Testicular tumours

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Testicular tumours. Urology 2012 . Case presentation. History 25 C/o hemoptysis, abdominal discomfort; History of UDT, right side-operated No child. 2. On exam: Generally well Scar R groin Nodes palpable, inguinal Big R testis, normal L testis What next?. Outcomes. - PowerPoint PPT Presentation

Transcript of Testicular tumours

  • Testicular tumoursUrology2012

  • Case presentationHistory25C/o hemoptysis, abdominal discomfort; History of UDT, right side-operatedNo child*

  • On exam:Generally wellScar R groinNodes palpable, inguinalBig R testis, normal L testisWhat next?

  • OutcomesClinical presentation age, MetastasisClassificationDiagnosisDifferential diagnosisManagement

  • Epidemiology

    Incidence2-3/100 000 in whites L 2-3% bilateral95% Germ cellAge16-35 yrs

  • AetiologyGonadal dysgenesisHereditary not clearEnvironmental factorsChemical carcinogens Infections7-10% in undescended testis- Dysgenesis, temp, Abn blood supply, endocrine dysf(x)

  • Risk Factors

    Previous history of testicular tumor UDTInfertility Atrophic testis CIS

  • Anatomy

  • ClassificationGerm cellSeminomaNon seminomaEmbryonalChoriocarcinomaTeratocarcinomaYolk sac tumourMixed variantNon Germ cellLeydig cellSertoli cellSarcoma leukaemiaLymphomametastasis

  • Frequency

    Seminoma -30%Embryonal Carcinoma- 30%Teratoma- 10%Teratocarcinoma- 25%Choriocarcinoma -1%Combined- 15%o

  • Tumour markersAFPB-HCGLDH

  • Metastatic patternLocal Lymphatichematogenous

  • Clinical presentetion50% have metastasis on diagnosis10% present with this as first sxNeck mass, respiratory, GIT, bone pain, neurological, lower extremities LocalHeavy feeling or painless swelling10% acute testicular pain

    5% Gynecomastia

  • ExaminationLocal examContra lateral vs. ipsilateral testis, EpydidimisSpermatic cordAbdominalGeneral

  • Differential diagnosisTesticular torsion Epidydimo-orchitisHydrocoeleInguinoscrotal hernia paratesticular tumours

  • InvestigationsLaboratory

    Serum tumour markersFBC, U&E,LFT`s

    Radiological

    SonarCXRCT scan abdomenRole of MRI?

  • Sonar

  • CT Scan

  • MRI

  • stagingClinical and surgicalTumor type degree of infiltrationVascular invasionLymph metastasisDistant metastasisSerum tumor markers

  • StagingA- confined to testisB -Retroperitoneal spreadB1-3C- Metastatic disease Or TNMS staging

  • Prognosis Mortality 50% in 1970Cure rate of > 95 % now!MorbidityTumour related Treatment relatedFertility?,QOL

  • PrognosisSeminoma overall cure rate is > 90%Age older patientsSperm cryopreservation?B HCG positive in 5-10% very radio & chemosensitive

  • Non seminomaChoriocarcinoma- Can present with extensive metastasiss with paradoxically small primaryTeratoma- mature and immature elementsYolk sac tumour- In infants and young children

  • treatmentNB Multimodal

    Radical orchidectomyRadiotherapy ChemotherapyRetroperitoneal lymph node dissectionFollow up

  • General comments Misdiagnosis common No transscrotal biopsies Good work-upQuick referralFollow up !

  • OtherExtragonadal germ cell tumoursLeydig cell 10% malignant, present in children with virilising and in adults feminising.Sertoli cell- any age.10% malignantGonadoblastoma- In dysgenetic gonads

  • Secondary tumoursLymphomaLeukaemic infiltrationMetastasis- prostate, Breast, kidney

  • Thank you