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REGUB - Pathology of Male GUT (iii) Testicular Tumours (Germ cell tumours,…
REGUB - Pathology of Male GUT (iii) Testicular Tumours
Intro
rare
remember not all testis lumps are tumours - infections, cysts etc
Germ cell tumours
90%
seminoma
55%
age peak 40s
give adjuvant radiation if needed (although now changing to chemo to avoid longterm risks of radiation)
no specific tumour marker in blood but LDH often increased (non-specific, just indicates increased cell turnover)
non-seminoma
age peak 30s
give adjuvant chemo if needed
subtypes
embryonal carc
teratoma: least sensitive to chemo
yolk sac tumour: marker = AFP
choriocarc: uncommon, marker - hHCG, haemorrhagic + ill-circumscribed
LDH raised
always malignant (can be benign in boys)
mean age = 30s-40s, but bell-shaped curve (teens + older men less frequently get it)
most common solid tumour in young men
survival v good due to chemo + radiation (v responsive)
Risk factors
racial: white > black
cryptorchidism
Klinefelter syndrome (XXY)
TNM staging
T1: limited to testis
T2: limited to testis but invades through tunica albuginea +/or shows vasc invasion
T3: invades cord
T4: invades scrotum
increasing incidence (possibly environmental)
spread
nodes: iliac 1st, then upward towards chest (NOT INGUINAL)
haematogenous: lungs, brain (most common in non-seminoma)
if in situ (precursor, NOT DYSPLASIA) cannot met
Sex cord/Stromal tumours
<10%
Leydig cell tumour = most common
most (but not all) are benign
Rare tumours
lymphoma
mets (esp older men)