Page 288 - Medicine and Surgery

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284 Chapter 6: Genitourinary system

mitotic rate and contain abundant eosinophilic cy- Incidence/prevalence
toplasm. They do not contain glycogen. Amongst the 32% of testicular tumours; ∼1–2/100,000 per annum.
larger cells, are small cells which resemble sperma-
tocytes. Despite the apparent histological features of Age
aggressiveness they have an indolent growth and show Any. Peak 20–30 years.
virtually no tendency to metastasise.
Around 10% of seminomas contain trophoblastic gi- Sex
ant cells, and these produce human chorionic go- Males
nadotrophin, which may be detectable in the blood.
However, this does not appear to affect prognosis, or
Aetiology
response to treatment.
As for other testicular tumours.
Complications Pathophysiology
i Seminomas tend to spread via the lymphatics initially, Teratomas are more aggressive than seminomas, al-
to the iliac and para-aortic lymph nodes. though this is dependent on the tumour histology. The
ii Bloodstream spread is a late feature. range of teratoma subtypes reflects the totipotency of the
germ cells, which may develop along either embryonic
or extra-embryonic cell lines. It has prognostic value.
Management
All patients undergo radical orchidectomy as an initial Clinical features
measure. As for testicular tumours.
Stage I: Localised radiotherapy or 1–2 cycles of carbo- Teratoma differentiated (TD): This is a relatively un-

platin chemotherapy reduce relapse to around 1–3%. common and usually occurs in infants. The tumour
Stage II and above (metastatic disease): Generally

consists of epithelial-lined cysts and stroma contain-
advised to have combination chemotherapy, usually
ing fully differentiated cells of many types with no
with cisplatin/etoposide/bleomycin. Residual tumour features of malignancy. It is associated with a good
is treated with further chemotherapy or radiotherapy. prognosis.
All patients should be regularly followed up with tu- Malignant teratoma intermediate (MTI): This is a

mour markers and imaging, e.g. chest X-ray +/− ab- partly solid and partly cystic with some areas appear-
dominal USS or CT as indicated. ingmorelikeTD(muscle,stromalcellswithepithelial-
lined spaces) and other areas which show pleomor-
phism. Fifty per cent of patients have an elevated
Prognosis
serum βhCG or αFP level.
More than 99% of cases stage I disease have a normal
Malignant teratoma undifferentiated (MTU) or em-
lifespan. Even with metastatic disease 90% of these fall
bryonal carcinoma (WHO classification): Typically,
into the good prognosis category and they have an 86%
these are small, poorly demarcated grey-white lesions
5-year survival. There is a higher risk of contralateral
which have a variegated appearance due to foci of
cancer, but this usually responds well to treatment.
fleshy and necrotic areas. Microscopically, they ap-
pear pleomorphic, with many mitoses and primitive
epithelial cells forming irregular sheets, tubules, alve-
Teratoma (non-seminomatous germ
cell tumours) oliandpapillarystructures.Ninetypercentofpatients
have elevated serum βhCG or αFP levels.
Definition Malignant teratoma trophoblastic (MTT): Tumours
Testicular germ cell tumour which has differentiated containing any area of syncytiotrophoblast and
along embryonal and extra-embryonal lines. cytotrophoblast arranged in a villous pattern behave