Editing Bladder and Testis Oncology (section)

== Testicular Tumors ==

* '''More likely benign in pre-pubertal males''' (in contrast to post-pubertal males where most testicular tumours are malignant)
* Epidemiology
** ''The most common pathologic diagnosis in children with a testicular mass is a YST, followed by teratoma''
* '''Germ Cell Tumors'''
** '''Pathology'''
*** '''Tertatoma'''
**** ''According to some series, teratomas are the most common testicular tumor in children and consist of variable combinations of the three primitive embryologic germ cell layers [contradicts above]''
**** '''Consist of variable combinations of the three primitive embryologic germ cell layers'''
**** '''Do not express AFP'''
**** '''In contrast to teratoms in post-pubertal males, most teratomoas in pre-pubertal male are benign, consisting of mature elements only''', and do not metastasize
**** '''Preferred treatment for suspected teratoma is partial orchiectomy'''
*** '''Epidermoid cysts'''
**** Benign lesion; represent a monolayer teratoma
**** May account for >15% of prepubertal testis lesions
**** '''Do not express AFP'''
**** '''Preferred treatment for suspected epidermoid cysts is partial orchiectomy'''
**** No surveillance is required after treatment
*** '''Yolk-sac tumour (YST)'''
**** '''Pathology'''
***** '''Schiller-Duval bodies consist of a central blood vessel surrounded by two layers of tumor cells'''
****** '''Pathognomonic for YSTs.'''
**** '''AFP levels are elevated  '''
**** '''When metastases occur, YSTs often exhibit hematogenous spread to the lungs, without retroperitoneal disease.''' '''For these reasons retroperitoneal lymph node dissection (RPLND) plays very little role in pre-pubertal YST.'''
***** RPLND is used exclusively for patients with a residual retroperitoneal mass or persistently elevated AFP after chemotherapy and orchiectomy
** '''Presentation, Evaluation, and Staging'''
*** '''See CW11 Figure 156-7'''
*** '''Ultrasonography'''
**** '''Teratomas'''
***** '''Heterogeneous complex lesions and may contain cystic and solid components.'''
***** Bony elements appear as calcifications with shadowing.
***** Adipose tissue appears as echogenic areas without shadowing.
**** '''Epidermoid cysts'''
***** Characteristic appearance described as '''“onion skin” comprised of concentric rings''' of alternating hypoechoic and hyperechoic lesions.
**** YSTs
***** Typically well circumscribed and heterogeneous in appearance.
***** May appear hypervascular and may have areas of hemorrhage and necrosis.
**** Sertoli and Leydig cell tumors
***** Similar in appearance
***** Commonly manifest as a well-circumscribed hypoechoic mass.
*** '''Labs'''
**** '''Tumour markers'''
***** '''Interpretation of AFP levels in infants undergoing evaluation for a testis mass must be performed with caution as a result of the physiologically persistent elevation of AFP in infants age < 1'''
* Tumors Associated with Disorders of Sexual Differentiation
** See Disorders of Sexual Differentiation Chapter Notes
** Patients with dysgenetic testis or hypovirulization have an increased incidence of testicular tumors
* '''Gonadal Stromal Tumors'''
** Juvenile granulosa cell tumors
*** Most common testicular tumors affecting neonates
** '''Leydig cell tumors'''
*** Hormonally active; associated with precocious puberty.
** '''Sertoli cell'''
*** Usual presentation is a painless mass
*** Associated with endocrinologic and genetic syndromes such as Peutz-Jeghers and Carney syndromes
*** 10% are hormonally active
* Leukemia and Lymphoma
** The most common cancers with metastases to the testis are leukemia and lymphoma