Presentation is loading. Please wait.

Presentation is loading. Please wait.

 Are rare, lifetime probability 0.2%  90-95% are germ cell tumor  More common in whites (4 fold)  More in high socioeconomic class (2 fold)  More.

Similar presentations


Presentation on theme: " Are rare, lifetime probability 0.2%  90-95% are germ cell tumor  More common in whites (4 fold)  More in high socioeconomic class (2 fold)  More."— Presentation transcript:

1  Are rare, lifetime probability 0.2%  90-95% are germ cell tumor  More common in whites (4 fold)  More in high socioeconomic class (2 fold)  More common on right side  Geographical difference noted

2  1-2% are bilateral  50% in men with history of UDT  Synchronously or asynchronously  Seminoma is the most common germ cell tumor in primary type  Malignant lymphoma is the most common bilateral tumor of testis

3  Cryptorchidism, most important  7-10% in men with Hx of UDT  Seminoma is the most common form  Risk is higher in intra-abdominal testis  Orchiopexy do not alter the risk  Exogenous estrogen to pregnant mother  Truma  Infection related atrophy

4  Seminoma Embryonal Teratoma Nonseminoma Choriocarcinoma Mixed tumors

5  Has 3 histologic type  Classic seminoma 85%  More common in 4 th decade of life  Syncytiotrophoblastic elements in 10-15%  Anaplastic seminoma 5-10% of all seminoma  More than 3 mitosis and high pleomorphism  Present at higher stage than classical type  Spermatocytic seminoma 5-10%  More than 50% are over the 50 years

6

7

8  Adult type and infantile type(Yolk sac tumor)  Extensive hemorrhage and necrosis  Marked pleomorphism and mitosis  Yolk sac tumor is most common germ cell tumor of infants and children  Embryoid body commonly seen and resemble 1-2 week embryo

9

10  Seen in adult and children  Contain more than one germ cell layer  Mature teratoma may have elements resembling benign structures derived from ectoderm,mesoderm and edoderm

11  Are rare tumors  Lesion are small with central hemorrhage  Syncytio-and cytotrophoblasts must be seen  Are aggressive tumors with early hematogenous spread

12  Most are teratocarcinoma ( 25%)  Treatment is like nonseminomatous germ cell tumor  Carcinoma in situ : 5% in contralateral testis  Contralateral atrophy or microlithiasis may be a sign of CIS and needs BX  CIS usually treated by radiotherapy

13  Spread in a stepwise lymphatic fashion  Lymph nodes of testis extend from T1-L4  Primary site for right testis is interaortocaval area  Primary site for left testis is para-aortic area  Right to left crossover metastasis are common  Visceral metastasis may be seen in advance disease  Lung,Liver,Brain,Bone,Kidney,Adrenal,GI,Spleen  Choriocarcinoma is the exception with early hematogenous spread especially to lung

14  Stage A: confined to testis  Stage B: regional lymph node spread  Stage C: Beyond retroperitoneal lymph node  Stage I: confined to testis  Stage II: retroperitoneal lymph node involvement:IIA 2cm  Stage III: supradiphragmatic node involvement or visceral involvement

15

16  Painless enlargement of testis  Acute testicular pain (10%)  Symptoms related to metastatic disease (10%)  Back pain, cough, bone pain  Asymptomatic (10%)

17  Testis mass or diffuse enlargement  Mass is firm and non tender  Hydrocele  Gynecomastia (5% all, 30-50%sertoli and leydig cell tumors)  Hemoptysis

18  Anemia  Renal function tests  Liver function tests  Placental Alkaline phosphatase (PLAP)  Gamma-glutamyl tranpeptidase (GGT)

19  Glycoprotein, half life : 4-6 days  High level in fetal serum  Trace amount after 1 y/o  Never found in seminoma  present in many NSGCT

20  Glycoprotein, half life: 24 hrs  Has 2 subunit: alpha, beta  Normal men has not significant level of HCG  Elevated in all NSGCT and in 7% of seminoma

