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.