Testicular Tumors — MCQs
A young male presents with a testicular mass on the right side. The AFP is elevated while the HCG is normal. The most appropriate next step is
Which of the following is the ovarian counterpart of testicular seminoma?
Identify the condition represented in the image of a testicular tumor.
All of the following are the risk factors for testicular tumors except:
A 36-year-old man presents to his primary care physician complaining of painless enlargement of the testis. Further laboratory studies reveal an increase in serum hCG. Of the following, which is the most likely diagnosis?
Which of the following testicular tumors is not a germ cell neoplasm?
All of the following are true about cryptorchidism EXCEPT:
A 27-year-old man presents with a left testicular tumor and a 10 cm retroperitoneal lymph node mass. Which of the following is the treatment of choice?
All of the following statements are correct about vasectomy EXCEPT:
Which of the following is not seen in testicular carcinoma?
Testicular Tumors Indian Medical PG Practice Questions and MCQs
Question 1: A young male presents with a testicular mass on the right side. The AFP is elevated while the HCG is normal. The most appropriate next step is
- A. Biopsy
- B. Orchidectomy (Correct Answer)
- C. USG
- D. Wait and Watch
Explanation: ***Radical Inguinal Orchidectomy*** - In a patient who already presents with a **testicular mass** and **elevated AFP** (suggesting non-seminomatous germ cell tumor), the most appropriate next step is **radical inguinal orchidectomy**. - This procedure is both **diagnostic and therapeutic**, providing tissue for histopathological confirmation while removing the primary tumor. - The standard management sequence is: clinical examination → scrotal USG → tumor markers → **orchidectomy** → staging imaging → further treatment based on histology and stage. - Since the mass is already identified and tumor markers are done, proceeding directly to orchidectomy is appropriate. *USG* - Scrotal **ultrasound** is typically the **first imaging modality** when a testicular mass is suspected or palpated. - However, in this scenario, the mass is already clinically identified and tumor markers (AFP) have been measured, suggesting that initial workup including USG has likely been completed. - USG would have been the appropriate answer if the question asked for the "first investigation" before tumor markers were done. *Biopsy* - Direct **biopsy** of a testicular mass is **contraindicated** due to the high risk of tumor cell spillage along the needle tract, which can alter staging and worsen prognosis. - Testicular cancer is diagnosed via **radical inguinal orchidectomy**, not biopsy. *Wait and Watch* - A **wait and watch** approach is inappropriate and dangerous in the presence of a **testicular mass with elevated AFP**, which strongly suggests malignancy (non-seminomatous germ cell tumor). - Delayed treatment can lead to disease progression, metastasis, and poorer outcomes.
Question 2: Which of the following is the ovarian counterpart of testicular seminoma?
- A. Dermoid
- B. Dysgerminoma (Correct Answer)
- C. Endodermal sinus tumor
- D. Brenner tumor
Explanation: ***Dysgerminoma*** - **Dysgerminoma** is the most common malignant germ cell tumor of the ovary and is histologically identical to testicular **seminoma** [1]. - Both tumors arise from **primordial germ cells** and share similar morphology, including large, uniform cells with clear cytoplasm and prominent nucleoli, often arranged in nests and separated by fibrous septa with lymphocytic infiltration [1], [3]. *Dermoid* - **Dermoid cysts**, also known as mature cystic teratomas, are germ cell tumors composed of well-differentiated tissues from all three germ layers (ectoderm, mesoderm, endoderm) [2]. - They are typically benign and do not have a direct testicular counterpart that is histologically identical to seminoma. *Brenner tumor* - **Brenner tumors** are uncommon epithelial ovarian tumors characterized by nests of transitional epithelial cells resembling urothelium, separated by a fibrous stroma. - They are not germ cell tumors and do not have a testicular counterpart to seminoma. *Endodermal sinus tumor* - The **endodermal sinus tumor** (yolk sac tumor) is another type of malignant germ cell tumor of the ovary, but it is characterized by structures resembling the primitive yolk sac and the presence of **Schiller-Duval bodies**. - While it has a testicular counterpart, it is not histologically identical to seminoma; its testicular counterpart is also called a yolk sac tumor and is distinct from seminoma [3]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1034-1035. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1035-1036. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 979-980.
