Spermatogenesis: spermatogonia → spermatocytes → spermatids → spermatozoa. Takes ∼2 months in adult men. LN drainage. L testicle: testicular vein → L renal vein → paraaortic LN. R testicle: testicular vein → IVC below level of renal vein → paracaval and aortocaval nodes. Prior inguinal surgery may disrupt drainage and redirect through iliac nodes. Pathology: >95% are germ cell tumors (GCTs) = seminomas and nonseminomatous germ cell tumors (NSGCTs). Sixty percent of tumors are mixed and 40% are pure (seminoma most common pure). Seminoma is the most common single histology, but together NSGCTs are more common. Seminoma subtypes: classic (>90% of cases, stains + for PLAP) and spermatocytic (older age, cured by orchiectomy, rarely metastasizes, stains negative for PLAP). Anaplastic no longer considered a subtype. NSGCTs subtypes: embryonal carcinoma (most common NSGCT), yolk sac tumor (elevated AFP, Schiller Duval bodies), choriocarcinoma (elevated β-hCG, rarest pure GCT), teratoma, and mixed GCTs. Other tumors: Sertoli cell tumors (produce estrogen, present with gynecomastia); Leydig cell tumors (produce androgens and estrogen, present with early puberty, gynecomastia); lymphoma; embryonal rhabdomyosarcoma. Risk factors: undescended testicle, first-born, pre/perinatal estrogen exposure, polyvinyl chloride exposure, advanced maternal age, Down’s syndrome, Klinefelter’s syndrome (47XXY), CIS, HIV/AIDS.
KeywordsRenal Vein Testicular Cancer Embryonal Carcinoma Undescended Testicle Early Puberty
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