Testicular tumors and STDs

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Testicular tumors and STDs

• Dr. Basu MD

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Our topic

1. Classification of testicular tumor.
2. Seminoma
3. Embryonal carcinoma
4. Yolk sac tumor
5. Choriocarcinoma
6. Teratoma
7. Diagnosis of these tumors

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What you should know about a Testicular tumor

• Age
• Gross and microscopy
• Markers
• Clinical Presentation

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Classification of testicular tumor.

• Tumor arising from the Germ cells
• Tumor arising from Leydig cells( produce
  endocrine abnormality).
• Tumor arising from Sertoli cells.

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Tumor arising from the Germ cells

• Tumors with one histological pattern
• Seminoma
• Embryonal carcinoma
• Yolk sac tumor
• Choriocarcinoma
• Teratoma
• Tumor with more than one histological pattern
• Miscellaneous

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Seminoma Vs Non seminomatous tumor of testis
Seminoma Embryonal carcinoma, Yolk sac tumor, choriocarcinoma
Radiosensitive Not
Late metastasis Early
Good prognosis Bad
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Tumors and the diagnostic points
Classic Seminoma Seminoma cells. Lymphocyte in stroma. Cells are positive for PAS
Embryonal Carcinoma Primitive cells. Both AFP and beta hcG elevated
Choriocarcinoma Malignant trophoblast. Elevated beta hcG
Yolk sac tumor Schillar Duval body glomeruloid body Elevated AFP
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Teratoma
Pure Teratoma Tissues of all three germ-cell layer. No specific marker
Teratoma foci of choriocarcinoma Tissues of all three germ-cell layer malignant trophoblast Increased beta-hcG
Teratoma foci of Embryonal carcinoma Tissues of all three germ-cell layer Embryonal carcinoma Increased AFP hcG
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Seminoma Classic

• Most common types of testicular neoplasm.
• Age 15 to 34 years
• Note
• Some Seminoma may contain trophoblastic content.
• In these type of Seminoma Beta-HCG will be mildly
  elevated.

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Variant of Seminoma

• Variant Spermatocytic Seminoma
• In this case metastasis is rare, common in old
  people.
• Three types of cell are seen
• large multinucleated cells,
• medium size cells and
• small cells that reminiscent of spermatocytes

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Seminoma Gross
Features large, soft, homogenous, grey-white
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Seminoma Microscopy

1. Seminoma cells ( PAS positive Large cells
   with distinct border , round nuclei and prominent
   nucleoli.
2. Lymphocytes, plasma cell in stroma.

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Seminoma counterpart in Ovary

• DYSGERMINOMA

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Embryonal carcinoma

• Age 20-30 years.
• Features
• Often multiple metastasis is present at the time
  of diagnosis.
• Often it contain other foci of Yolk sac tumor,
  teratoma and Chorio-carcinoma.
• So both AFP and beta hcG will be elevated ( non
  specific)

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Embryonal carcinoma
Features Red to tan to brown areas, including
prominent hemorrhage and necrosis.
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Sheets of primitive looking blue cells.
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Embryonal carcinoma and Teratoma
Teratocarcinoma
Features Chondroid white areas (teratoma) in
a Embryonal carcinoma.
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Solid cystic mass in Ultra sound- Teratocarcinoma
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Teratoma in testis

• Age all ages
• Almost always malignant ( unlike ovary where it
  is usually benign)

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Yolk sac tumor endodermal sinus tumor

• Age 3 years
• Histology Presence of Schiller Duvall body (
  glomeruloid body)
• Specific Marker AFP

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Schillar Duval body glomeruloid structurein
yolk sac tumor locate it
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Choriocarcinoma

• Age 20 -30
• Pure Chorio carcinoma is rare in testis.
• It is always mixed with Teratoma, or other tumor
  even with Seminoma.
• Histology Malignant cyto and syncytiotrophoblast
  without villous formation.
• Specific Marker beta hcG

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Mixed tumor

• Add.

