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282 Chapter 6: Genitourinary system

Non-Germ Cell Tumours

Leydig cell tumour (2%) Sertoli cell tumour (2%) Other

Majority are benign, may Majority are benign Lymphoma (7%)
produce androgens or
oestrogens Metastases (<3%)
(bronchus, prostate,
malignant melanoma)
Acute lymphoblastic
leukaemia ‘hides’ in the
testis and is resistant
to chemotherapy

Figure 6.11 The British Testicular Tumour Panel Classification of Non-germ cell tumours (% are as a proportion of all
testicular tumours).

tumours are uncommon. Other tumour types include nous spread leads to metastases most commonly in the
lymphoma and metastases. lungs, liver and bone.

Clinical features Investigations
Testicular tumours usually present as slow, painless, USS of the scrotum, especially if there is clinical doubt.
smooth or irregular enlargement of a testis. A dull ache Scrotal biopsy should be avoided, as this increases the
or dragging sensation in the lower abdomen or per- risk of local spread and recurrence.
ineal/scrotal area is common. Acute pain occurs as a Other tests are directed at the staging of the tumour:
presenting feature in 10%, which may be attributed to Tumour markers – Alpha-fetoprotein (αFP), beta-
trauma.Malignanttumoursmaypresentwithmetastatic human chorionic gonadotrophin (β–HCG) and lac-
diseasebeforetheprimaryisnoticedandoccasionallythe tate dehydrogenase (LDH) should be measured before
tumour secretes hormones, causing symptoms such as treatment. These are raised in ∼50% of patients and
gynaecomastia or precocious puberty. are useful for follow-up after treatment.
On examination, there may be a concomitant hy- Achest X-ray, CT abdomen and pelvis are generally
drocele, making examination more difficult. The testes needed. CT thorax/head may be indicated, if metas-
should be soft, smooth and mobile. Suspicious features tases to these areas are suspected.
include a hard, fixed mass, which may have smooth Staging is from I to IV see Fig. 6.12 but the TNM
or irregular borders. If the mass transilluminates, this staging is also used.
suggests a hydrocele, but it is not possible to exclude
an underlying tumour without imaging. Associated gy-
Management
naecomastia or lymphadenopathy should be looked
Testicular cancer is now one of the most curable solid
for, as well as any evidence of metastases, e.g. to the
organ tumours. Radical orchidectomy via an inguinal
liver.
incision, with occlusion of the spermatic cord before
mobilization (to reduce risk of intraoperative spread)
Complications is needed for all patients, to establish the histology,
Spread is generally initially through the lymphatics, to grade and staging (TNM). A testicular prosthesis may
iliac and para-aortic lymph nodes via the spermatic be placed at the time of surgery. Retroperitoneal lymph
cord, then the mediastinal lymph nodes. Haematoge- node dissection at the same time is indicated in low stage