Histopathological analysis of testicular tumors

Correspondence: Dr. Shovana Karki, MD Department of Pathology, Institute of Medicine, Tribhuvan university teaching hospital, Kathmandu, Nepal Email: shovana_karki@hotmail.com Background: Testicular cancers are rare in most countries. However, in many western countries its incidence has been increasing since the middle of the twentieth century. A definite geographic and racial distribution is seen in testicular tumors. The purpose of the study was to analyze the pattern and distribution of testicular cancers in one of the hospital in Nepal.

from the surgical pathology report and analyzed.Software SPSS 10 version was used to analyze data wherever applicable.

RESULTS
There were a total of 70 (0.27%) testicular biopsies of 26,753 biopsies received in the department of pathology, Institute of Medicine, during the study period.Eighty percent (80%) of these testicular biopsies were of orchidectomy specimen and 20% were small biopsies.Thirty percent of the total specimen comprised of undescended testis.Out of the total 70 cases, 11.4% (8/70) were diagnosed as malignant testicular tumor.Age wise distribution of the patients along with diagnosis is shown in Table 1.

DISCUSSION
Though the incidence of testicular cancer is low, it is one of the commonest malignancies occuring in young adults.As described in the literature, testicular tumors were rare in this study.
Undescended testis comprised 30% (21 cases) of the total testicular biopsies received, however none of these cases showed malignancy.
Most of the malignant cases were seen in the 4th and the 5th decades, 2 cases each.Testicular tumors are limited to three age group, infancy, late adolescence to young adulthood (20-35 yrs) and 50 years and above. 9cording to the literature, the histologic pattern and behavior of the tumor differ with each age period.Seminomas have not been reported in infants, while embryonal carcinoma and teratoma are the most common tumors of infancy and childhood.In young adults seminoma, embryonal carcinoma, teratoma, and teratocarcinoma are common but seminoma is more common in the fourth decade while spermatocytic seminoma and lymphoma occur in the elderly.
In this study, Non Hodgkin lymphoma (NHL) and spermatocytic seminoma were seen in elderly, pure seminoma occurred in the 4 th decade, while leukemic infiltration was noted in the 5 th decade of life.
Out of the total 8 malignant tumors in this study, 62.5% (5 cases) consisted of germ cell tumors.According to Mostofi et al., germ cell tumors constitute more than 94% of testicular tumors. 9Among the 5 cases of germ cell tumors in this study, 2 (40%) were mixed germ cell tumors, which is similar to that seen in other studies.In this study, a 1 case of mixed germ cell tumor comprised of teratoma and embryonal carcinoma, whereas other contained predominance of seminoma with embryonal carcinoma.Seminoma (fig. 1) comprises 35-71% of testicular tumors.In this study, seminoma consisted of 28.5% (2 cases) of all testicular tumors.This variation in data may be due to the small number of cases included in this study.
A single case (12.5%) of choriocarcinoma (fig.2) with metastasis to the lung was seen in the 5th decade.Pure choriocarcinoma are rare in ovary and testis.Though confined to patients in the second and third decade of life, it has also been reported in the 6th decade, which is in accordance with our study.
A solitary case (12.5%) of NHL (fig.3), diffuse large B cell type was seen in 75 year old.Fonesca el al. reported median age at presentation of extranodal NHL to be 68 years. 10rimary testicular lymphoma accounts for about 1% of all lymphomas and is the most common testicular malignancy in men more than 60 years of age. 11dgkin lymphoma occurring primarily in testis has not yet been reported so far in the literature.Hodgkin lymphoma

Histopathological analysis of testicular tumors
was not seen in this study well.
NHL is the commonest neoplasm presenting as metastasis to the testis comprising about 1% of testicular tumors. 9It may occur at any age group ranging from 21-87 years with most of the cases presenting in the 6 th and 7 th decades.One case presenting with metastatic NHL in the fifth decade was seen in the current study.
The testis represents a potential sanctuary site for tumor cells especially in ALL. 15 The incidence of testicular leukemia has increased with the improved survival of childhood ALL. 16cording to Mostofi et al, stromal tumors consist of 3% of testicular tumors.However, in this study stromal tumors were not encountered.This could be due to the small number of cases in the study.Since, this study was limited by small number of cases, follow up study involving a larger study population is recommended.

CONCLUSION
Testicular tumors are uncommon in our population.Most common tumor was germ cell tumor as is evident in other parts of the world.However, unlike in the Western population, malignancy developing in the undescended testis is rare.Karki S et al.