Testicular tumors and STDs
Dr. Basu MD
Our topic
A. Classification of
testicular tumor.
B. Seminoma
C. Embryonal carcinoma
D. Yolk sac tumor
E. Choriocarcinoma
F. Teratoma
G. Diagnosis of these
tumors
What you should know about a
Testicular tumor
Age
 Gross and microscopy
 Markers
 Clinical Presentation

Classification of testicular tumor.
1. Tumor arising from the Germ cells
2. Tumor arising from Leydig cells(
produce endocrine abnormality).
3. Tumor arising from Sertoli cells.
Tumor arising from the Germ cells
1.
A.
B.
C.
D.
E.
Tumors with one histological pattern
Seminoma
Embryonal carcinoma
Yolk sac tumor
Choriocarcinoma
Teratoma
2. Tumor with more than one histological
pattern
3. Miscellaneous
Seminoma Vs Non seminomatous tumor of
testis
Seminoma
Radiosensitive
Late metastasis
Good prognosis
Embryonal
carcinoma, Yolk sac
tumor,
choriocarcinoma
Not
Early
Bad
Tumors and the diagnostic points
Classic
Seminoma
Seminoma
cells.
Lymphocyte in
stroma.
Primitive cells.
Cells are positive
for PAS
Choriocarcinoma
Malignant
trophoblast.
Elevated beta
hcG
Yolk sac tumor
Schillar Duval
body –
glomeruloid
body
Elevated AFP
Embryonal
Carcinoma
Both AFP and
beta hcG
elevated
Teratoma
Pure Teratoma
Tissues of all three
germ-cell layer.
No specific
marker
Teratoma + foci of Tissues of all three
choriocarcinoma
germ-cell layer +
malignant
trophoblast
Increased
beta-hcG
Teratoma + foci of Tissues of all three
Embryonal
germ-cell layer +
carcinoma
Embryonal
carcinoma
Increased
AFP & hcG
Seminoma [Classic]
1. Most common types of testicular
neoplasm.
2. Age : 15 to 34 years
3. Note:
Some Seminoma may contain
trophoblastic content.
 In these type of Seminoma Beta-HCG
will be mildly elevated.

Variant of Seminoma
Variant : Spermatocytic Seminoma


In this case metastasis is rare,
common in old people.
Three types of cell are seen
1. large multinucleated cells,
2. medium size cells and
3. small cells that reminiscent of
spermatocytes
Seminoma Gross
Features : large, soft,
homogenous, grey-white
Seminoma : Microscopy
1. Seminoma cells ([ PAS positive] : Large cells
with distinct border , round nuclei and
prominent nucleoli.
2. Lymphocytes, plasma cell in stroma.
Seminoma counterpart in Ovary
DYSGERMINOMA
Embryonal carcinoma
Age : 20-30 years.
Features :
1. Often multiple metastasis is present
at the time of diagnosis.
2. Often it contain other foci of Yolk
sac tumor, teratoma and Choriocarcinoma.
3. So both AFP and beta hcG will be
elevated ( non specific)
Embryonal carcinoma
Features : Red to tan to brown areas,
including prominent hemorrhage and
necrosis.
Sheets of primitive looking blue cells.
Embryonal carcinoma and Teratoma [
Teratocarcinoma]
Features : Chondroid white areas
(teratoma) in a Embryonal
carcinoma.
Solid cystic mass in Ultra soundTeratocarcinoma
Teratoma in testis
Age = all ages
 Almost always malignant ( unlike
ovary – where it is usually benign)

Yolk sac tumor [ endodermal sinus
tumor]
 Age
: 3 years
 Histology
: Presence of Schiller –
Duvall body ( glomeruloid body)
Specific
Marker = AFP
Schillar Duval body – glomeruloid
structure
in yolk sac tumor ; locate it
Choriocarcinoma
Age = 20 -30
 Pure Chorio carcinoma is rare in testis.
 It is always mixed with Teratoma, or other
tumor even with Seminoma.
 Histology : Malignant cyto and
syncytiotrophoblast without villous
formation.

