Malignant Testicular Masses PDF - Module 9.3

Malignant Testicular Masses 1 Malignant Testicular Masses References DMS 4th : Ch: 17 DMS 5th Ch: 19 Rumack 6th Ch: 20 2 Solid Scrotal Masses Most Extra testicular (ET) masses are benign In general, ALL IT masses should be...

Malignant Testicular Masses 1 Malignant Testicular Masses References DMS 4th : Ch: 17 DMS 5th Ch: 19 Rumack 6th Ch: 20 2 Solid Scrotal Masses Most Extra testicular (ET) masses are benign In general, ALL IT masses should be considered malignant! most present with painless unilateral testicular masses, or diffuse enlargement 90 - 95% are of germ cell origin and are highly malignant  incidence with cryptorchid testis Sonography is sensitive in diagnosing the intratesticular masses and delineation between intratesticular and extratesticular disease processes 3 Malignant Testicular Masses 90 -92 % of all testticular tumours are germ cell tumour ▪Germ Cell tumor comprises 95% of malignant IT tumors ▪ Seminoma *** (most common, **radiosensitive) ▪ embryonal cell carcinoma ▪ Yolk sac tumors Non-seminomas ▪ Teratoma *Responds to ▪ Choriocarcinoma surgery and chemo ▪ Mixed germ cell tumors ▪Non- Germ cell tumors or Stromal tumors -Gonadal stromal tumors (Leydig cell, Sertoli cell) ▪ Secondary tumors: Lymphomas, Leukemia, other Mets 4 Germ cell tumours (GCT)- most common signle cell type testeticular tumour Seminoma Comprise up to 50% of the primary testicular neoplasms Peak incidence in 4th,5th decades Commonly confined within the tunica albuginea *m/c tumor type in cryptorchid testes Radiosensitive and chemosensitive> most favourable prognosis AFP- Normal in pure seminomas Sono (m/c)… hypoechoic*** homogeneous*** smooth, well defined, without calcifications and cystic areas some flow 5 Germ cell tumours (GCT)- Seminoma 6 Germ Cell Tumors (Non-Seminomatous) Embryonal cell carcinoma Yolk sac tumors (endodermal sinus tumor) Teratoma Choriocarcinoma Mixed germ cell tumors Occur in younger patients than do seminomas 2-3 decade Pure NSGCT are rarerare to have pure but can be seen in infancts. mostly produce hormones Are more aggressive than seminomas Frequently invade the tunica albuginea Not as sensitive to radiation as Seminomas 7  Non- Seminomatous GCT’s Embryonal cell embryonic anaplastic cells Occurs in men 25-35 Invades tunica albuginea Most aggressive **  AFP &  beta hCG Sonographic Features: Non-specific Testicular enlargement -hypoechoic , poorly defined mass 8  Non- seminomatous GCT Choriocarcinoma RAREST GCT 2nd - 3rd decade Worst prognosis (Highly malignant) mets via lymp and blood Clinical Presentation: **usually presents with s/s of hemorrhagic mets **Gynecomastia ( hCG) Sonographic Features: hemorrhage, focal necrosis cp- bloody cough and blooy vomit, cns symptopms complex calcifications 9  Non- seminomatous GCT Yolk Sac tottipotent cells with extraembryonic fetal memebrane tumors(Endodermal Sinus Tumors) Accounts for 80% of childhood testicular tumors, < 2yrs of age**  AFP Rare in its pure form in adults Sonographic Features Non- specific inhomogeneous May contain echogenic foci echogenic foci beceasue of necrosis and hemorrhage 10 Non- Seminomatous GCT’s Teratoma Contain multiple tissue elements-bone, soft tissue, muscle, skin, cartilage etc.. comprises 5 - 10% of testicular neoplasia Infancy, pediatrics, early 30’s Infancy-usually benign 2nd m/c testicular tumors in infants & children ** < 4yrs. Adults- usually malignant Sonographic Features inhomogeneous complex focal calcifications +/- shadowing 2 types mature and imature usually normal bhcg and afp but can be high 11  Non- seminomatous GCT’s Mixed Germ Cell Tumors Constitute upto 60% of all GCT Contain non-seminomatous germ cells in various combinations. -Embryonal cell ca is the m/c component. Eg: Teratocarcinoma Sonographic Features Variable can contian seminal cells but will not effect treatment 12  Regressed(or Burned –Out) Germ Cell Tumors Widespread mets from testicular primary But, primary intratesticular tumor has regressed Known as “Azzopardi tumors” -Variable sonographic appearance! regression due to high metabloic reate and vascualr outgrouwth 13  Non-germ Cell Tumors/ Gonadal Stromal Tumors sex cord cells - contain sertoli, lydingin, thecal, lutin, gransula cells— can be multicellular of sinle cell type ***Leydig Cell 20-50yrs Sertoli Cell CP: Gynecomastia, impotence Sonographc Features: Small, solid, hypoechoic Necrosis Calcs May be bilateral Malignant types- large, ill-defined A& B- Leydig Cell Tumor C-Sertoli Cell Tumor 14  Metastases to Testes Lymphoma m/c mets of the testeis m/ c bilateral testicular tumor** Older males > 60 painless mass,  size *most are NHL non hodkin Sonographic features: homogeneous HYPOechoic Diffuse involvement Vascularity 15  Metastases to Testes Leukemia -2nd m/c metastatic testicular neoplasm painless enlargement Bilateral/unilateral Sonographic features: HYPOechoic Homogeneous Diffuse involvement Vascularity primary is rare in children bone marrow remission will increase luekimima scanatory site for cells in chemotherapy because blood testivuclar barrier prevent accumulation of chemo 16 Metastases to Testes Nonlymphomatous metastases to the testes are uncommon **Lung and prostate gland Melanoma, kidney, colon, stomach, and pancreas. SF: variable 6-7 decade Melanoma 17 Metastases to Testes 18 Summary! Malignant Testicular Masses ▪ Germ Cell tumor comprises 95% of malignant IT tumors ▪ Seminoma *** (most common, **radiosensitive) ▪ embryonal cell carcinoma ▪ Yolk sac tumors Non-seminomas ▪ Teratoma *Responds to surgery and ▪ Choriocarcinoma chemo ▪ Mixed germ cell tumors ▪ Non- Germ cell tumors or Stromal tumors -Gonadal stromal tumors (Leydig cell, Sertoli cell) ▪ Secondary tumors: Lymphomas, Leukemia, other Mets 19 Thank You ! 20