Question 3: Identify the condition represented in the image of a testicular tumor.
- A. Non-seminomatous germ cell tumor
- B. Teratoma (testicular tumor)
- C. Seminoma (Correct Answer)
- D. Leydig cell tumor
Explanation: ***Seminoma*** - Seminoma is a type of **germ cell tumor** that typically presents with a **painless testicular mass**, making it one of the common types of testicular cancer [1]. - This condition is characterized by the presence of **large, uniform cells** and is highly sensitive to **radiation therapy**, which aids in management [1]. *Non-seminoma* - Non-seminomas encompass a group of tumors including **embryonal carcinoma**, **choriocarcinoma**, and **yolk sac tumor**, which often present with more variable histological features [1]. - Generally considered more aggressive than seminomas, they may yield **higher levels of tumor markers** such as **AFP** or **hCG** [1]. *Teratoma* - Teratomas typically contain **multiple germ layers (ectoderm, mesoderm, and endoderm)**, often presenting with more complex histopathology compared to seminomas [1]. - They can occur in both children and adults, but in adults, they are often a component of a **non-seminomatous germ cell tumor** instead of a pure form [1,2]. *Germ cell differentiate tumor* - This term broadly refers to any tumor originating from **germ cells**, including both seminomas and non-seminomas, lacking specificity [1]. - It does not reflect the defined characteristics of seminoma and can encompass a range of histological types with diverse behaviors [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 979-982. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 512-513.
Question 4: All of the following are the risk factors for testicular tumors except:
- A. Testicular feminization syndrome
- B. Klinefelter's syndrome
- C. Acute Epididymo- Orchitis (EDO) (Correct Answer)
- D. Administration of DES in utero
Explanation: ***Acute Epididymo- Orchitis (EDO)*** - **Acute epididymo-orchitis** is an inflammation or infection of the epididymis and testes, typically caused by bacteria or viruses, and is not a known risk factor for testicular tumors. - While it can cause testicular pain and swelling, it does not predispose individuals to the development of germ cell tumors or other testicular malignancies. *Testicular feminization syndrome* - This syndrome, also known as **Androgen Insensitivity Syndrome (AIS)**, is a significant risk factor for testicular germ cell tumors due to the presence of undescended testes (gonads) and abnormal hormonal environments. - Individuals with AIS have XY chromosomes but are phenotypically female, and if the gonads are not removed, they carry an increased risk of developing **dysgerminoma or seminoma**. *Klinefelter's syndrome* - **Klinefelter's syndrome** (47, XXY) is associated with an increased risk of extragonadal germ cell tumors, particularly **mediastinal germ cell tumors**, as well as a slightly elevated risk of testicular germ cell tumors. - This genetic condition is characterized by primary testicular failure, gynecomastia, and infertility, and the abnormal chromosomal complement contributes to the oncogenic risk. *Administration of DES in utero* - Maternal use of **diethylstilbestrol (DES)** during pregnancy has been linked to an increased risk of reproductive tract abnormalities and certain cancers in offspring, including testicular cancer. - Exposure to DES in utero has been associated with **epididymal cysts**, cryptorchidism, and an elevated risk of **clear cell adenocarcinoma** of the vagina/cervix in females, and testicular germ cell tumors in males.
Question 5: A 36-year-old man presents to his primary care physician complaining of painless enlargement of the testis. Further laboratory studies reveal an increase in serum hCG. Of the following, which is the most likely diagnosis?
- A. Seminoma
- B. Yolk sac tumor
- C. Embryonal carcinoma (Correct Answer)
- D. Dysgerminoma
Explanation: ***Embryonal carcinoma*** - This highly **malignant tumor** often presents with **elevated hCG** and a **firm, painless testicular mass**. - It frequently consists of mixed germ cell tumors, with embryonal components contributing to the hCG surge. - Among the options provided, this is the most likely diagnosis with elevated hCG (note: choriocarcinoma would show the highest hCG levels but is not listed). *Seminoma* - While it causes **painless testicular enlargement**, seminoma is typically associated with **elevated LDH and placental alkaline phosphatase (PLAP)**, not significant hCG elevation. - Pure seminomas occasionally show mild hCG elevation (~10-15% of cases), but this is not their characteristic tumor marker. *Yolk sac tumor* - These tumors are characterized by significantly **elevated alpha-fetoprotein (AFP)** levels. - While they can cause testicular enlargement, hCG elevation is not its primary tumor marker. *Dysgerminoma* - **Dysgerminomas** are a type of **ovarian germ cell tumor**, primarily found in females, and thus highly unlikely in a male patient. - The male equivalent is a **seminoma**, which does not typically show significant hCG elevation.
