Testicular tumors

Cryptorchidism

Premature birth increases chances

Seminoma

Testicular Germ Cell Tumor 1. *Most common testicular tumor* 2. Ages 15 - 35 years 3. Malignant --> Late metastasis 4. Painless homogenous testicular enlargement 5. Fried egg appearance on histology 6. Radiosensitive 7. Good prognosis

Yolk sac tumor

1. #Most common testicular cancer in children <3 years* 2. Aggressive malignancy of tests (analogous to ovarian yolk sac tumor) 3. *elevated AFP* 4. appears yellowish and mucinous 5. *Schillar-Duval bodies* - resemble primitive glomeruli

Testicular lymphoma

1. *Most common testicular cancer in older men 2. *Metastasis to testes* from a metastatic lymphoma

Tunica vaginalis lesions

1. Congenital Hydrocele a. due to incomplete fusion of processus vaginalis b. transilluminating swelling c. common cause of scrotal swelling in infants 2. Spermatocele a. due to dilated epididymal duct or rete testis b. Paratesticular fluctuant nodule 3. Varicocele a. Dilated veins in pampiniform plexus b. can cause infertility c. "bag of worms"

Choriocarcinoma

1. Malignant a. disordered syncytiotrophoblastic and cytotrophoblastic elements 2. *Elevated hCG* a. elevated hCG causes symptoms of hyperthyroidism (e.g. gynecomastia), because hCG is structurally similar to LH, FSH and TSH 3. *metastasize hematogenously* to *lung* and brain

Embryonal carcinoma

1. Malignant, most commonly mixed with other tumor types 2. *Painful* palpable mass in scrotum a. hemorrhagic mass with necrosis 3. *elevated hCG* 4. AFP normal (when pure) AFP elevated (when mixed) 5. Papillary morphology

Teratoma

1. Mature teratomas in males may be malignant (not malignant in females) a. benign in children 2. Multiple tissue types (hair, teeth) 3. Elevated hCG 4. *Elevated AFP* (50% of tumors)

Leydig cell tumor

1. Most common non-germ cell tumor 2. androgen-producing: testosterone secreting a. gynecomastia (men) b. precocious puberty (boys) 3. Reinke crystals (eosinophilic cytoplasmic inclusions) 4. Golden brown color

Acquired hydrocele

1. Scrotal fluid collection usually secondary to ... a. infection b. trauma c. tumor If bloody --> hematocele

Sertoli cell tumor

1. Secrete estrogen a. gynecomastia 2. associated diseases a. Peutz-Jeghers syndrome b. Carney syndrome 3. Androblastoma from sex cord stroma

Spermatogonia

Maintain germ pool and produce primary spermatocytes Location: line seminiferous tubules

Sertoli Cells

Stimulated by FSH --> secretion of androgen binding protein (and MIF during embryologic development) Increase temperature --> decreased sperm production and inhibin B (increased T seen in varicocele, cryptorchidism) Location: Line seminiferous tubules Convert testosterone and androstenedione to estrogens via aromatase

Leydig cells

Stimulated by LH --> secretion of testosterone (homolog of female theca interna cells) *testosterone production unaffected by temperature* Location: interstitium

Testicular Non-germ cell tumors

~5% of all testicular tumors, *mostly benign* Types: 1. Leydig cell tumor 2. Sertoli Cell tumor 3. Testicular Lymphoma

Testicular germ cell tumors

~95% of all testicular tumors. Most often occuring in young men. Risk factors: cryptorchidism, Klinefelter syndrome Finding: testicular mass that does not transilluminate Types: 1. Seminoma (similar to dysgerminoma of ovary) 2. Yolk sac tumor 3. Chariocarcinoma 4. Tertaoma 5. Embryonal carinoma