1
Forth stage
Surgery (Urology)
Lec-17
د.محمد فوزي
9/3/6102
Testicular tumor
99% of testicular tumor is malignant ,It is one of most common tumor in young
adult
Maldescent of testis predispose to malignancy
Despite that the testis is easily palpable organ, a testicular tumor often escapes
detection until it has metastasized
Classification of testicular tumors :
1. Sminoma (40 % ) age 35 to 45 years
2. Teratoma (32 % ) age 20 to 35 years
3. Combined seminoma and teratoma ( 14%
)
4. Interstitial tumors (1.5
%
)
5. Lymphoma (7%
)
6. Other tumors (5.5% )
Seminoma derived from seminiferous tubule .it metastasized via lymphatics to
retroperitoneal lymph nodes ,and metastasis via blood is un common
Teratoma arise from totipotent cell in the rete testis and often contain a variety of
cell type
Interstitial tumor
Leydig cell tumor : (masculinises)
- Prepubertal.
- secrete androgene.
- cause precaucious puberty.
Sertoli cell tumor :(feminises)
- Postpubertal
- cause loss of lipido
- gynecomastia, aspermia
both are usually benign and treated by simple orchidectomy
2
Staging of tumor :-
Stage 1 testes lesion only ,no spread
Stage2 nodes below the diaphragm only
Stage3 nodes above the diaphragm
Stage 4 pulmonary or hepatic metastasis
Presentation (sign and symptom) :-
painless enlargement discovered during ex.
(10 percent may be painful)
May present after trauma (10% )
Secondary retroperitoneal deposit may be palpable,
some time enlarged supraclavicular L N maybe the only sign of tumor
Occasionally the predominant symptom is that of metastasis ,abdominal or
lumbar pain, mass in the epigastrium
Pulmonary metastasis usually silent but may cause chest pain or hemoptysis
(teratoma)
Atypical cases may resemble epididymitis which not respond to antibiotic
On examination testis is enlarged, smooth ,firm and heavy
Mild secondary hydrocele may present
Investigation :-
ULS : For testes and abdomen
CT,MRI : For retroperitoneal LN metastasis
Chest XR : For pulmonary metastasis
Tumor marker HCG,AFP,LDH : For diagnosis and follow up after
treatment
3
Treatment :-
-for any testicular tumor first thing to do is inguinal radical orchidectomy
-send for histopathology to know the tumor type ,and after staging of the tumor
the treatment are
1-seminoma
-Seminoma is radio sensitive
-stage 1 and 2 treated by radiotherapy of involved LN ,recently some give
adjuvant chemotherapy (cisplatin)
-For metastatic seminoma chemotherapy with cisplatin
2-teratoma
-it is insensitive to radiotherapy
- for stage 1 : after orchidectomy follow up with measurement of tumor marker
and MRI of retroperitoneal LN .some give adjuvant chemotherapy
- For stage 2 to 4 teratoma : chemotherapy with Cisplatin ,Methotrexate
,Bleomycin and Venicrestin
-Retroperitoneal L N dissection some time needed when retroperitoneal masses
remain after chemotherapy.
SH.J