Testicular Tumours King Georges Medical University睾丸肿瘤国王医学院.pptVIP

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Testicular Tumours King Georges Medical University睾丸肿瘤国王医学院.ppt

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Testicular Tumours King Georges Medical University睾丸肿瘤国王医学院

Vinod Jain 02.09.2014 Testicular TumoursPart 1 Testicular Tumours Classification Incidence Etiology Spread of tumour Clinical Staging Clinical features Differential Diagnosis Investigations Treatment Follow up schedule Classification Secondary Tumour Para testicular neoplasm Germ Cell tumour Non Germ Cell tumour Lymphona Leukaemia Metastatic Seminoma (SGCT) Non Semimomatous (NSGCT) Leydig cell Tm Sertoli Cell Tm Gonadoblastoma Adeno CA of rete tests Terratoma Embryonal CA Chorio CA Yolk sac Tumour Mixed Tumour Primary Tumour Metastatic testicular Tumour In decreasing order Prostate Lung Gut Melanoma Kidney Incidence Age – most common solid tumor of men between 20-30 years Race – White : Black = 4:1 in U.S. Side – Right Left Socio-economic status – high : low = 2:1 Geographical Highest in Scandinavia, Germany, Switzerland Intermediate – USA UK Low – Africa and Asia Age wise incidence of testicular tumour Tumour Type Age group (years) Seminoma 35-40 Pure Terratoma Pediatric age group Embryonal CA 25-30 Chorio CA 25-35 Yolk sac Tumour infancy child hood Mixed terrato CA 25-30 Lymphoma 50 Etiology Congenital – 3-14 times common in undescended testes Abnormal germ cell morphology Elevated temperature Interference with blood supply Gonadal dysgenesis Endocrine dysfunction Acquired Trauma – co incidence Endocrine – sex hormone fluctuation Infection – Mumps induced atrophy/ non-specific infections Spread of Tumour Local Lymphatic – Right? inter aortocaval at L2 ? precaval ? preaortic ? Right common iliac ? Right ext. iliac Left ? Paraortic at renal hilium ? preaortic ? common iliac ? Left ext. iliac (Cross metastasis more common in right side tumour) Spread of Tumour Blood (Distant metastases in decreasing order Lung Liver Brain Bone Kidney Adrenal GIT Spleen Clinical Staging (Boden and Gibbs – 1971) Stage I (A) – confined to testis with no spread t