Testicular seminoma is the most common malignant tumor of the testis. It classically manifests as a painless mass. Radiologic evaluation with high frequency ultrasonography is critical for diagnosis. Seminomas are usually homogeneously hypoechoic masses.
Starts in the mediastinum of testis and lower pole. Grossly it is lobulated, fleshy, homogeneous, creamy or pinkish in colour and it compresses adjacent testicular tissue. Histologically, malignant cells resemble spermatocytes which are cells containing clear cytoplasm with large nucleus, and are arranged in sheets with fibrous stroma in between which is in turn infiltrated by lymphocytes. It spreads through testicular lymphatics into the para-aortic lymph nodes and then to left supraclavicular lymph node. Through blood, it spreads to lungs, bone, brain, liver.
TYPES OF SEMINOMA
- Typical/classic form—it is most common type; occurs in middle age; syncytiotrophoblastic type (15%) occurs and produces high levels of beta HCG.
- Spermatocytic seminoma—occurs in older people with different phases of spermatogonia. Spread in this type is very rare.
- Anaplastic type has got high mitotic index/nuclear pleomorphism/ anaplasia with high potentiality to spread.
- Atypical form of seminoma shows cytoplasmic expression of low molecular weight keratin type 1 precursor to blood group antigen where typical seminoma stains negative
- Enlargement of testis.
- Fullness and heaviness in the scrotum.
- Pain in the testis (30%).
- Testis is enlarged, firm, heavy, with loss of testicular sensation (in early stage only).
- Secondary hydrocele is common.
- Cremaster is hypertrophied and thickened.
- Vas, prostate and seminal vesicles are normal.
- Often in epigastric region para-aortic lymph nodes may be palpable as hard, nodular, nontender, nonmobile, vertically placed, resonant mass (not moving with respiration).
- Measurement of tumour markers (β-HCG, AFP, LDH).
- AFP and β-HCG are elevated in nonseminomatous germ cell tumours (teratomas)—65%.
- LDH level depends on growth rate, is increased in 80% of advanced seminomas
- Placental alkaline phosphatase (PLAP) is increased in seminoma.
- Chest X-ray to look for lung secondaries.
- HRCT scan is ideal.
- Ultrasound abdomen
- CT abdomen is better.
- Ultrasound scrotum to see echogenicity of testis and tumour within.
Clematis, Pulsatilla, Aurum Met, Spongia, Belladonna, Lachesis, Mercurius, Graphites, Rhododendron, Silicea, Nitric Acid, Bromium