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Hydrocele and tumors of testis Introduction.pptx

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Sizan Thapa

Presentation for MBBS student. Short notes on Hydrocele, and Introduction of Testicular tumors, Etiopathogenesis, including the WHO classification of Testicular tumors, 5th Edition, 2022.

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HYDROCELE & TESTICULAR TUMORS Dr. SIZAN THAPA MBBS, MD
Objectives Hydrocele Definition Causes Clinical Features Testicular tumors Classification Etiology Histogenesis Common tumor markers
HYDROCELE
Defination Abnormal collection of serous fluid in tunica vaginalis (between visceral and parietal layers of tunica vaginalis) May be acute or chronic, congenital or acquired Presents as swelling of scrotum or groin area Common in men over the age of 40.
Hydrocele and tumors of testis Introduction.pptx
Causes Exact cause is unknown May be associated with: Trauma Systemic edema: cardiac failure, renal disease Inflammation of testis and epididymis Gonorrhoea, Syphilis Tuberculosis Cancers/tumors of testicle or kidney
Cause of fluid accumulation: Defective absorption of fluid by tunica vaginalis: may be due to damage to endothelial wall by low-grade infection Interference with drainage of fluid by lymphatic vessels of cord Excessive production of fluid Communication with peritoneal cavity
Mild Pain Swelling of scrotum Redness of scrotum Feeling of pressure at base of penis may be present Testicular torsion Infertility Clinical Features
TESTICULAR TUMORS
Classification Broadly divided into 3 main groups: Germ cell tumor Majority of testicular tumors ~ 95% arise from germ cells or their precursors in seminiferous tubules Sex- cord stromal tumors < 5% originate from sex cord- stromal components Mixed forms
WHO Classification of Testicular Tumors A. Germ cell tumors derived from Germ cell neoplasia in situ Non-invasive : Germ cell neoplasia in situ (GCNIS) Tumors of single histologic type (pure forms) Seminoma Non-seminomatous germ cell tumors Embryonal carcinoma Choriocarcinoma Yolk sac tumors, postpubertal type Teratoma, postpubertal type Teratoma with somatic type malignancy Non- seminomatous germ cell tumors of more than one histologic type:
B. Germ cell tumors unrelated to germ cell neoplasia in situ Spermatocytic tumor Teratoma, prepubertal type Yolk sac tumor, prepubertal type Mixed teratoma and yolk sac tumor, prepubertal type C. Sex- cord stromal tumors Leydig cell tumor Sertoli cell tumor Granulosa cell tumor D. Tumors with both germ cell and sex-cord stromal elements Gonadoblastoma
Germ cell tumors Categorised into 2 main groups: Seminomatous Composed of cells that resemble primordial germ cells or early gonocytes Non- seminomatous Composed of undifferentiated cells resembling embryonic stem cells (as in embryonal carcinoma) or may differentiated along other cell lines giving rise to yolk sac tumors, choriocarcinomas and teratomas
Hydrocele and tumors of testis Introduction.pptx
Hydrocele and tumors of testis Introduction.pptx
Etiologic factors Environmental factors Associated with testicular dysgenesis syndrome: cryptorchidism, hypospadias, impaired testicular development and poor sperm quality Increased by inutero exposure to pesticides and non-steroidal estrogens
- Associated with cryptorchidism-seen in approx 10% of testicular GCTs Risk asscociated with higher temperature to which undescended testis in groin or abdomen is exposed - Klinefelter syndrome: associated with mediastinal GCTs but not testicular tumors
Genetic factors Risk increases in first-degree family members Susceptibility genes include genes encoding ligand for receptor tyrosine kinase KIT and BAK , which are inducers of apoptosis
Histogenesis Cell of origin: Primordial germ cell/gonocytes with acquired defect in differentiation into spermatogonia Activating mutation in KIT receptor kinase that stimulates proliferation Precursor lesion: Germ cell neoplasia in situ (GCNIS) : found in all types of GCTs except spermatocytic tumors and unusual types that arise in infancy
Lesional cells retain expression of transcription factors OCT3/4 and NANOGimportant in maintenance of pluripotent stem cells Progression to full blown germ cell tumors associated with reduplication of short arm of chromosome 12 (isochromosome 12p)
Hydrocele and tumors of testis Introduction.pptx
TUMOR MARKERS Polypeptide hormones and enzymes secreted by tumors that can be detected in blood Helps in detection but not diagnostic of cancers Evaluation of serum tumor markers helps in: Initial evaluation of testicular mass Staging of testicular GCTs: persistent increase on hCG or AFP after orchidectomy indicates metastatic spread In assessing tumor burden In monitoring the response to therapy
Common tumor markers Chorionic gonadotropin (hCG): Choriocarcinoma, Seminoma Alpha-fetoprotein (AFP): Yolk sac tumor, Embryonal carcinoma Lactate dehydrogenase (LDH): Seminoma Human placental lactogen (HPL): Choriocarcinoma Placental alkaline phosphatase: Seminoma
Hydrocele and tumors of testis Introduction.pptx

