Testicular and Penile Cancer😍

Testicular Tumors

Most Common Types

  • In children: Yolk sac tumor.
  • Overall: Seminoma.
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  • In elderly: Lymphoma.
  • Precursor/Risk Factor: Cryptorchidism.
  • Associated Chromosomal Disorders:
    • Klinefelter syndrome.
    • Isochromosome 12p.
  • Precursor Lesion:
    • GCNIS/ITGSN (Germ Cell Neoplasia In Situ) for most testicular cancers.
    • "In situ" indicates a precancerous stage.
    • Exceptions: 
      • Teratoma and Spermatocytic Seminoma do not have a GCNIS stage.
      • Mnemonic: I sneeze (gSNIS) Sperm (spermatocyte) in my territory (teratoma)
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Classification of Testicular Tumors

  • Testicular tumors are broadly classified into Germ Cell Tumors and Non-Germ Cell Tumors.

I. Germ Cell Tumors

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  • “fried-egg” or clear cell appearance
Tumor Type
Characteristics
Mnemonic→ in london
Classical Seminoma
- Similar to ovarian Dysgerminoma.
- Gross: "Cut potato appearance".
- Micro: "Fried egg appearance".
Tumor Markers:
- LDH and PLAP always positive.
- hCG can be positive in 15-20% of cases. 
- AFP always negative.
Semen (seminoma) and germ (dysgerminoma) in fried egg (fied egg app). So we ate potato (cut potato app). then Beat (β HCG) Plab (PLAP) in Luck (LDH). No protein to eat (No AFP)
Spermatocytic Seminoma
- Occurs in elderly people (above 65 years).
- Better prognosis due to no metastasis.
- No GCNIS precursor stage.
- Associated with gain in chromosome 9.
- Micro: Shows small, medium, and large multinucleated cells.
in london → Elderly people () with small, medium and large multinational companies () → always pass sperm (spermatocytic) to transgender people (chr 9)
Yolk Sac Tumor
- Characterized by Schiller-Duval bodies.
- Alpha-fetoprotein positive.
Protein kittan (afp) → Yolk eduthitt (yolk sac) → 2 times chill (duval schiller) cheyth

Mnemonic: Yal → AFP, LDH
Choriocarcinoma
- Characteristically Beta-hCG positive.
People Chori Beta in london
Mnemonic: ch → hc → HCG
Teratoma
- Can be mature or immature.
- No GCNIS precursor stage.
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Embryonal Carcinoma
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II. Non-Germ Cell Tumors

A. Sex Cord Stromal Tumors

  • Sertoli Cell Tumors.
  • Leydig Cell Tumors:
    • Presence of Reinke's crystalloids.
    • Lady has crystal
        • Rod like cytoplasmic inclusions
        Rod like cytoplasmic inclusions

B. Lymphoma (Testicular Lymphoma)

  • Mnemonic: BBB
    • Big (elderly people, >60-65 years).
    • Usually Bilateral involvement.
    • Bcell lymphoma (DLBCL - Diffuse Large B-cell Lymphoma).
    • Bad prognosis

Clinical Features

  • Painless testicular mass.
  • Abdominal lump
    • due to paraaortic lymph node metastases,
      • which are the first draining nodes
          • Associated Tumor
          Condition
          Leydig cell tumor
          Precocious puberty & masculinization
          Sertoli cell tumors
          Feminization & gynecomastia
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Cannonball mets

  • B/L circular, similar sized structures.
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  • M/c primary malignancies
    • CRESP
      • Colorectal Ca
      • Prostate Ca
      • Endometrial Ca/ Choriocarcinoma Ca
      • RCC
      • Synovial CA
  • Canon ball hit ur groin → bleeding from urethra (RCC, Prostate), vagina (endometrial carcinoma) and anus (colorectal cancer)

Tumor Markers

  • Included in TNMS Staging
    • AFP
    • β-hCG
    • LDH
  • Not included in TNM staging
    • PLAP (Placental Alkaline Phosphatase)
      • Elevated in seminoma
  • IOC for Retroperitoneal LN → CECT

Testicular Tumor Biopsy/FNAC

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  • FNAC (Fine Needle Aspiration Cytology)
    • CONTRAINDICATED in testicular tumors.
    • Inserting needle can create a path for cancer cell spread.
  • If FNAC is performed on a lymph node (e.g., inguinal) where testicular tumor has metastasized:
    • Characteristic microscopic finding of seminoma
      • tigroid background
        (dark and light stripes) → germ cell tumors
      • Lymphocytic infiltration

Management

  • Suspected case → Chevassu maneuver
    (High inguinal incision f/b Frozen section)
    • If Positive → High inguinal radical orchidectomy (HIRO)

Post-Orchidectomy Management

Stage
Seminoma
Non-Seminomatous
Stage I
Radiotherapy + One cycle of Carboplatin
BEP ± RPLND
Stage II
BEP
BEP + RPLND
Stage III & IV
BEP + Radiotherapy
BEP + RPLND
  • BEP: Bleomycin + Etoposide + Cisplatin → Chemo
  • RPLND: Retroperitoneal Lymph Node Dissection

Specimen Handling for Testicular Tissue

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  • Fixative type depends on extraction reason.
  • For Infertility Cases:
    • Use Bouins fixative (contains picric acid).
    • Helps visualize spermatogonia, spermatocytes, and sperm to assess fertility.
    • If infertile → Pick (Picric acid) a boy (Bouin)
  • For Cancer/Tumor Cases:
    • Use 10% Neutral Buffered Formalin (NBS).
    • An entire excision is typical, not just a biopsy.

Penile Cancer

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  • Squamous Cell Carcinoma (SCC).

Premalignant Conditions

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  • Bowen’s disease of the shaft.
  • Erythroplasia of Queyrat (reddish papules).
    • Glans
  • Leukoplakia.
  • Balanitis xerotica obliterans.
  • Genital warts (HPV).

Jackson Staging

  • T1: Skin involved.
  • T2: Corpora involved.
  • T3: Urethra involved.
  • T4: Adjacent structures involved.

Penile Cancer Management

  • Diagnosis: Biopsy of lesion.
  • Moh’s micrographic surgery?
      • Condition
      Tumor Mx
      A. In situ carcinoma
      Topical 5-FU/laser
      B. Distally placed
      Partial penectomy (if residual stump ≥2 cm)
      C. Proximally placed
      Total amputation + Perineal urethrostomy
      Condition
      Lymph Node Mx
      Not enlarged
      Sentinel lymph node biopsy
      T3, T4
      Prophylactic superficial inguinal lymph node dissection
      Enlarged
      Ilioinguinal lymphnode clearance or radiotherapy
 
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