Types of Non Germ Cell Tumors

00:02 Our topic here is testicular neoplasia and now we’re moving away from germ cell tumors.

00:07 These are non-germ cell tumors.

00:10 Some types of non-germ cell tumors are called sex cord-stromal tumors and they present as an asymmetric testicular mass.

00:16 The majority are painless, however if a patient develops pain, it may indicate there is bleeding into the tumor.

00:22 Non-germ cell testicular tumors represent about 5% of all testicular cancers, recall that the other 95% are germ cell tumors as we already discussed.

00:32 The non-germ cell tumors may produce androgens - also known as testosterone - and this may cause precocious puberty in boys.

00:39 If the testosterone that is produced undergoes aromatization into estrogen, it can present with gynecomastia in 20 to 50% of patients.

00:47 The most common sex cord-stromal tumor is called a Leydig cell tumor but overall, this accounts for only 1 to 2% of all testicular tumors.

00:55 Gynecomastia is seen in 20 to 30% of patients with Leydig cell tumors.

01:00 The histology shows Reinke crystals which are pathognomonic and should be memorized for testing purposes.

01:05 These appear as cytoplasmic dense needle-like or rhomboid structures.

01:10 They are rarely seen in a normal testes but are seen in about one-third of Leydig cell tumors.

01:14 Leydig cell tumors are seen in both children and adults, with the peak ages of presentation between ages 5-10 then later between ages 30 to 35.

01:24 Overall, Leydig cell tumors are seen more often in adults than children.

01:28 Two other types of testicular cancer that are non-germ cell tumors, are classified as sex cord-stromal tumors. These are leydig cell and Granulosa cell tumors.

01:37 Sertoli cell tumors present with a painless testicular mass and a minority of patients have gynecomastia.

01:43 They occur in all age groups, more often in adults.

01:46 Granulosa cell tumors have both a juvenile and an adult type.

01:51 The juvenile type presents in babies under age 6 months, and for the adult type, the average age of presentation is 44 years old.

01:58 It is important to know the age group of presentation for the different types of testicular cancers for testing reasons.

02:04 Testicular lymphoma is not always considered testicular cancer but rather a form of Hodgkin lymphoma.

02:10 It can be primary or metastatic and is seen in both young adults and men over age 55.

02:16 To summarize: Testicular cancer in the most common malignancy in young men ages 15 to 35, but 7% of testicular cancer occurs in men over age 55.

02:27 Germ-cell tumors make up 95% of all testicular cancer, and non-germ cell tumors make up the remaining 5%.

02:35 One classification of non-germ cell tumors are called sex cord-stromal tumors, which are Leydig cell, Sertoli cell, and the rare granulosa cell tumor.