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Chapter 6: Genitourinary oncology 285

aggressively, invading blood vessels. Blood-borne prognostic markers are good, down to 48% for poor
metastases are a common early feature. βhCG and prognostic markers. However, when salvage chemother-
αFP are commonly found in the serum and can be apy is needed for relapse, response is generally less good
detected in cells by immunocytochemistry. although new agents such as paclitaxel and gemcitabine
Yolk sac Tumour. Pure yolk sac tumours tend to be appear to be giving better results.

found in young children, with yellow-white mucinous
lesions. Yolk sac elements are often found with other Leydig cell tumour
germ cell tumour elements, when they form solid and
papillary lesions which consists of micro-sheets and Definition
cordsofcells with vacuolated cytoplasm. These are Thisisanon-germcelltumourofthestromaofthetestis,
highly malignant and confer a worse prognosis. derived from the Leydig cells.
Mixedgerm-cell tumour: Tumours may consist of any

combination of teratoma, seminoma, yolk sac tumour Incidence/prevalence
andhCG-containinggiantcells(trophoblastic).‘Tera- Less common than germ-cell tumours.
tocarcinoma’intheWHOclassificationindicatesneo-
plasms containing both teratoma and embryonal car- Age
cinoma (MTU). Twopeaks 5–10 years and 30–35 years.

Complications Sex
Spread occurs via the blood stream to lung, liver, brain Male only
andbone.Nodalspreadalsooccurs(iliacandpara-aortic
lymph nodes). Aetiology
As for all testicular tumours.
Management
Afterradical orchidectomy: Pathophysiology
StageI:Retroperitoneallymphnodedissectionisoften Leydig cells are cells contained in the interstitium which

needed if the tumour staging (TNM) showing risk for normally produce testosterone. Leydig cell tumours may
metastasis. It is often positive, i.e. turning the patient produce levels of steroid hormones (e.g. testosterone,
into Stage II. oestrogens, corticosteroids) sufficient to cause systemic
Stage II and above (metastatic disease): Chemother- effects. Approximately 15% of adult tumours are malig-

apy (triple agent, e.g. cisplatin, etoposide, bleomycin) nant (in children they are invariably benign).
is used for metastatic disease. If there is residual tu-
mour, with normal markers, surgical resection is in- Clinical features
dicated to remove tumour bulk, which often is only Local features as for testicular tumours, but they more
mature teratoma. If tumour markers do not respond, commonly present with secondary effects such as gy-
second choice chemotherapy is tried. Radiotherapy is naecomastia and loss of libido in adults. In pre-pubertal
generally ineffective. cases,precociouspubertyandgynaecomastiamayoccur.

Prognosis Macroscopy/microscopy
Apart from higher stage disease, the worst prognosis is in Circumscribed, yellow-brown, uniform tumour which
those with very high tumour markers and histologically ranges from 1 cm to a bulky mass. Microscopically, the
in those which are undifferentiated, vascular invasive or cellsresemble normal Leydig cells – sheets or nests of
if containing trophoblastic or yolk sac elements. Even large, polygonal cells with round nuclei and abundant
for metastatic disease modern treatment has improved granular eosinophilic cytoplasm. Vacuolated cytoplasm,
the 5-year survival rates significantly to over 90% if all or pinkish crystals of Reinke may be seen.