Testicular tumor that is rare in childhood:
Ans. a (Seminoma). (Ref. Bailey 24th/1385).Teratomas tend to occur in younger men, with the peak incidence being between 20 and 35 yearst whereas the peak incidence of seminoma is between 35 and 45 years. Seminoma is rare before puberty.COMMON TUMORS OF THE TESTISSeminoma (40%)Most common tumor.Extremely rare before puberty, and presents between 35-45 yrs.Seminomas are radiosensitive and excellent results have been obtained by irradiating stage 1 and stage 2tumours.More recently, the tumour has been shown to be highly sensitive to cisplatin, which is already being used for patients with metastatic disease.Teratoma (32%)Tends to occur at a younger age, presenting between 20 and 35 yrs.Teratomas are less sensitive to radiation.Stage 1 tumours can be managed by watching the level of serum markers and by repeated computerised tomography. Teratomas at stages 2--4 are managed by chemotherapy.Cisplatin, methotrexate, bleomycin and vincristine have been used in combination with great success.RPLND (Retroperitoneal lymph node dissection) is sometimes needed when retroperitoneal masses remain after chemotherapy. The operations can be formidable if the tumour is large and retrograde ejaculation is likely unless steps are taken to preserve the sympathetic outflow to the bladder neck.Combined seminoma and teratoma (14%)-Radical orchidectomy + ChemoradiotherapyLymphoma (7%)Constitutes the most common form of teticular cancer in men over the age of 60 yrs.ChemotherapyInterstitial TumorsMajority between 20Radical orchidectomy(1.5%)and 30 years. SEMINOMA# Represents about 50% of all GCTs# Has a median age in the fourth decade# 70% patients present with stage I disease, about 20% with stage II disease, and 10% with stage III disease;# Lung or other visceral metastases are rare.# Rx:# Radiation therapy is the treatment of choice in patients with stage I disease and stage II disease where the nodes are <5 cm in maximum diameter.# When a tumor contains both seminoma and nonseminoma components, patient management is directed by the more aggressive nonseminoma component.Germ Cell TumorsMost common malignancy in men 15 to 34 years of ageSeminoma# Rare in infants, incidence increases to a peak in the fourth decade# 10% are anaplastic seminomas; show nuclear atypia# Prognosis; with treatment; 5-year survival rate exceeds 90%# Highly radiosensitive; metastases rareEmbryonal carcinoma# Most commonly in the 20-30-year-age group# Aggressive, present with testicular enlargement# 30% metastatic disease at time of diagnosis# Serum AFP: elevated# 5-year mortality rate 65%# Less radiosensitive than seminomas# Often metastasize to nodes, lungs, and liver# May require orchiectomy and chemotherapyChoriocarcinoma# Most common in men 15-25 years of age, highly malignant# May have gynecomastia or testicular enlargement# Elevated serum and urine hCG levels# Tends to disseminate hematogenously, invading lungs, liver, and brain# Treated with orchiectomy and chemotherapyYolk sac tumor# Most common in children and infants, although rare overall# Elevated alpha fetoprotein (AFP)# Very aggressive; exhibiting a 50% 5-year mortality rate# May be considered a variant form of embryonal carcinomaTeratoma# Can occur at any age, but are most common in infants and children# Appears as a testicular mass# Exhibit a variety of tissues, such as nerve, muscle, cartilage, and hair# Benign behavior during childhood, variable in adults# 2-year mortality is 30%# Treatment: orchiectomy, followed by chemotherapy and radiationNon-Germ Cell TumorsLeydig cell tumor# Usually unilateral# Can produce androgens or estrogens# Children: present with masculinization or feminization; adults: gynecomastia# Usually benign and only 10% are invasive; surgery may be curativeSertoli cell# Usually unilateral# Can produce small amounts of androgens or estrogens, usually not enough to cause endocrinologic changes# Present with testicular enlargement# Over 90% are benignLymphoma# Lymphomas are the most common testicular cancer in elderly men# The tumors are rarely confined to the testes (often disseminated)
Seminoma
Teratoma
Interstitial cell tumor
None
Testis & Scrotum