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Pathology of Testes tumours

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pathology of testicular tumours.

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Pathology of Testes tumours

  1. 1. CLINICAL PATHOLOGY The foundation of clinical medicine. Shashidhar Venkatesh Murthy A/Prof & Head of Pathology College of Medicine & Dentistry MGS4: Male Genital: Testes Tumors CPC : Term4 Week4 - MGS 4/6 System : Male Genital System. Topic : 1: Overview 2: STD 3: Orchitis 4: Tumours 5: Penis 6: GLS
  2. 2. 3 Testes Tumors: Features:  Commonest tumour of young males, painless swelling.  Etiology: Idiopathic, Undescended testes (10%, 10 times)  Classification:  95% Germ cell Tumours,  Seminoma 45% - good prognosis.  Non seminoma (NSGT) 45% - poor prognosis. Embryonal ca, Teratoma, Chriocarcinoma, Mixed - common  5% Sertoli / Leydig cell tumours.  Clinical features:  Adults 20-40y – Seminoma.  Children <10y – NSGT- Yolksac tum.  Painless, dragging, unilateral, solid.  Metastases – Para aortic LN*.
  3. 3. 4 Seminoma:  Commonest Germ cell tumour, 20-40y.  Firm, grey, smooth, painless,  Many subtypes: classical*, spermatocytic etc..  Microscopy: uniform clear cells + lymphocytes.  Mixed seminoma  Seminoma + Teratoma, embryonal carcinoma or choriocarcinoma (βhCG 10%). Etc.
  4. 4. 5 Seminoma Testes: Lymphocytes Clear cells
  5. 5. 6 Seminoma Testes: Lymphocytes Clear tumour cells
  6. 6. 8 NSGT: Embryonal Ca  Clinical: painless swelling, hemorrhagic, malignant, poor prognosis, metastases.  Germ cell tumor – embryonic cells.  Gross: Hemorrhagic, necrotic tumor.  Adults: Embryonal Ca.  Children: Yolksac tumor.  Tumor Marker: AFP (α feto protein)  Microscopy: Pleomorphic cells, embryoid structures. Pink AFP globules in cells.
  7. 7. 9 NSGT: Teratoma / Teratocarcinoma  > 1 tissue type (mature / immature)  Teratoma + other germ cell tum (Embryonal ca)  Common, 10-30y, aggressive, poor prognosis.  Both βhCG & AFP +ve - if mixed.
  8. 8. 10 Testes Tumors: summary  Germ cell Tumours (95%)  Gonadal: Seminoma Non Seminoma Germ Cell tum (NSGT)  Embryonic: Embryonal ca.  Extraembryonic: Yolk sac tum, Choriocarcinoma.  Somatic: Teratoma  Mixed: (40%) Tumor – Incidence Age Tumor Marker Seminoma 50% 40-50y 10% βhCG Embryonal ca. 20-30y Negative (pure) Yolk sac tumour < 3y 90% AFP Choriocarcinoma 20-30y 100% βhCG Teratoma (Pure) All ages Negative Mixed 15% 15-30y 90% βhCG & AFP

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