Question

Discussions:

1. Where do most malignancies of the testis arise from?
2. What are stromal tumors of the testis?

Testicular cancer is the most common malignant tumor affecting adolescent young men. Testicular tumors are solid growths of malignant cells and are not fluid-filled cystic structures, a characteristic that figures into the patient’s initial evaluation. Testicular cancers have several histological appearances, but almost all are curable if detected early. AJ is a 26-year-old, recent college graduate who has just begun working for a startup software company and really likes the job. When not behind a computer, he’s either on his bike or out hiking. Several months ago, while showering, he noticed that his left testicle seemed slightly larger than his right. There was no pain and no obvious mass, so he decided to wait and see if things would change. About a month later, it had become obvious that his left testicle had continued to increase in size, but still there was no pain or redness. As a fan of Lance Armstrong, he knew of Lance’s testicular malignancy so he called his doctor. After mentioning the reason for his call, he was given an appointment the next day.


Tumors of the testis are grouped into two major categories, according to their cell of origin:   
• Germ cell (or germ line) tumors, which arise from the sperm forming epithelium of the seminiferous tubules, are uniformly malignant, and represent about 95% of all testicular tumors. • Stromal tumors, which arise from specialized interstitial cells, such as Leydig cells, are almost always benign, represent about 5% of testicular tumors, and may even secret hormones into the bloodstream.
Germ cell tumors can have a wide range of histological appearances and varying degrees of aggressiveness. All are malignant and can spread widely in the body. If untreated, the patient will die of the cancer. Fortunately, great therapeutic strides have been made.   
• Removal of the affected testis and a significant portion of the spermatic cord are essential. • Abdominal radiation will destroy microscopic bits of tumor that may have spread there (metastasis). • New formulations of chemotherapy are as effective as radiation at destroying tumor metastases, and since the chemotherapy travels to all parts of the body
  


by way of the blood stream, it eradicates microscopic areas of tumor spread that may not be amenable to radiation.
  

Answer 1

                       Most types of testicular cancer develop in the sperm-producing cells known as germ cells and are referred to as germ cell tumors. Germ cell tumors in men can start in several parts of the body: The testicles, which is the most common location.

Germ cell Tumors

                            Germ cell tumors are growths that form from reproductive cells. Tumors may be cancerous or noncancerous. Most germ cell tumors that are cancerous occur as cancer of the testicles (testicular cancer).

Two of the most common germ cell tumors are seminoma and nonseminoma.

· Seminomas make up about half of all germ cell tumors. They usually grow slowly. Our doctors can often cure early-stage seminomas because they’re less likely to metastasize (spread) to other parts of the body.

· Nonseminomas are often more aggressive than seminomas, and more likely to spread beyond the testicle.

Symptoms:

· A painless lump in the testicle (the most common sign)

· Swelling of the testicle (with or without pain) or a feeling of weight

· Pain or a dull ache in the testicle, or groin

Stromal tumors of the testis

                Testicular sex cord stromal tumors include Leydig cell tumors, Sertoli cell tumors, and granulosa cell tumors.

Leydig cell tumors are derived from normal Leydig cells that produce testosterone and are located in the interstitium of the testis.

A typical Sertoli cell tumor is a tumor derived from Sertoli cells, located within seminiferous tubules, which help support spermatogenesis

Granulosa cells are not native to the testis. Adult-type granulosa cell tumors of the testicle are much less common than in the adult female ovary. The juvenile type of this condition is a rare sex cord stromal tumor that occurs in males in the first few months of life.