Testicular tumors

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

Neoplasms can be benign and malignant, hormone-producing and non-secretive hormone.

Pathogenesis

With tumors of testicles, patients, as a rule, are oncological, and only hormone-active tumors can be subject to observation by an endocrinologist.

The most common hormonal-active testicular tumors are leidigomas. They refer to well-differentiated variants of tumors of the stroma of the sexual strand. Tumor, as a rule, grows slowly, it often affects one testicle, in which a solitary knot is formed. The tumor is formed by Leydig cells of varying degrees of maturity. Pathognomonic for Leydig are Reinke crystals, which are found only in 40% of tumors. About 10% leidigom is malignant. They are characterized by an increase in mitotic activity, the phenomena of cellular and nuclear polymorphism, angioinvasia, and spreading to the epidermis and epididymis. In the vicinity of the tumor, as well as in the contralateral testicle, there is active spermatogenesis with the development of spermatids. Spermiogenesis does not occur. The size of the opposite testicle is reduced, but all these changes are reversible: the removal of the tumor is accompanied by the normalization of the structure and size of the testicles.

Tumors from Sertoli cells (sertolio, androblastoma), which are also well differentiated versions of stroma tumors of the genital tract, but which determine the feminization of the patient more often, are found mainly in children, but can occur at any age. The left testicle is more often affected. It is an encapsulated tumor measuring from 1 to 8-10 cm, solitary, expressed lobate, grayish-white or yellowish in color on the incision. It is formed mainly by tubular structures lined with Sertoli cells of different degree of differentiation. Sometimes tumor cells form follicle-like structures, so-called callus-Exner corpuscles. Some tumors also contain a variety of Leydig cells, more often mature cells. Malignant tumors from Sertoli cells are rare. Changes in the testicle next to the tumor and in the contralateral testicle are similar to the transformations observed with leidigomas, but spermatogenesis is inhibited to a greater extent. They cause the development of hypogonadism in patients with hormonal-active testicular tumors.

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

Symptoms of the testicular tumors

Symptoms of all testicular tumors are similar. The earliest symptom is a painless increase or thickening of the tissue. At the beginning of the disease, it can palpably detect a small tight knot with a normal consistency of the surrounding tissue. As the tumor grows, the testicle turns into a dense, hummocky tumor. The testicle can be enlarged several times, sometimes its dimensions remain normal. If the tumor is malignant, then gradually the epididymal process is involved in the tumor process. Often, the tumor is accompanied by an effusion in the testicle.

Diagnostics of the testicular tumors

Diagnosis of a testicular tumor is usually not difficult. When palpation, it is defined as a knot or part of the testicle, sometimes it takes up the entire testicle, but the appendage, as a rule, is not changed during palpation.

To hormone-producing tumors is one of the varieties of teratoblast - chorionepithelioma, which gives a high content of chorionic gonadotropin in the urine, the study of which helps to correctly diagnose.

Hormone-producing tumors of the testicle are also tumors originating from the interstitial cells of the testicle, the Ledigoma. By secreting androgens, they cause premature sexual development in boys. According to the histological structure, these tumors can be an adenoma or carcinoma. They have high androgenic activity. The diagnosis is established on the basis of premature sexual development (the appearance of pubic hair, the growth of the external genitalia, rapid growth, etc.) and palpation of enlarged and tuberous testis. A differential diagnosis between congenital adrenal cortex dysfunction (or congenital adrenogenital syndrome) and a hormone-active testicular tumor is established based on a study in urine of 17-CS and 17-hydroxy progesterone. These indicators for congenital dysfunction of the adrenal cortex are high, and after a sample with prednisolone (dexamethasone) with adrenal disease, they are significantly reduced.

Tumors from sertolium cells (sertolio), as well as leidigomas, are rare and can lead to premature sexual development.

With congenital dysfunction of the adrenal cortex, the boys often palpable testicular tumor (more often bilateral). With their histological examination, both leidigomas and hyperplastic tissue of the adrenal cortex were identified.

[10], [11], [12]

Treatment of the 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 apply all three types of treatment at once.

When detecting testicular tumors in patients with congenital adrenal cortex dysfunction, the knots of the testicles are enucleated (enucleated). Glucocorticoid therapy is mandatory.