TESTICULAR NEOPLASM Most important cause of firm, painless enlargement of the testis. MORPHOLOGY 5/100 000 males.

Seminomas 20-34 yrs old. (Classic seminomas) 95% arise from germ cells. Large, soft, well-demarcated, usually homogeneous,gray-white tumour Cause- unknown. Microscopically: Cryptorchidism a/w 3-5x increase of risk of cancer. (10% of the Large + uniform cells cancer case) distanct cell borders Intersex syndrome increase risk. More common in white. clear, glycogen-rich cytoplasm round nuclei with conspicuous nucleoli Classification testicular germ cell tumors: Tumours w 1 histologic pattern Spermatocytic seminomas Seminoma A mixture of medium-sized cells, large uninucleate or multinucleate tumour cells, and small cells with round nuclei Non-seminomatous Embryonal carcinoma Embyronal carcinomas Yolk sac tumour Ill-defined, invasive masses Choriocarcinoma The constituent cells are large and primitive looking, with Teratomas basophilic cytoplasm, indistinct cell borders, and large Mature nuclei with prominent nucleoli Immature With malignant transformation of Yolk sac tumours somatic elements Often large and may be well demarcated Tumours w multiple histologic pattern Low cuboidal to columnar epithelial cells forming microcyst, sheets, glands, and papillae, often associated with eosinophilic hyaline globules CLINICAL FEATURES Schiller-Duvall bodies Seminomas Non-seminomatous germ cell noeplasm Choriocarcinomas Often remain confined Metastasize ealier : Small, nonpalpable lesions to the testis for haematogenous + lymphatic prolonged intervals (lung +liver) Sheets of small cuboidal cells irregularly intermingled with Metastases- iliac + or capped by large, eosinophilic syncytial cells para-aortic lymph nodes (upper lumbar Teratomas region) Masses that on cut surface often contain cysts and Hematogenous spread recognizable areas of cartilage occur later Mature teratomas- fully differentiated tissues Painless enlargement of testis Immature teratomas- immature somatic elements Mixed germ cell tumours 40% of all testicular germ cell neoplasms Combinations of the any of the described patterns Most common-combination of teratoma, embryonal carcinoma, and yolk sac tumours

STAGING Stage I: tumour confined to the testis Stage II: regional lymph node metastases only Stage III: nonregional lymph node and/or distant organ metastases SPECIAL FEATURES Assay of tumour markers: - secreted by tumor cell - important for clinical evaluation + staging hCG - produced by: synthiotropoblastic - always in choriocarcinoma + seminoma (xde cytotropoblastic) AFP: - is a glycoprotein synthesized by fetal yolk sac -indicate for the present of nonseminomatous - bcoz yolk sac x found in pure seminomas TREATMENT Chemotherapy Tx determine by: -Histologic pattern -The stage of disease at the time of diagnosis Seminoma: -radiosensitive -respond well to chemotherapy Non seminomatous tumour: -platinum-based chemotherapy regimens.