A 18 years study of testicular tumours in Jodhpur, western Rajasthan.A Deotra, DR Mathur, MC Vyas
Dept of Pathology, Dr Sampurnanand Medical College, Jodhpur, Rajasthan.
The present study based on WHO histologic typing of testicular tumours deals with 100 cases recorded in the files of the Department of Pathology from 1969 to 1987. These tumours accounted for 2.57% malignancies of male genital system. Maximum number of tumours were recorded in the third and fourth decades. Right testis was affected in 60% cases. Scrotal swelling was the predominant presenting feature, followed by pain. Five cases of testicular tumours were observed in undescended testis. Germ cell tumour of one histologic type constituted 76% of testicular tumors. Germ cell tumors of more than one histologic type were 23%. One case (1%) belonged to lymphoid and haemopoietic system and was of large cell lymphocytic lymphoma. Amongst the germ cell tumors with one histologic type, seminoma (34%) and embryonal carcinoma (28%) were predominant while teratocarcinoma was a predominant tumour in combination group.
Keywords: Adolescent, Adult, Carcinoma, Embryonal, epidemiology,Child, Child, Preschool, Endodermal Sinus Tumor, epidemiology,Human, Incidence, India, epidemiology,Infant, Male, Middle Age, Neoplasms, Multiple Primary, epidemiology,Retrospective Studies, Seminoma, epidemiology,Testicular Neoplasms, epidemiology,
Testicular tumours are rare, yet they constitute the fourth common cause of death. Their peak incidence is in the fourth decade. The incidence of testicular tumours as recorded in literature varies from 0.5% to 2.73% of all malignant tumours in males and 13.04% to 23.4% of male uro-genital system tumours,,.
A retrospective study was carried out using 100 cases of testicular tumours recorded in the Department from 1969 to 1987. All the sections of testicular tumours were reviewed and their diagnosis made. Special staining like PAS. Von Gieson and reticulin were done where necessary. These tumours were classified according to Mostofi and Sobin classification adopted by WHO expert committee (1977). Since it is a retrospective study, no staging, mode of treatment and prognosis could be included in this study.
During the 18 years period, testicular tumours accounted for 2.57% of all tumours of the male genital system. Among the germ cell tumour of one histologic type, seminoma constituted 34%, embryonal carcinoma 28%, yolk sac tumour 7% and teratoma 7%. Among tumours of more than one histological type, embryonal carcinoma and teratoma (teratoma carcinoma) constituted 16%, embryonal carcinoma and seminoma 2%, embryonal carcinoma and choriocarcinoma 1 %, teratocarcinoma and seminoma 3% and teratoma and seminoma 1%. Among lymphoid and haemopoietic tumours, large cell lymphocytic lymphoma constituted 1%.
These tumours occurred commonly during third decade of life with mean age of 32 [Table - 1].
Testicular tumours commonly involved right testis (60%) except yolk sac tumour, which involved left testis predominately. However, bilateral involvement was not observed.
Scrotal swelling was noted in 88 cases, pain in 20 and trauma in 4. Five cases were recorded as undescqided testis. Of these 18.82% were seminoma, 7.14% embryonal carcinoma and 6.25 % teratocarcinoma.
Maximum number of cases was observed in third decade of life. Kurohara et al and Moge, et al observed the peak during fourth decade. Incidence of testicular tumours in undescended testis reported by other workers is shown in the [Table - 2].
Germ cell tumour of one histologic type: Seminoma was the commonest tumour, constituting 34%. It was observed between third and fourth decades. 8.82% cases were found in undescended testis. Melicow[10] in his study of 55 cases of seminoma, found incidence of 5.5% in undescended testis. The symptoms were, painless scrotal swelling (100%) and history of pain in 15.6% cases. Rusche[11] recorded 41 cases of which 36 were with painless scrotal swelling and 4 with history of pain. Microscopically tumour cells were arranged in tubular form. Lymphocytic reaction was common in 78% cases. While studying the group of seminoma cases, 2 cases of anaplastic seminoma with choriocarcinoma type giant cell (of them 1 even showed urinary HCG positivity with bilateral pulmonary metastases) were observed.
Embryonal carcinoma constituted 28% with peak age incidence during third and fourth decades. Patients presented with painless scrotal swelling in majority of cases. 7.14% cases were recorded in undescended testis. Kalra, et al made same observations. Microscopically tumour cells wore arranged in papillary form and there was moderate to marked degree of necrosis and haemorrhage. Mostofi observed same findings in his study. Cryptorchidism is an established risk factor for testicular cancer (oestrogen used during early pregnancy and low birth weight)[12].
In children below 2 years of age, the yolk sac tumour was the commonest tumour constituting 7% of the total. Young at al[13] recorded 2-5% cases while Pratap and Agarwa noted a higher incidence of 11.97% in their series. Microscopically tumour cells were arranged in reticular pattern. Schiller dual body was the characteristic feature.
Teratoma constituted 7% in this study. However, a low incidence of 1% and high incidence of 42% was recorded by Kimbrough and Cook[14] and Graham and Gibson[15] in their respective series. Age incidence was between 21 to 30 years. Histologically elements from all three germ layers were present. 7 cases of teratoma have been reviewed, of which 5 were of immature type and 2 were of mature type; histologically all these cases showed no malignant transformation.
Germ cell tumour of more than one histologic type: Among combined tumours, teratocarcinoma constituted 16% of all testicular tumours. A high incidence of 40% and a low incidence of 6.8% were recorded by Graham and Gibson and Kaira at al respectively in their study. The occurrence of this tumour was between third and fourth decades. However Kalra at al recorded this tumor during first three decades. 6.25% cases were observed in undescended testis. Fons, et al[16] noted similar incidence in their series. Microscopically both elements, teratomatous and embryonal carcinomatous elements were observed.
The incidence of other combined tumors was 2% (embryonal carcinoma and seminoma, embryonal carcinoma and choriocarcinoma, teratoma and seminoma). But teratocarcinoma and seminoma constituted 3% incidence. High incidence of 6.3% in embryonal carcinoma and seminoma and 8.70% in teratoma and seminoma was observed by Kurohara et al and Bhargava and Reddy in their respective series. Most of these tumours occurred during third decade. Microscopically findings of embryonal carcinoma and choriocarcinoma and carcinomatous elements of both embryonal carcinoma and cytotrophoblast and syncytotrophoblast cells of chodocarcinoma. Incidence of different histologic types of testicular tumour reported in different studies is depicted in [Table - 3].
In our series, large cell lymphocytic lymphoma was observed in a patient of 55 years who presented with a painless swelling in left testis. Size of the tumour was 5 x 4 x 2.5 cm. The cut surface of the tumour was greyish white and lobulated. Tumour cells showed monotonous picture resembling small lymphocytes.
[Table - 1], [Table - 2], [Table - 3]