sertoli cell tumor.

3. Secondary Tumors: Lymphoma, leukemia, and melanoma are the

most common malignancies that metastasize to the testicle.

Testicular Tumors

Age:

• First Decade → Yolk Sac Tumors – Teratomas.

• Second & Third Decade → Teratoma & Choriocarcinoma.

• Forth And Fifth Decade → Seminoma.

Testicular Tumors

Tumors Markers:

• Alpha Fetoprotein → All Yolk Sac Tumors – 75% Of Embryonal

Carcinoma.

• Human Chorionic Gonadotrophin (hCG) → All

Choriocarcinoma - 60% Embryonal Carcinoma.

Testicular Tumors

Spread:

• Lymphatic Spread.

• Hematogenous Spread.

• Local.

Testicular Tumors

Clinical:

• Asymptomatic.

• Mass.

• Metastasis.

• Hormonal disturbance.

Imaging

Testicular Tumors

Plain X-Ray:

• Metastasis.

Testicular Tumors

CT:

• Staging

Testicular Tumors

MRI:

• Homogeneously hypointense on T2-weighted

images. Larger tumors may be more heterogeneous.

Testicular Tumors

US:

• Hypoechoic relative to

the surrounding

parenchyma.

Testicular Tumors

US:• Seminomas are well defined within the tunica

albuginea and homogeneously hypoechoic

Testicular Tumors

US:

• Nonseminomatous lesions are more often cystic with

interspersed areas of calcification.

Testicular Tumors

US:

• Embryonal cell cancers are heterogeneous.

• The borders of the tumor are less distinct.

• More aggressive in behavior.

• The tunica albuginea may be invaded.

Testicular Tumors

US:

• Embryonal cell cancers.

Testicular Tumors

US:

Yolk Sac Tumor:

• Imaging findings are

nonspecific,especially in children,

in whom the only finding may be

testicular enlargement without a

defined mass.

Testicular Tumors

US:

Teratoma:

• Well-circumscribed complex

masses.

• Cysts are a common feature and

may be anechoic or complex,

depending on the cyst contents (ie,

serous, mucoid, or keratinous fluid)

Testicular Tumors

US:

• Choriocarcinomas are often

heterogeneous with multiple

internal calcifications present.

Testicular Tumors

US:

• Leydig and Sertoli cell, are

generally well defined and

hypoechoic.

• Calcifications are frequently

described.

Testicular Tumors

US:

• Testicular lymphoma generally

appears as discrete hypoechoic

lesions, which may completely

infiltrate the testicle &

epididymis.

Testicular Tumors

“Burned-out" Germ Cell Tumor

• The patient may present with

widespread metastases even

though the primary tumor has

involuted.

Testicular Tumors

“Burned-out" Germ Cell Tumor

• The pathogenesis of this

phenomenon may be that the

high metabolic rate of the tumor

causes it to rapidly outgrow its

blood supply.

Testicular Tumors

“Burned-out" Germ Cell Tumor

• These tumors are clinically

occult, with the testis being

normal to small upon

palpation.

Testicular Tumors

“Burned-out" Germ Cell Tumor

• US plays a vital role in the search

for the primary regressed tumor.

• These primary tumors have a

variable appearance. They are

generally small and can be

hypoechoic, hyperechoic, or

merely an area of focal

calcification.