Testicular Tumors

Overview of Testicular Tumors

  • Understanding testicular tumors is easier if one has mastered ovarian tumors.
  • Testicular tumors fall into two main categories due to the absence of surface epithelium in testicles:
    • Germ cell tumors
    • Sex cord stromal tumors

Presentation of Testicular Tumors

  • Patients present with a firm, painless testicular mass.
  • Important to note that the mass cannot be transluminated (unlike a hydrocele).

Biopsy Considerations

  • Testicular tumors are not biopsied due to:
    1. Risk of tumor seeding the scrotum during biopsy.
    2. Majority (over 95%) of testicular tumors are germ cell tumors, which are typically malignant.

Germ Cell Tumors

  • Incidence: Most common form of testicular tumors, especially in males aged 15 to 40.

  • Risk Factors: Include cryptorchidism and Klinefelter syndrome.

  • **Key Germ Cell Tumors:

    1. Seminoma:
    • Description: Malignant tumor; large cells with clear cytoplasm and central nuclei.
    • Characteristics: Often resembles ovarian dysgerminoma, it's a homogeneous mass lacking hemorrhage and necrosis.
    • Prognosis: Good, responds well to radiotherapy.
    1. Embryonal Carcinoma:
    • Description: Malignant, primitive cells resembling embryonic tissue that can form glands.
    • Characteristics: Hemorrhagic mass with necrosis; aggressive with early hematogenous spread.
    • Secretions: Can secrete alpha-fetoprotein (AFP) or beta-human chorionic gonadotropin (hCG), can also differentiate into teratoma after chemotherapy.
    1. Yolk Sac Tumor:
    • Description: Resembles yolk sac; most common testicular tumor in children.
    • Secretions: Elevates AFP; classic histology shows Schiller-Duval bodies (glomeruloid structures).
    1. Choriocarcinoma:
    • Description: Malignant tumor of placental tissue lacking villi; contains syncytiotrophoblasts and cytotrophoblasts.
    • Secretions: Produces elevated beta-hCG, can lead to secondary issues like hyperthyroidism or gynecomastia.
    • Characteristics: Typically shows a tiny primary tumor in testicle with massive metastasis elsewhere.
    1. Teratoma:
    • Description: Composed of mature fetal tissue from 2 or 3 embryonic layers.
    • Notable Distinction: Benign in females but malignant in males; can produce AFP or beta-hCG.

  • Mixed Germ Cell Tumors: Most germ cell tumors are mixed, and prognosis is based on the worst component.

Sex Cord Stromal Tumors

  • Resemble normal testicular structures and are usually benign.
  • Key Types Include:
    1. Sertoli Cell Tumors:
    • Composed of Sertoli cells; clinically silent.
    1. Leydig Cell Tumors:
    • Produce androgen leading to precocious puberty in children or gynecomastia in adults.
    • Characteristic: Exhibit Renke crystals on histology.

Differential Diagnosis by Age

  • Testicular tumors are primarily germ cell tumors in males aged 15-40.
  • In males over 60, lymphoma is a more common cause of testicular masses, typically diffuse large B-cell lymphoma and may be bilateral.

Conclusion

  • Understanding the types, presentations, and management of testicular tumors is crucial for diagnosing and treating these conditions effectively.