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Leydig cell tumor Clinical features

• Small( 1-3 cm), nodular, circumscribed tumor,
  yellowish in colour
• Bilateral gyenecomastia and testicular
  enlargement force the patient to seek medical
  assistance.

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Quiz name the markers
Yolk sac tumor
Choriocarcinoma
Teratoma Yolk sac tumor Teratoma choriocarcinoma
Teratoma Embryonal carcinoma
AFP
hcG
AFP
hcG
AFP and hcG
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Testicular tumor clinical features

1. Painless swelling
2. Seminoma usually confined to testis.
3. Other non-seminomatous tumor widely metastasize .
4. Metastasis occur by both hematgenous and
   lymphatic route.

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Rest your eyes Time for Sexually transmitted
disease
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At a glance- STDs
Pathogens Diseases Diagnostic points
HPV ( 6,11) Condylomata acuminata Koilocyte in the squamous epithelial cells.
Chlamydiae Trachomatis Urethritis, Epididymitis. Lymphogranuloma Venereum. Granuloma and Neutrophils Mucopurulent urethral discharge. Culture negative
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STDs
Pathogens Diseases Diagnostic points
Neisseria Gonorrhoeae Epididymitis, salpingitis Mucopurulent discharge. Culture positive.
Hemophilus ducreyi Chancroids (soft chancre) Tender ulcer, exudates present at ulcer base.
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Syphilis Treponema pallidum
Primary syphilis Hard chancre Negative serological tests Painless ulcer, clean moist base of the ulcer. Positive for treponoma pallidum in scrap smear
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Secondary syphilis

• Strongly Positive both
• Anti treponomal antibody test and
• Nontrepomomal test

Secondary syphilis Generalized lymphadenopathy. Maculopapular rash. Condylomata lata Serological testes positive
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Syphilis
Positive anti treponomal antibody test. Negative
Nontrepomomal antibody test
Tertiary syphilis Cardiovascular disease. Neurosyphilis ( general paresis) Development of gumma in bone , skin, mucus membrane.
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STDs
Calymmatobacterium donovani Granuloma Inguinale Ulcerative papular lesions on the external genitalia.
Genital herpes simplex Painful erythematous vesicles Presence of cowdry type A inclusion
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Condylomata acuminata ( HPV infection type 6,11)
Genital Warts
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Gonorrhea clinical features

• Male Epididymitis, may involve prostate.
• Female salpingitis, infertility
• Infants ( during delivery) Purulent infection
  of the eye Ophthalmia neonatorum).

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Lymphogranuloma Venereum, LGV lymphadenopathy.
Mixed Granulomatous and neutrophilic inflammation.
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Diagnosis - LGV

• Demonstration of organism in Biopsy section /
  exudates- in active lesion.
• ELISA performed on serum.

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Soft chancre Chancroid in Hemophilus
ducreyiinfection. Ulcer contain yellowish
exudates.
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Syphilis ( Primary- Painless clear base ulcer, no
exudates) hard chancre
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Syphilis ( secondary maculopapular rash)
Histology shows plasma cells and lymphocytes
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Syphilis - Secondary Condylomata lata - This
broad base, elevated lesion seen in the moist
areas.
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Cause of false positive VDRL test

1. SLE
2. Lepromatous leprosy
3. Pregnancy
4. Antiphospholipid syndrome

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Granuloma Inguinale ulcerated papular lesion
Calymmatobacterium donovani
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Genital herpes simplex Painful erythematous
vesicles
Etiology HSV type 2 and 1
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Gonorrhea Neisseria gonorrhea
Syphilis Treponema pallidum
Genital Herpes Herpes simplex, Type2 (mostly), occasionally HSV-1
Genital Warts Human papilloma virus (HPV)
Granuloma Inguinale Calymmatobacterium donovani
Chlamydial Infections Chlamydia trachomatis
Lymphogranuloma Venereum C. trachomatis
Chancroid Haemophilus ducreyi
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Best of luck