Testicular Masses Diagnosis
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Questions and Answers

What percentage of all testicular tumors are germ cell tumors?

  • 50%
  • 95%
  • 90-92% (correct)
  • 80%
  • All intratesticular masses should be considered benign.

    False

    What is the most common type of germ cell tumor?

    Seminoma

    The majority of malignant testicular tumors originate from __________.

    <p>germ cells</p> Signup and view all the answers

    Which of the following is NOT a type of non-seminomatous germ cell tumor?

    <p>Seminoma</p> Signup and view all the answers

    What are the primary sonographic features of a seminoma?

    <p>Hypoechoic, homogeneous, smooth, well-defined</p> Signup and view all the answers

    Choriocarcinoma has the worst prognosis among germ cell tumors.

    <p>True</p> Signup and view all the answers

    At what age range do non-seminomatous germ cell tumors typically occur?

    <p>25-35 years</p> Signup and view all the answers

    Match the following germ cell tumors with their characteristics:

    <p>Seminoma = Most common, radiosensitive Choriocarcinoma = Worst prognosis, highly malignant Yolk sac tumors = Accounts for 80% of childhood testicular tumors Teratoma = Contains multiple tissue elements</p> Signup and view all the answers

    Leukemia is the most common metastatic testicular neoplasm.

    <p>False</p> Signup and view all the answers

    What is the sonographic feature of lymphoma metastasis to the testes?

    <p>Homogeneous, hypoechoic, diffuse involvement</p> Signup and view all the answers

    Study Notes

    Malignant Testicular Masses Overview

    • Most extra testicular (ET) masses are benign, while all intratesticular (IT) masses should be considered malignant.
    • Common presentation includes painless unilateral testicular masses or diffuse enlargement.
    • 90-95% of testicular cancers are of germ cell origin and are highly malignant.
    • Higher incidence observed in individuals with cryptorchidism (undescended testicles).
    • Sonography effectively diagnoses intratesticular masses and distinguishes from extratesticular diseases.

    Germ Cell Tumors (GCT)

    • Account for 90-92% of all testicular tumors, with 95% being malignant IT tumors.
    • Types include:
      • Seminoma: Most common, radiosensitive, peaks in 4th and 5th decades, confined within the tunica albuginea, and has a favorable prognosis.
      • Non-seminomatous Germ Cell Tumors (NSGCT): More aggressive than seminomas, invade tunica albuginea, and often produce hormones.

    Seminoma

    • Comprises 50% of primary testicular neoplasms, usually hypoechoic, homogeneous, and smooth on ultrasound.
    • Normal levels of alpha-fetoprotein (AFP) in pure seminomas.

    Non-Seminomatous Germ Cell Tumors

    • Includes:
      • Embryonal Cell Carcinoma: Most aggressive, occurs in men aged 25-35, presents with elevated AFP and beta-hCG.
      • Choriocarcinoma: Rarest GCT with the worst prognosis; presents with signs of hemorrhagic metastases and gynecomastia.
      • Yolk Sac Tumors: Comprise 80% of childhood testicular tumors (in children <2 years), with elevated AFP.
      • Teratoma: Contains multiple tissue elements, usually benign in infants but malignant in adults. Sonographically inhomogeneous with calcifications.
      • Mixed Germ Cell Tumors: Comprise up to 60% of GCT, often have embryonal cell carcinoma as the primary component.

    Regessed (Burned-Out) Germ Cell Tumors

    • Metastatic disease from primary tumor that has regressed.
    • Variable sonographic appearance, also known as "Azzopardi tumors."

    Non-Germ Cell Tumors

    • Gonadal Stromal Tumors:
      • Leydig Cell Tumors: Common in men aged 20-50.
      • Sertoli Cell Tumors: May cause gynecomastia and impotence, can be bilateral or malignant.

    Metastatic Conditions

    • Lymphoma: Most common metastatic testicular tumor, typically seen in older males (>60), presents as a painless mass.
    • Leukemia: Second most common, may present bilaterally.
    • Other Non-Lymphomatous Metastases: Rare; primarily from lung, prostate, melanoma, kidney, colon, stomach, and pancreas.

    Key Sonographic Features

    • Germ cell tumors generally appear as hypoechoic, homogeneous masses.
    • Metastatic lesions may show diffuse involvement with variable echogenicity depending on the primary cancer type.

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    Description

    This quiz covers the symptoms, characteristics and diagnosis of malignant testicular masses, including their incidence, origin and presentation. It also compares extra-testicular and intra-testicular masses.

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