Question 6: Which of the following testicular tumors is not a germ cell neoplasm?
- A. Yolk sac tumor
- B. Seminoma
- C. Sertoli cell tumor (Correct Answer)
- D. Teratoma
Explanation: ***Sertoli cell tumor*** - Sertoli cell tumors are classified as **sex-cord stromal tumors** [1][2], not germ cell neoplasms, and arise from **Sertoli cells** in the testis. - They are characterized by **hormonally active** properties and may lead to conditions like **gynecomastia** due to estrogen production. *Seminoma* - Seminomas are a type of **germ cell tumor** [2][3], derived from the germ cells in the testes, and typically present with **elevated AFP** and **hCG** levels. - Known for their **slow growth** and better prognosis compared to non-seminomatous germ cell tumors. *Yolk sac tumor* - Also a germ cell neoplasm [3], yolk sac tumors typically produce **alpha-fetoprotein (AFP)**, indicating their germinal origin. - Commonly occur in **younger males** and present as a **rapidly growing** tumor with a poor prognosis if not treated early. *Teratoma* - Teratomas are categorized as germ cell tumors [3] that can contain differentiated tissues and arise from **primitive germ cells**. - They are generally classified as either **mature** or **immature**, with the immature type being more aggressive and occurring primarily in **younger patients**. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 513-514. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 510-512. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 979-980.
Question 7: All of the following are true about cryptorchidism EXCEPT:
- A. Contralateral testis is also at risk
- B. Orchidopexy reduces the risk of malignancy (Correct Answer)
- C. Seminoma is the most common tumor
- D. Cryptorchidism is a risk factor for testicular tumor
Explanation: ***Cryptorchidism is a risk factor for testicular tumor*** - **Cryptorchidism**, or undescended testes, is a well-established risk factor for developing **testicular germ cell tumors**. This risk is 3- to 14-fold higher in affected individuals. - The increased risk is thought to be due to the **abnormal temperature environment** and intrinsic cellular abnormalities of the maldescended testis, leading to malignant transformation. *Contralateral testis is also at risk* - While the undescended testis has a significantly higher risk, the **contralateral (normally descended) testis** also has an elevated risk for developing a testicular tumor, though to a lesser extent. - This suggests that factors other than just temperature (e.g., genetic predisposition or inherent cellular abnormalities) play a role in the increased tumor risk. *Seminoma is the most common tumor* - **Seminoma** is indeed the most common type of testicular germ cell tumor overall, accounting for approximately 50% of all testicular cancers. - In cases of cryptorchidism, while seminoma is common, **non-seminomatous germ cell tumors (NSGCTs)** may also be more prevalent than in the general population. *Orchidopexy reduces the risk of malignancy* - **Orchidopexy** (surgical correction of cryptorchidism) can make the testis more accessible for examination and may improve fertility, but it **does not eliminate** the increased risk of malignancy. - The risk of developing testicular cancer remains elevated even after orchidopexy, especially if performed after puberty, as the cellular changes predisposing to malignancy may have already occurred.
Question 8: A 27-year-old man presents with a left testicular tumor and a 10 cm retroperitoneal lymph node mass. Which of the following is the treatment of choice?
