Testicular tumours
How most testicular cancers arise from germ cells that failed to mature before birth, how seminoma and non-seminomatous tumours differ in appearance and markers, and why they spread first to the para-aortic nodes.
By the end, you can
- Describe the cells of the testis and explain why its lymph drains to the para-aortic nodes.
- Explain how germ cell neoplasia in situ arises and the main risk factors for testicular germ cell tumours.
- Compare the gross and microscopic features of seminoma and the non-seminomatous germ cell tumours.
- Relate AFP, hCG and LDH to the tumour components that make them, and explain gynaecomastia.
- Describe lymphatic and blood-borne spread and the findings they cause.
- Recognise the classic microscopic features, classifications, staging and tests of testicular tumours, including why the testis is removed through the groin, and explain how orchidectomy, platinum chemotherapy, radiotherapy and sperm banking act.
What it is
About 95% of testicular tumours are germ cell tumours, the commonest solid cancer in young men. Most arise from germ cell neoplasia in situ (GCNIS) and are either seminomas or non-seminomatous germ cell tumours (embryonal carcinoma, yolk sac tumour, choriocarcinoma, teratoma, often mixed). The rest are sex cord-stromal tumours (Leydig and Sertoli cell tumours) and, in older men, lymphoma.
5 types to tell apart
- Seminoma
- Sheets of uniform germ cells resembling primordial germ cells; a fleshy, well-demarcated mass. Peak in the fourth decade; AFP is not raised.
- Non-seminomatous germ cell tumours
- Embryonal carcinoma, yolk sac tumour, choriocarcinoma and postpubertal-type teratoma, usually mixed; a varied, haemorrhagic mass. Peak in the third decade; AFP or hCG often raised.
- Germ cell tumours not derived from GCNIS
- Spermatocytic tumour (formerly spermatocytic seminoma) in older men, and prepubertal-type teratoma and yolk sac tumour in young children.
- Sex cord-stromal tumours
- Leydig cell and Sertoli cell tumours, mostly benign; Leydig cell tumours can secrete androgens or oestrogens.
- Lymphoma
- Usually diffuse large B-cell lymphoma; the commonest testicular tumour in men over about 60.
US spelling: tumours → tumors, tumour → tumor.
Normal function
Germ cells, Sertoli cells and Leydig cells
Each lies in the scrotum inside a tough capsule, the tunica albuginea, and is divided into lobules of coiled seminiferous tubules. Along the basement membrane of each tubule, spermatogonia divide and mature towards the lumen into spermatocytes, spermatids and sperm, supported by Sertoli cells. Between the tubules, Leydig cells make testosterone under the control of luteinising hormone (LH).
Sperm pass from the tubules through the rete testis into the and on along the .
The testis develops on the back wall of the abdomen and descends into the scrotum before birth, bringing its vessels with it. The still arises from the aorta, and the testis’s lymph runs back up beside the testicular vessels to the para-aortic (lumbar) nodes near the kidneys, not to the inguinal nodes that drain the scrotal skin.
| Feature | Testis | Scrotal skin |
|---|---|---|
| Where it develops | Back wall of the abdomen, then descends | Skin of the perineum |
| Artery | Testicular artery from the aorta | External pudendal arteries |
| First lymph nodes | Para-aortic (lumbar) nodes near the kidneys | Superficial inguinal nodes |
Lymph and blood vessels keep the route set by where an organ first developed.
Underlying change · Step 1 of 4
Germ cells that never matured: GCNIS
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Underlying change · Step 2 of 4
Seminoma and the non-seminomatous family
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Disrupted function · Step 3 of 4
Up the testicular vessels to the para-aortic nodes
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Consequences · Step 4 of 4
Serum markers and hormonal effects
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Symptoms and signs
Symptoms, signs and findings
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Exam detail
Exam detail
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Treatment
How treatment works
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Recap
Recap
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Self-check
Check your understanding
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .