Oncology / / April 22, 2016
Testicular tumors account for about 1-2% of all cancers in men.
Among the factors predisposing to testicular tumors, it should be noted cryptorchidism (observed in 22-25% of patients with tumors of the testis), trauma, inflammatory diseases.These processes are accompanied by hormonal disorders, hypoplasia and atrophy of testicular tissue, which apparently contributes to the tumor.A role in the genesis of tumors of the testis play an endocrine disorder.
Pathological anatomy and classification
testicular tumors are extremely complex structure.There are two tumor groups: germ cell derived from the seed of the epithelium, and negerminogennye, emerging from other elements of the stroma eggs.
tumor that develops from embryonic tissue, account for approximately 95% of all testicular tumors.Among this group, the following types: seminoma, teratoblastomu, embryonal carcinoma, horionepiteliomu.The most common type of tumor in this group is a seminoma (60-70% of patients).
There are four stages of tumor:
??The tumor is located within the tunica testis;body size is not increased.
??The tumor invades the tunica albuginea is not, but distorts the egg and causes it to increase.
??The tumor invades the tunica albuginea.
??The tumor extends beyond the testis and epididymis, invades the scrotum and (or) the spermatic cord.
Symptoms are mostly affected men aged 20 to 40 years.The right testicle is affected slightly more often the left.Bilateral tumor is extremely rare.One of the first symptoms is a pain-free seal.As the tumor grows in size egg, it becomes dense, lumpy.Often noted effusion egg shells.With the localization of the tumor in the testicle kriptorhicheskom noted swelling in the groin or above the pubis depending on the type of cryptorchidism (groin or abdominal).Often testicular tumors are asymptomatic, that is the cause of delayed diagnosis.
In some forms of testicular cancer is the development of secondary sexual characteristics (gynecomastia at horionepitelioma, precocious puberty when androblastoma).Sometimes the disease first manifests itself with the appearance of metastases.
testicular tumors tend mostly lymphogenous metastasis.Hematogenous spread is most characteristic when horionepitelioma, although this path is sometimes metastasize seminoma and embryonal carcinoma.
testicular tumor detection often encounters certain difficulties and is overdue, which is associated with a long asymptomatic, sometimes similarities with chronic inflammation and tumor localization in nespustivshemsya testicle with cryptorchidism.
On examination, you can set the increase of one of the halves of the scrotum, the presence of a dense node in the testis.Raying the seal area in the transmitted light is usually a negative note.Often accompanied by a seal in the egg by thickening of the spermatic cord to the expansion of its veins.
clinical blood and urine of patients with testicular tumor, usually no indication of tumor process does not.Of great importance is the definition of human chorionic gonadotropin, mainly in patients with horionkartsinoma, using a biological sample (reaction Aschheim - Tsondeka) and embriospetsificheskogo alfaglobulina (AFP) immunological method.
X-ray examination of the urinary system and organs of the chest are aimed primarily at identifying metastases.A valuable auxiliary method of diagnosis - ultrasound.
One of the methods is informative cytology primary testicular tumor and its metastases by means of biopsy, available even on an outpatient basis.
differential diagnosis should be performed with testicular inflammation (orchitis, orchiepididymitis, tuberculosis testicle and epididymis), syphilitic lesions of the testicle.In all cases of doubt, it is a needle or open biopsy.
Treatment Testicular tumors are one of the tumors, in which the combined treatment gives the best effect.
In all cases, the removal of the primary tumor is one of the main stages of complex treatment.The only exceptions are large tumors, especially kriptorhicheskogo testicular tumor removal when prefaced by chemotherapy or radiation.Removal of the primary tumor is carried out using high gemikastratsii to the level of the deep inguinal ring (orhofunikulektomiya).
removal of retroperitoneal lymph nodes should be considered mandatory for all malignant testicular tumors other than seminomas.When seminoma to a radical lymphadenectomy not resort due to the fact that this tumor is extremely sensitive to radiation treatment and chemotherapy drugs.
forecast results of treatment and prognosis depend on the stage and histological structure of the tumor.The most favorable prognosis should be considered when testicular seminoma.
One of the most real neoplasms prevention testicle is timely surgical correction of cryptorchidism.When different kinds of testicular hypoplasia, as well as a history of trauma must be strict clinical supervision.