Testicular tumors

In men, testicular tumors occur at any age, but most often at 20-40 years. In children, this disease is rare, most often during the first 3 years of life. Rarely, tumors of both testicles are observed.

Neoplasms can be benign or malignant, hormone-producing or non-hormone-secreting.

Pathogenesis

Patients with testicular tumors usually have cancer, and only hormonally active neoplasms can be monitored by an endocrinologist.

The most common hormonally active testicular tumors are leydigomas. They are well-differentiated variants of sex cord stromal tumors. The tumor usually grows slowly, most often affecting one testicle, in which a solitary node is formed. The tumor is formed by Leydig cells of varying degrees of maturity. Reinke crystals are considered pathognomonic for leydigomas, which are found in only 40% of tumors. About 10% of leydigomas are malignant. They are characterized by increased mitotic activity, cellular and nuclear polymorphism, angioinvasion, and spread to the membranes and epididymis of the testicle. Active spermatogenesis with the development of spermatids is noted near the tumor, as well as in the contralateral testicle. Spermiogenesis does not occur. The size of the opposite testicle is reduced, but all these changes are reversible: removal of the tumor is accompanied by normalization of the structure and size of the testicles.

Sertoli cell tumors (sertolioma, androblastoma), which are also well-differentiated variants of sex cord stromal tumors but which more often cause feminization of the patient, are found mainly in children, but can occur at any age. The left testicle is most often affected. This is an encapsulated tumor ranging in size from 1 to 8-10 cm, solitary, with a pronounced lobular structure, grayish-white or yellowish in section. It is formed mainly by tubular structures lined with Sertoli cells of varying degrees of differentiation. Sometimes tumor cells form follicle-like structures, the so-called Koll-Exner bodies. Some tumors also contain a variable number of Leydig cells, most often mature ones. Malignant tumors of Sertoli cells are rare. Changes in the testicle adjacent to the tumor and in the contralateral testicle are similar to the transformations observed in leydigomas, but spermatogenesis is inhibited to a greater extent. They are the ones that cause the development of hypogonadism in patients with hormonally active testicular tumors.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ]

Symptoms testicular tumors

The symptoms of all testicular tumors are similar. An early symptom is a painless enlargement or tissue compaction. At the onset of the disease, a small, dense nodule can be palpated in it with normal consistency of the surrounding tissue. As the tumor grows, the testicle turns into a dense, lumpy tumor. The testicle can be enlarged several times, sometimes its size remains normal. If the tumor is malignant, then the epididymis is gradually involved in the tumor process. Often, the tumor is accompanied by effusion in the membranes of the testicle.

Diagnostics testicular tumors

Testicular tumor diagnosis is usually not difficult. When palpated, it is determined as a node or part of the testicle, sometimes it occupies the entire testicle, but the appendage, as a rule, is not changed when palpated.

Hormone-producing tumors include one of the varieties of teratoblastomas - chorionepithelioma, which produces a high content of chorionic gonadotropin in the urine, the study of which helps to make a correct diagnosis.

Hormone-producing tumors of the testicle are also tumors originating from the interstitial cells of the testicle - leydigomas. Secreting androgens, they cause premature sexual development in boys. According to the histological structure, these tumors can be adenoma or carcinoma. They have high androgenic activity. The diagnosis is established on the basis of premature sexual development (the appearance of pubic hair, enlargement of the external genitalia, rapid growth, etc.) and a palpably enlarged and lumpy testicle. The differential diagnosis between congenital dysfunction of the adrenal cortex (or congenital adrenogenital syndrome) and a hormonally active testicular tumor is established on the basis of a study of 17-KS and 17-hydroxyprogesterone in the urine. These indicators are high in congenital dysfunction of the adrenal cortex, and after a test with prednisolone (dexamethasone) in case of adrenal genesis of the disease, they decrease significantly.

Sertoli cell tumors (sertoliomas), like leydigomas, are rare and can cause premature sexual development.

In boys with congenital dysfunction of the adrenal cortex, testicular tumors (usually bilateral) are often detected by palpation. Histological examination of these tumors reveals both leydigomas and hyperplastic tissue of the adrenal cortex.

[ 10 ], [ 11 ], [ 12 ]

Treatment testicular tumors

Treatment of testicular tumors is surgical. In malignant neoplasms, surgical intervention is often combined with chemotherapy or radiation. Sometimes it is necessary to use all three types of treatment at once.

When testicular tumors are detected in patients with congenital dysfunction of the adrenal cortex, enucleation of the existing nodes from the testicles is performed. Glucocorticoid therapy is mandatory.