Most radiosensitive testicular tumour is: March 2008
Ans. A: Seminoma Tumours of the testis are classified according to their predominant cellular types: Seminoma (40%) Teratomas (32%) subdivided into: - Teratoma differentiated - Malignant teratoma intermediate - Malignant teratoma undifferentiated - Malignant teratoma trophoblastic (choriocarcinoma is the most lethal form and it is the least common at 1% of the non-seminomatous type) Combined seminoma and teratoma (14%) Interstitial tumours (1.5%) Risk factors include: Cryptorchidism or testicular maldescent. Klinefelter's syndrome. Family history. Male infeility (increases risk by a factor of three). Low bih weight, young maternal age, young paternal age, multiparity, breech delivery. Infantile hernia. Height - taller men are more at risk of developing germ cell tumours. Testicular microlithiasis (small intratesticular calcifications seen on ultrasound). Diagnosis is usually confirmed by ultrasound. Tissue histology can follow an inguinal orchidectomy. Disease can be staged by thoraco-abdominal CT scanning. Tumour markers are useful in staging and assessing response to treatment. Alpha-fetoprotein is produced by yolk sac elements but not produced by seminomas. Beta-human chorionic gonadotrophin is produced by trophoblastic elements and so may be elevated levels in both teratomas and seminomas. LDH should be measured. Tumour markers are present in 75% of teratomas. Royal Marsden staging of testicular tumours: Stage I - disease confined to the testis. Stage IM - as Stage I but with tumour markers rising after operation. Stage II - para-aoic lymph node involvement with fuher division into Stage IIA with nodes5 cm in diameter. Stage III - the disease has spread above the diaphragm with fuher subdivision into A, B and C as for Stage II. Stage IV - extra lymphatic metastases. - Stage L1 - - Stage L2 - >3 lung metastases but all Stage L3 - >3 lung metastases with 1 or more >2 cm in diameter. Stage H+ - liver metastases. Seminomas are radiosensitive.Teratomas are not radiosensitive:
Seminoma
Teratoma
Interstitial tumours
Lymphoma