Embryonal carcinomaBy mahyarHistory: 24-year old man with the complaints of coughing, low back pain, night sweating, and weight lost. He had no history of cigarette smoking, alphafetoprotein: 1250 (0-2UI/ml), HCG: 0.02 (0-5mUI/ml). Testis USG revealed a left testicular mass. Findings:
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:: CT 5 ::CT scan without contrast Discussion: testicular tumors: Epidemiology: Represent 1%of all neoplasms in men, most common solid neoplasm in men between 15 and 40 years. Histology: Malignant germ cell tumors: 90% of all testicular tumors. Seminoma: Peak age 36 years. 35%. Nonseminomas: Peak age 26 years. 1. Embryonal carcinoma. 20%. 2. Teratoma 25%. 3. Mixed tumors. 15%. 4. Choriocarcinoma. Less than 1%. - Burned-out tumor: Regressed testicular tumor with metastatic spread. Stromal tumors: 5% of all testicular tumors. Leydig cell tumors and less commonly Sertoli cell tumors: 90% are benign. Occur at any age. Frequently associated with abnormal sexual development. Nonprimary testicular tumors: - Lymphoma: Especially in men aged 60 or older, usually B-cell NHL.5% of all testicular tumors. Typical manifestation of recurrent leukemia after chemotherapy in children (blood-testis barrier). - Metastasis: Rare, typically from prostate or bronchial cancer. Etiology: Riskfaccars: Undescended testis. microlithiasis. contralateral testicular tumor. Imaging signs: Modality of choice: Ultrasound. MRI, CT to exclude metastasis. Ultrasound findings: Focal intratesticular lesion, irregularity in the normal homogeneous, medium level echotexture of the testis. Large tumors completely replace the testis or leave only a thin margin of normal parenchyma. Sonographic findings must be correlated with palpation in all cases. Concomitant hydrocele may be present. Local tumor staging by ultrasound is unreliable: - T1: confined to the testis. - T2: involves the tunica albuginea or the epididymis, - T3: involves the spermatic cord. - T4: involves the scrotum. Tumor tissue types cannot be reliably differentiated solely by their ultrasonographic appearance and only histologic examination allows tumor characterization. Seminoma: hypoechoic, smooth margins, cystic components may be present hyper vascular tumor. Germ cell tumors: heterogeneous, calcifications, fibrosis. (Contain cartilage, bone and cysts, irregular contour, invasion of the tunica albuginea. Teratoma: heterogeneous, macrocalcifications, complex cysts (internal echoes, thickened wall, septa). Burned-out tumor: echogenic scar or calcification, no focal lesion. Leydig cell tumor: cystic, necrotic, and hemorrhagic. Sertoly cell tumor: Hypoechoic, smoothly marginated, round, lobulated. Lymphoma/leukemia: Hypoechoic, one or multiple lesions, testicular enlargement, geographic echopattem, often bilateral, hypervascular, involvement of the epididymis and spermatic cord. MRI findings: Hypointense mass on T2-weighted images, isointense to hypointense on T1Weighted images, inhomogeneous areas due to calcifications, necrosis, and hemorrhage. CT findings: Detection of retroperitoneal lymph node and lung metastases, if present. Typical presentation: Painless, palpable mass, testicular enlargement. Most testicular tumors are discovered by the patients themselves. 10%present with acute pain and fever. Hormonally active stromal tumors cause bilateral gynecomastia, precocious virilization, and loss of libido. Lymphoma is associated with weight loss and often bilateral testicular swelling. . Course - Stage I: No metastases. - Stage II: Lymph node metastases below the diaphragm. - Stage III: Lymph node metastases above the diaphragm. Germ cell tumars: Lymphatic spread to retroperitoneal, paraaortic, and supraclavicular lymph nodes. Late hematogenous spread, e,g to the lungs. Choriocarcinoma: is an exception with early hematogenous spread typically to the brain. Treatment options: 1. Orchiectomy. Adjuvant prophylactic retroperitoneal radiotherapy in seminoma. 2. Abdominal lymph node dissection in patients with nonseminoma and suspected lymph node involvement. Possible adjuvant chemotherapy, e.g. in patients with lymphatic metastatic spread of nonseminoma. 3. Neoadjuvant chemotherapy: with subsequent resection in advanced testicular cancer. Prognosis: - Seminoma: 100% 5-year survival rate in stage I. 85%in metastatic seminoma. - Nonseminoma: 100% 5-year survival rate in stage I. 95% in tumors with retroperitoneal metastases, and 30% in the presence of distant metastases. - Choriocarcinoma: Very poor 1-year survival rate. Differential diagnosis: 1- Choriocarcinoma 2- Stromal tumors 3- Lymphoma 4- Metastasis Diagnosis confirmation: Surgery / Histo Category: Urogenital Region / Organ: Pelvis-Testis Etiology: congenital References: Direct diagnosis in radiology) Translation of: Urogenitales system I Bernd Hamm ... let al.). 2007. Get more for Embryonal carcinoma Peer-reviewed resources Literature  More publications about Embryonal carcinomaChallenge yourself with the case quiz! |