 Specific
Marker = beta hcG
Mixed tumor

Add………….
Leydig cell tumor : Clinical features
Small( 1-3 cm), nodular,
circumscribed tumor, yellowish in
colour
Bilateral gyenecomastia and testicular
enlargement force the patient to seek
medical assistance.
Quiz : name the markers
Yolk sac tumor
AFP
Choriocarcinoma
hcG
Teratoma + Yolk sac
tumor
Teratoma +
choriocarcinoma
Teratoma + Embryonal
carcinoma
AFP
hcG
AFP and
hcG
Testicular tumor; clinical features
1. Painless swelling
2. Seminoma usually confined to
testis.
3. Other non-seminomatous tumor
widely metastasize .
4. Metastasis occur by both
hematgenous and lymphatic route.
Rest your eyes : Time for Sexually
transmitted disease
At a glance- STDs
Pathogens
Diseases
Diagnostic points
HPV ( 6,11)
Condylomata
acuminata
Chlamydiae
Trachomatis
Urethritis,
Koilocyte in the
squamous
epithelial cells.
Granuloma and
Neutrophils
Mucopurulent
urethral discharge.
Culture negative
Epididymitis.
Lymphogranulo
ma Venereum.
STDs
Pathogens
Diseases
Neisseria
Gonorrhoeae
Epididymitis,
salpingitis
Hemophilus
ducreyi
Diagnostic
points
Mucopurulent
discharge.
Culture positive.
Chancroids
Tender ulcer,
(soft chancre) exudates present
at ulcer base.
Syphilis ; Treponema pallidum
Primary
syphilis
Hard chancre
Painless ulcer,
clean moist base
Negative
serological tests of the ulcer.
Positive for
treponoma
pallidum in scrap
smear
Secondary
syphilis
Strongly Positive both
Anti treponomal
antibody test and
Nontrepomomal test
Secondary Generalized
Serological
syphilis
lymphadenopathy testes positive
.
Maculopapular
rash.
Condylomata
lata
Syphilis
Tertiary
syphilis
Positive anti treponomal
antibody test.
Negative –
Nontrepomomal antibody
test
Cardiovascular
disease.
Neurosyphilis
( general
paresis)
Development of
gumma in bone ,
skin, mucus
membrane.
STDs
Calymmatobact Granuloma
erium donovani Inguinale
Genital herpes
simplex
Ulcerative
papular
lesions on
the external
genitalia.
Painful
Presence of
erythematous cowdry type
vesicles
A inclusion
Condylomata acuminata ( HPV
infection type 6,11) : Genital Warts
Gonorrhea ; clinical features
Male : Epididymitis, may involve
prostate.
 Female : salpingitis, infertility
 Infants ( during delivery) : Purulent
infection of the eye : Ophthalmia
neonatorum).

Lymphogranuloma Venereum, LGV
lymphadenopathy.
Mixed Granulomatous and neutrophilic
inflammation.
Diagnosis - LGV
Demonstration of organism in Biopsy
section / exudates- in active lesion.
 ELISA performed on serum.

“Soft chancre” –Chancroid in Hemophilus
ducreyi
infection. Ulcer contain yellowish exudates.
Syphilis ( Primary- Painless clear
base ulcer, no exudates) ; hard
chancre
Syphilis ( secondary – maculopapular
rash)
Histology
shows
plasma cells
and
lymphocytes
Syphilis - Secondary :: Condylomata lata This broad base, elevated lesion seen in the
moist areas.
Cause of false positive VDRL test
1.
2.
3.
4.
SLE
Lepromatous leprosy
Pregnancy
Antiphospholipid syndrome
Granuloma Inguinale ; ulcerated
papular lesion
Calymmatobacterium donovani
Genital herpes simplex
: Painful erythematous vesicles
Etiology : HSV type 2 and 1
Gonorrhea
Syphilis
Genital Herpes
Neisseria gonorrhea
Treponema pallidum
Herpes simplex, Type2
Genital Warts
Human papilloma virus
Granuloma Inguinale
Calymmatobacterium
donovani
Chlamydia trachomatis
C. trachomatis
Chlamydial Infections
Lymphogranuloma
Venereum
Chancroid
(mostly), occasionally
HSV-1
(HPV)
Haemophilus ducreyi
Best of luck