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Testicular tumors and STDs

Testicular tumors and STDs. Dr. Basu MD. Our topic. Classification of testicular tumor. Seminoma Embryonal carcinoma Yolk sac tumor Choriocarcinoma Teratoma Diagnosis of these tumors. What you should know about a Testicular tumor. Age Gross and microscopy Markers

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Testicular tumors and STDs

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  1. Testicular tumors and STDs Dr. Basu MD

  2. Our topic • Classification of testicular tumor. • Seminoma • Embryonal carcinoma • Yolk sac tumor • Choriocarcinoma • Teratoma • Diagnosis of these tumors

  3. What you should know about a Testicular tumor • Age • Gross and microscopy • Markers • Clinical Presentation

  4. Classification of testicular tumor. • Tumor arising from the Germ cells • Tumor arising from Leydig cells( produce endocrine abnormality). • Tumor arising from Sertoli cells.

  5. 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

  6. Seminoma Vs Non seminomatous tumor of testis

  7. Tumors and the diagnostic points

  8. Teratoma

  9. 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.

  10. 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

  11. Seminoma Gross Features : large, soft, homogenous, grey-white

  12. Seminoma : Microscopy • Seminoma cells ([ PAS positive] : Large cells with distinct border , round nuclei and prominent nucleoli. • Lymphocytes, plasma cell in stroma.

  13. Seminoma counterpart in Ovary DYSGERMINOMA

  14. 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)

  15. Embryonal carcinoma Features : Red to tan to brown areas, including prominent hemorrhage and necrosis.

  16. Sheets of primitive looking blue cells.

  17. Embryonal carcinoma and Teratoma [ Teratocarcinoma] Features : Chondroid white areas (teratoma) in a Embryonal carcinoma.

  18. Solid cystic mass in Ultra sound- Teratocarcinoma

  19. Teratoma in testis • Age = all ages • Almost always malignant ( unlike ovary – where it is usually benign)

  20. Yolk sac tumor [ endodermal sinus tumor] • Age : 3 years • Histology : Presence of Schiller –Duvall body ( glomeruloid body) • Specific Marker = AFP

  21. Schillar Duval body – glomeruloid structurein yolk sac tumor ; locate it

  22. 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

  23. Mixed tumor • Add………….

  24. 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.

  25. Quiz : name the markers AFP hcG AFP hcG AFP and hcG

  26. Testicular tumor; clinical features • Painless swelling • Seminoma usually confined to testis. • Other non-seminomatous tumor widely metastasize . • Metastasis occur by both hematgenous and lymphatic route.

  27. Rest your eyes : Time for Sexually transmitted disease

  28. At a glance- STDs

  29. STDs

  30. Syphilis ; Treponema pallidum

  31. Secondary syphilis Strongly Positive both • Anti treponomal antibody test and • Nontrepomomal test

  32. Positive anti treponomal antibody test. Negative – Nontrepomomal antibody test Syphilis

  33. STDs

  34. Condylomata acuminata ( HPV infection type 6,11) : Genital Warts

  35. Gonorrhea ; clinical features • Male : Epididymitis, may involve prostate. • Female : salpingitis, infertility • Infants ( during delivery) : Purulent infection of the eye : Ophthalmia neonatorum).

  36. Lymphogranuloma Venereum, LGV lymphadenopathy. Mixed Granulomatous and neutrophilic inflammation.

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

  38. “Soft chancre” –Chancroid in Hemophilus ducreyiinfection. Ulcer contain yellowish exudates.

  39. Syphilis ( Primary- Painless clear base ulcer, no exudates) ; hard chancre

  40. Syphilis ( secondary – maculopapular rash) Histology shows plasma cells and lymphocytes

  41. Syphilis - Secondary :: Condylomata lata -This broad base, elevated lesion seen in the moist areas.

  42. Cause of false positive VDRL test • SLE • Lepromatous leprosy • Pregnancy • Antiphospholipid syndrome

  43. Granuloma Inguinale ; ulcerated papular lesion Calymmatobacterium donovani

  44. Genital herpes simplex: Painful erythematous vesicles Etiology : HSV type 2 and 1

  45. Best of luck

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