4th stage
UROLOGYLec
د.محمد فوزي
9/3/2016
Testicular tumor99% of testicular tumor is malignant , It is one of most common tumor in young adult
Mal descent 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 :
Sminoma (40 % ) age 35 to 45 years
Teratoma (32 % ) age 20 to 35 years
Combined seminoma and teratoma ( 14% )
Interstitial tumors (1.5 % )
Lymphoma (7% )
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
Staging of tumor :-
Stage 1 testes lession only,no spreadStage2 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% )
Secodary 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 lumbere pain,mass in the epigastrium
Pulmonary metastesis usually silent but may cause chest pain or hemoptesis (teratoma)
Atypical cases may resemble epididymitis which not respond to antibiotic
On exa.testis enlarged.smoth ,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
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 sensetive stage 1 and 2 treated by radiotherapy of involved LN ,recently some give adjuvant chemotherapy (cisplatin)
For metastatic seminoma chemotherapy with cisplatin
2-teratoma
its insensetive to radiotherapy - for stage 1 : after orchidectomy follow up with measurment 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.