21  A cellular enzyme, has 5 isoenzyme  Normally found in muscle, liver, kidney and brain  Elevated level of total and isoenzyme I in NSGCT  May be elevated in seminoma

22

23  Incorrect initial diagnosis in 25%  Epididymitis and epididymo-orchitis  Hydrocele  Hematocele, spermatocele  Varicocele  Epidermoid cyst

24  Scrotal sonography  CT scan  Chest radiography (85-90% of lung metastasis)  Pedal lymphangiography

25

26 Figure 13a. Testicular germ cell tumor. Chavhan G B et al. Radiographics 2008;28: ©2008 by Radiological Society of North America

27

28

29

30  Low stage:  Radical orchiectomy+ retroperitoneal irradiation  95% of stage I are cured  Low-volume retroperitoneal disease can be treated by radiation  No prophylactic mediastinal radiation  Chemotherapy as salvage therapy

31

32  High stage (bulky seminoma )  Primary chemotherapy  Cisplatin, Bleomycin, Etoposide  PEB for 3 cycle or PE for 4 cycles  90% complete response  Residual mass are 90% fibrosis  If well circumscribed and >3 cm consider excision

33  Low stage  Orchiectomy and:  Survveillance  RPLND or modified RPLND  Primary chemotherapy (PEB)

34  Tumor is NSGCT, confined to tunica albuginea  No vascular invasion  Tumor markers normalize after orchiectomy  No evidence of disease in imaging(CXR, CT)  Patient is reliable

35

36

37  High stage NSGCT:(>3cm node or >3 node)  Primary platinum based chemotherapy  Resection of residual mass if tumor markers will normalize  20%residual cancer usually embryonal cell  If markers not normalized salvage chemotherapy (BEP+Ifosfamide)  70% cure rate

38  5-6% of all testis tumors  Leydig cell tumors  Sertoli cell tumors  Gonadoblastoma

39  Most common Non-germ cell tumor  1-3% of all testis tumor  25% in childhood  Peak incidence 5-9 y/o and y/o  Bilateral in 5-10%  No association with UDT  No necrosis and hemorrhage  Reinke crystals are pathognomic

40  Virilization and benign in prepubertal  Asymptomatic and 10% malignant in adults  Gynecomastia in 20-25%  Elevated level of 17 ketosteroid and estrogen  elevation of 17 keto steroid is typical of malignancy  Radical orchiectomy  RPLND for malignant lesions  Prognosis is excellent for benign lesion and poor for metastatic disease

41  Rare, < 1% of all testis tumor  Peak incidence <1 y/o and y/o  10% malignant  Testicular mass, Virilization in children, Gynecomastia in 30% adults  Radical orchiectomy  RPLND in metastatic disease

42  0.5% of all testis tumor  Almost exclusively in gonadal dysgenesis  Peak incidence in <30 years  4/5 patients are female phenotypically  Male patients have UDT or Hypospadiasis  Radical orchiectomy  If gonadal dysgenesis contralateral gonadectomy because 50% bilateral  Prognosis is excellent

43  Are rare  Lymphoma  Leukemia  Metastatic

44  Most common testis tumor in >50 yrs  Most common secondary neoplasm of testis  5% of all testis tumor  Hemorrhage and necrosis are common  Late presentation of widespread lymphoma  Initial presentation of occult disease  Primary extragonadal disease

45  Painless enlargement of testis  Bilateral testis involvement in 50%  Constitutional symptoms in 25%  Fine needle aspiration  Radical orchiectomy  Adjuvant chemotherapy for primary testicular lymphoma

46  A common site of relapse in ALL  Bilateral involvement in 50%  Testis biopsy for diagnosis  Bilateral testis radiation+ adjuvant chemotherapy  Metastatic tumor is rare  Prostate is the most common primary site


Download ppt " Are rare, lifetime probability 0.2%  90-95% are germ cell tumor  More common in whites (4 fold)  More in high socioeconomic class (2 fold)  More."

Similar presentations


Ads by Google