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Hydrocele and tumors of testis Introduction.pptx

  • 1. HYDROCELE & TESTICULAR TUMORS Dr. SIZAN THAPA MBBS, MD
  • 2. Objectives Hydrocele Definition Causes Clinical Features Testicular tumors Classification Etiology Histogenesis Common tumor markers
  • 4. Defination Abnormal collection of serous fluid in tunica vaginalis (between visceral and parietal layers of tunica vaginalis) May be acute or chronic, congenital or acquired Presents as swelling of scrotum or groin area Common in men over the age of 40.
  • 6. Causes Exact cause is unknown May be associated with: Trauma Systemic edema: cardiac failure, renal disease Inflammation of testis and epididymis Gonorrhoea, Syphilis Tuberculosis Cancers/tumors of testicle or kidney
  • 7. Cause of fluid accumulation: Defective absorption of fluid by tunica vaginalis: may be due to damage to endothelial wall by low-grade infection Interference with drainage of fluid by lymphatic vessels of cord Excessive production of fluid Communication with peritoneal cavity
  • 8. Mild Pain Swelling of scrotum Redness of scrotum Feeling of pressure at base of penis may be present Testicular torsion Infertility Clinical Features
  • 10. Classification Broadly divided into 3 main groups: Germ cell tumor Majority of testicular tumors ~ 95% arise from germ cells or their precursors in seminiferous tubules Sex- cord stromal tumors < 5% originate from sex cord- stromal components Mixed forms
  • 11. WHO Classification of Testicular Tumors A. Germ cell tumors derived from Germ cell neoplasia in situ Non-invasive : Germ cell neoplasia in situ (GCNIS) Tumors of single histologic type (pure forms) Seminoma Non-seminomatous germ cell tumors Embryonal carcinoma Choriocarcinoma Yolk sac tumors, postpubertal type Teratoma, postpubertal type Teratoma with somatic type malignancy Non- seminomatous germ cell tumors of more than one histologic type:
  • 12. B. Germ cell tumors unrelated to germ cell neoplasia in situ Spermatocytic tumor Teratoma, prepubertal type Yolk sac tumor, prepubertal type Mixed teratoma and yolk sac tumor, prepubertal type C. Sex- cord stromal tumors Leydig cell tumor Sertoli cell tumor Granulosa cell tumor D. Tumors with both germ cell and sex-cord stromal elements Gonadoblastoma
  • 13. Germ cell tumors Categorised into 2 main groups: Seminomatous Composed of cells that resemble primordial germ cells or early gonocytes Non- seminomatous Composed of undifferentiated cells resembling embryonic stem cells (as in embryonal carcinoma) or may differentiated along other cell lines giving rise to yolk sac tumors, choriocarcinomas and teratomas
  • 16. Etiologic factors Environmental factors Associated with testicular dysgenesis syndrome: cryptorchidism, hypospadias, impaired testicular development and poor sperm quality Increased by inutero exposure to pesticides and non-steroidal estrogens
  • 17. - Associated with cryptorchidism-seen in approx 10% of testicular GCTs Risk asscociated with higher temperature to which undescended testis in groin or abdomen is exposed - Klinefelter syndrome: associated with mediastinal GCTs but not testicular tumors
  • 18. Genetic factors Risk increases in first-degree family members Susceptibility genes include genes encoding ligand for receptor tyrosine kinase KIT and BAK , which are inducers of apoptosis
  • 19. Histogenesis Cell of origin: Primordial germ cell/gonocytes with acquired defect in differentiation into spermatogonia Activating mutation in KIT receptor kinase that stimulates proliferation Precursor lesion: Germ cell neoplasia in situ (GCNIS) : found in all types of GCTs except spermatocytic tumors and unusual types that arise in infancy
  • 20. Lesional cells retain expression of transcription factors OCT3/4 and NANOGimportant in maintenance of pluripotent stem cells Progression to full blown germ cell tumors associated with reduplication of short arm of chromosome 12 (isochromosome 12p)
  • 22. TUMOR MARKERS Polypeptide hormones and enzymes secreted by tumors that can be detected in blood Helps in detection but not diagnostic of cancers Evaluation of serum tumor markers helps in: Initial evaluation of testicular mass Staging of testicular GCTs: persistent increase on hCG or AFP after orchidectomy indicates metastatic spread In assessing tumor burden In monitoring the response to therapy
  • 23. Common tumor markers Chorionic gonadotropin (hCG): Choriocarcinoma, Seminoma Alpha-fetoprotein (AFP): Yolk sac tumor, Embryonal carcinoma Lactate dehydrogenase (LDH): Seminoma Human placental lactogen (HPL): Choriocarcinoma Placental alkaline phosphatase: Seminoma

Editor's Notes

  • #17: Hypospadis: congenital disorder where urethral opening is underside of penis Klinefelter syndrome: associated with excess of X chromosome 47XXY