Testicular Tumors: Classification and Markers

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Questions and Answers

Who does testicular cancer typically affect?

Young males

What are common risk factors for developing testicular cancer? (Select all that apply)

High blood pressure

Positive family history (correct)

Cryptorchidism (correct)

Previous testicular cancer (correct)

What do testicular tumors usually present as?

Hard, painless masses on the testis

When a hard, painless mass is detected on the testis, what happens?

Testicular masses are never biopsied; sperm is cryopreserved and the testis is removed. Signup and view all the answers

Why isn't a testicular mass biopsied?

It could allow tumor cells to seed in the scrotum. Signup and view all the answers

What are the tumor markers in testicular cancer?

AFP (Alpha-foetoprotein) and hCG Signup and view all the answers

How are the testicular cancers classified?

They are classified as seminomas and non-seminomas. Signup and view all the answers

Germ cell tumors develop from?

Totipotent germ cells Signup and view all the answers

What is seen in almost all germ cell tumors?

Isochromosome 12p or extra copies of 12p Signup and view all the answers

What does isochromosome 12p mean?

The long arm (q) on chromosome 12 is replaced by another copy of the short arm (p). Signup and view all the answers

Most germ cell tumors develop from what precancerous lesion and what percentage?

Germ cell neoplasia in situ (GCNIS), 60% Signup and view all the answers

GCNIS derived tumors can be divided into?

Seminomas and non-seminomas Signup and view all the answers

Describe seminomas vs non-seminomas?

Seminomas are slow and less likely to metastasize; non-seminomas are more aggressive and likely to metastasize. Signup and view all the answers

What is a seminoma?

The most common pure testicular germ cell tumor, characterized by homogenous masses without hemorrhage or necrosis. Signup and view all the answers

What are the tumor markers of seminoma?

10% produce hCG. Signup and view all the answers

Seminomas most commonly affect who?

Middle-aged males (40-50) Signup and view all the answers

What are the types of non-seminoma tumors? (Select all that apply)

Embryonal carcinoma Signup and view all the answers

What is embryonal carcinoma?

Composed of primitive, embryonal cells. Signup and view all the answers

What are the tumor markers of embryonal carcinomas?

No tumor markers Signup and view all the answers

Embryonal carcinoma most commonly affect who?

Young adults (20-30) Signup and view all the answers

What are yolk sac tumors?

Tumors arising from totipotent germ cells that undergo extraembryonic differentiation. Signup and view all the answers

What are the tumor markers of yolk sac tumors?

Produce AFP. Signup and view all the answers

What is choriocarcinoma?

A type of cancer where totipotent germ cells undergo differentiation into placental cells. Signup and view all the answers

What are the tumor markers of choriocarcinomas?

Produce hCG. Signup and view all the answers

Choriocarcinomas most commonly affect who?

Young adults (20-30) Signup and view all the answers

What is teratoma?

Tumors formed from totipotent germ cells undergoing intraembryonic differentiation. Signup and view all the answers

What are the tumor markers of teratomas?

No tumor markers. Signup and view all the answers

Postpubertal teratomas vs prepubertal teratomas?

Postpubertal teratomas are malignant, while prepubertal teratomas are benign. Signup and view all the answers

What are mixed germ cell tumors?

Germ cell tumors that contain more than one histological subtype. Signup and view all the answers

What are the most frequent mixed germ cell tumor combinations?

Embryonal carcinoma + seminoma, Embryonal carcinoma + teratoma, Embryonal carcinoma + teratoma + yolk sac tumor. Signup and view all the answers

What are non-GCNIS derived tumors?

Spermatocytic tumor, Prepubertal yolk sac tumor, Prepubertal teratoma. Signup and view all the answers

What is a spermatocytic tumor?

Develops from spermatogonia, occurs most frequently in older males. Signup and view all the answers

What are the tumor markers of spermatocytic tumors?

No tumor markers. Signup and view all the answers

What is a prepubertal yolk sac tumor?

The most common testicular tumor in children, almost always pure. Signup and view all the answers

What is a prepubertal teratoma?

The second most common testicular tumor in children, benign compared to the postpubertal type. Signup and view all the answers

What are sex-cord stromal tumors?

Tumors that arise from Leydig cells, Sertoli cells, or granulosa cells. Signup and view all the answers

What other tumors can occur in the testes?

Lymphomas, most frequently as diffuse large B-cell lymphoma. Signup and view all the answers

Study Notes

Testicular Cancer Overview

Most commonly affects young males, particularly between ages 15-35.
Hard, painless testicular masses are typical presentations.
Testicular masses are not biopsied due to risk of tumor seeding; instead, sperm is cryopreserved and the testis is surgically removed.

Risk Factors

Positive family history significantly increases risk.
Previous episodes of testicular cancer elevate likelihood.
Conditions such as cryptorchidism, Klinefelter syndrome, and Down syndrome are associated with higher risk.

Tumor Classification

Testicular tumors are primarily classified into germ cell tumors and sex-cord stromal tumors.
Germ cell tumors develop from totipotent germ cells, often originating from germ cell neoplasia in situ (GCNIS) in 60% of cases.

Germ Cell Tumors

Comprised of seminomas (50%) and non-seminomas (50%).
Isochromosome 12p is commonly found in almost all germ cell tumors, signifying genetic alterations.

Seminomas

Characterized as the most common pure testicular germ cell tumor, typically presenting homogeneous masses without hemorrhage or necrosis.
Tumor markers include hCG in 10% of cases.
Predominantly affect middle-aged males (ages 40-50).

Non-Seminoma Tumors

Include embryonal carcinoma, yolk sac tumor, postpubertal teratoma, and choriocarcinoma.
Generally more aggressive than seminomas and exhibit greater likelihood of metastasis.
Embryonal carcinoma consists of primitive cells, grows rapidly, and often metastasizes, lacking specific tumor markers.

Yolk Sac Tumors

Derived from totipotent germ cells transforming into yolk sac cells.
Produce AFP as a tumor marker.

Choriocarcinoma

Highly aggressive type of testicular cancer, formed when totipotent germ cells differentiate into placental cells.
Characterized by the production of hCG.

Teratomas

Develop from totipotent germ cells, producing tissues from multiple germ layers.
Postpubertal teratomas are malignant, while prepubertal variants are generally benign.

Mixed Germ Cell Tumors

Combinations featuring multiple histological subtypes, including embryonal carcinoma with seminoma or teratoma.

Non-GCNIS Derived Tumors

Include spermatocytic tumors, prepubertal yolk sac tumors, and prepubertal teratomas.
Spermatocytic tumors arise from spermatogonia, occurring mainly in older males, while prepubertal yolk sac tumors are common in children.

Other Testicular Tumors

Lymphomas, particularly diffuse large B-cell lymphoma, may also present in the testes.

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Description

This quiz focuses on the classification of testicular tumors and associated tumor markers. It covers key aspects such as demographics, risk factors, and clinical presentations related to testicular cancer. Ideal for medical students or healthcare professionals seeking to deepen their understanding of testicular tumors.