00:02
Testicular tumor.
00:03
We’ll take a look at the
parameters or the categories.
00:07
Tumor, morphology, marker,
prognosis, remark.
00:11
Our first major germ cell
tumor is a seminoma.
00:15
Take a look at the picture here.
A cut section.
00:17
Do you see any blood in here?
And very important
– none whatsoever.
00:22
Seminoma versus a
non-seminomatous germ cell tumors
are non-hemorrhagic.
00:29
Sometimes referred to as
being a walnut.
00:32
Okay. So if you cut
open a walnut,
maybe perhaps this is what
it looks like on the inside.
00:36
That area that you’re
seeing within the testicle,
that is more whitish would
be the actual tumor
within the testicle.
00:43
Morphology here:
Fried-egg appearance.
00:46
And by fried egg,
literally means as though
if you break open an egg,
the yolk falls in the middle,
around it will be the albumin.
00:53
The white.
00:54
That’s a fried-egg appearance.
00:56
The nucleus will
be in the middle.
00:57
Fried egg is a non-specific
morphology or description.
01:01
You’ve heard of
oligodendroglioma,
and that is a brain tumor
in which there once again,
the appearance –
With the morphology
would be fried egg.
01:10
Serum marker here, you’re going
to be using what’s known as your
human chorionic gonadotropin.
01:16
And you have something called
placental alkaline phosphatase.
01:22
Prognosis is excellent.
01:24
Here,
if you’re thinking metastasis,
it will be through lymphatic.
01:28
Where is it going?
Para-aortic
and it is important that
you pay attention to how
incredibly sensitive
it is to radiotherapy.
01:38
What you’re also doing is
comparing this seminoma,
which is the most common of
all of your germ cell tumors
versus the non-seminomatous,
which we’ll get into next.
01:49
Embryonal:
Well, the main thing
here about embryonal
is you take a look
at the section here
and you find at this section -- and
you’ll find it to be hemorrhagic.
02:00
Hemorrhagic versus if you
take a look at seminoma,
it looks like it’s
non-hemorrhagic.
02:08
Yolk sac tumor:
Also call it endodermal
sinus tumor (EST).
02:13
Endodermal sinus tumor
But guess what?
We did this for ovarian
tumor as well.
02:20
And with the ovarian tumor, remember once again,
ovarian tumor, this is not the
most common family of tumors.
02:26
What family are we doing?
Germ cell tumors.
02:30
For which gender?
Males.
02:34
EST stands for
endodermal sinus tumor.
02:37
Here with the yolk sac,
do you remember when
we had a discussion
and if you haven’t quite
gotten into it, that’s okay.
02:43
But the fact that glomeruli,
if you have these primitive
glomerular-like structures
that you would find
with yolk sac tumor,
you call this Schiller–Duval
bodies, glomerular-like.
02:54
Here, a yolk sac,
the type of tumor marker you
would expect to find would be
alpha fetoprotein
to be elevated.
03:01
Once you start getting
away from seminomatous,
this obviously will be a
non-seminomatous testicular tumor,
extremely aggressive,
and here, the most
common testicular tumor
in a boy less than
5 years of age
would be yolk sac tumor.
03:19
Something else that I wish
to bring to your attention.
03:22
When we get into ovarian tumor,
remember that a seminoma is
then referred to as being --
or it’s equivalent in a female
ovarian tumor is called
a dysgerminoma.
03:33
And these are thing that we’ll
discuss in ovarian tumor.
03:36
But you know me, I like to reinforce
information over and over again.
03:41
I want you to think.
03:43
This is choriocarcinoma.
03:45
Choriocarcinoma would be found
in two different locations
and that’s how you need to
approach the choriocarcinoma.
03:50
Pay attention.
03:51
Choriocarcinoma could
be either gestational
or could be non-gestational.
03:56
Either case, what do
we mean gestational?
Well, you might have heard
of choriocarcinoma being
an issue with the
cancer of the placenta.
04:04
True.
04:05
For example, hydatidiform
mole, complete mole,
may then give
rise to choriocarcinoma.
04:11
But that’s gestational cancer.
04:13
Where are you now?
A gonad.
04:16
Which gender?
The male, so testicles.
04:19
So this is testicular,
non-gestational choriocarcinoma.
04:23
Therefore, morphology, you would
expect to find placental tissue.
04:27
Trophoblastic.
04:28
"But Dr. Raj, we’re
in the testicle?"
Yes, but this is cancer. It
can do whatever it wants.
04:33
Just like you would with any
type of placental disorder
or in general
placentas involved,
pregnancy, placenta involved.
04:42
And you’ve heard of the
pregnancy test, beta hCG.
04:45
Aggressive.
04:47
Here, once you start getting
away from your seminomatous,
the non-seminomatous
will be hemorrhagic,
hemorrhagic and spread also
would be hematogenous.
05:00
Hyperthyroidism can develop in man with non-seminomatous germ cell tumors,
who have marketly elevated serum beta HCD-levels.
05:07
This is due to ligand receptor cross reactivity between the HCG and thyroid-stimulating hormones or TSH.
05:15
Do no forget these features
of choriocarcinoma.
05:19
Teratoma.
05:21
Really, the only thing that I
wish to bring to your attention
because we’ll be dealing with
teratoma quite a bit in a female.
05:26
And a teratoma in female is
known as a cystic teratoma.
05:31
And with a female,
we’ll be looking at the
mature teratoma more so,
which is benign in a female.
05:37
In a male, quite different.
05:39
A teratoma is going to be
all three germ layers,
so we have our endoderm,
ectoderm and our mesoderm.
05:47
And the immature form will be
extremely aggressive, malignant,
and your next step of management
here will be to resect the tumor.
05:55
Benign in children,
tends to be a teratoma.
05:57
And in addition, keep
in mind that teratoma
can be anywhere from head to toe
or head to basically the testicle.
06:05
So if it’s a child, you're most likely
thinking about the sacrococcygeal.
06:09
Can you picture that?
Or it could be in the midline.
06:12
And we had this discussion
when we did our neoplasia.
06:15
By midline, I mean that it could
be part of your pineal gland
or maybe perhaps in
your mediastinum.
06:20
Things that you want to pay
attention to teratoma.
06:23
At this point,
we have finished our discussion
of germ cell tumors.
06:28
The most common family of
all testicular tumors,
your focus definitely
should be on seminoma
and some salient points about
each one these other types of
testicular germ cell tumors.