- A. Radiotherapy
- B. Chemotherapy alone
- C. Immunotherapy with interferon and interleukin
- D. Radical inguinal orchiectomy plus chemotherapy (Correct Answer)
Explanation: ***Radical inguinal orchiectomy plus chemotherapy*** - For a suspected testicular tumor, the initial diagnostic and therapeutic step is a **radical inguinal orchiectomy** (high ligation of spermatic cord via inguinal approach) to avoid tumor seeding into the scrotum. - Given the presence of a 10 cm **retroperitoneal lymph node mass**, indicating bulky metastatic disease, **chemotherapy** (typically BEP regimen) is essential post-orchiectomy to address systemic spread. *Radiotherapy* - Radiotherapy may be used for specific stages of **seminoma**, but it is generally less effective for non-seminomatous germ cell tumors and is not the primary treatment for bulky metastatic disease (>5 cm). - It does not address the primary tumor in the testis directly and has higher long-term toxicities compared to chemotherapy for disseminated disease. *Chemotherapy alone* - While chemotherapy is crucial for metastatic testicular cancer, it cannot alone remove the primary tumor in the testis, which would leave a source of ongoing disease. - A **radical orchiectomy** is necessary to confirm the diagnosis, obtain tissue for histopathological staging, and remove the primary tumor. *Immunotherapy with interferon and interleukin* - **Immunotherapy** is generally not a first-line treatment for testicular germ cell tumors. - Standard treatment relies on platinum-based chemotherapy, which has excellent cure rates even in metastatic disease. Immunotherapy has limited role in testicular cancer management.
Question 9: All of the following statements are correct about vasectomy EXCEPT:
- A. No Scalpel Vasectomy (NSV) was first developed in China.
- B. It is less time consuming than tubectomy
- C. It increases the incidence of testicular cancer (Correct Answer)
- D. Additional contraception should be used for 3 months after vasectomy
Explanation: ***It increases the incidence of testicular cancer*** - Research has consistently shown **no causal link** between vasectomy and an increased risk of testicular cancer. - The reported incidence of testicular cancer in men who have undergone vasectomy is similar to that in the general population. *No Scalpel Vasectomy (NSV) was first developed in China.* - The **no-scalpel vasectomy (NSV)** technique was indeed developed in China by Dr. Li Shunqiang in 1974. - This method involves a smaller puncture incision rather than a traditional scalpel incision, leading to fewer complications. *It is less time consuming than tubectomy* - Vasectomy is generally a **simpler, less invasive, and quicker procedure** than tubectomy (female sterilization). - Tubectomy often requires general anesthesia and a more complex surgical approach, making it more time-consuming overall. *Addition contraception should be used for 3 months after vasectomy* - It takes approximately **3 months or 20 ejaculations** for all residual sperm to be cleared from the reproductive tract after a vasectomy. - Therefore, additional contraception is crucial during this period until a **sperm analysis (semen analysis)** confirms azoospermia (absence of sperm).
Question 10: Which of the following is not seen in testicular carcinoma?
- A. Epididymo-orchitis
- B. Inguinal lymphadenopathy (Correct Answer)
- C. Hydrocele
- D. Abdominal lump
Explanation: ***Inguinal lymphadenopathy*** - **Testicular carcinoma** does NOT spread to inguinal lymph nodes under normal circumstances. - The testis has **lymphatic drainage to para-aortic/retroperitoneal lymph nodes**, bypassing the inguinal region. - **Inguinal lymphadenopathy** would only occur if there was prior inguinal surgery, scrotal skin involvement, or invasion of scrotal wall—very rare scenarios. - This is the key anatomical distinction that differentiates testicular tumor spread from scrotal pathology. *Epididymo-orchitis* - This is an **inflammatory/infectious condition** of the epididymis and testis, not a feature of testicular carcinoma. - It is an important **differential diagnosis** that can clinically mimic testicular cancer with swelling and discomfort. - While both conditions can present as a testicular mass, epididymo-orchitis is a **separate pathological entity**, not something "seen in" or caused by testicular carcinoma. - However, rarely, inflammation may coexist with an underlying tumor, making careful clinical assessment essential. *Hydrocele* - A **hydrocele** (fluid collection around the testis) can occur as a **secondary reactive phenomenon** in 10% of testicular tumors. - The presence of a hydrocele does NOT rule out underlying **testicular carcinoma**—careful palpation through the fluid and ultrasound evaluation are essential. - **New-onset hydrocele** in adults should raise suspicion for underlying testicular pathology. *Abdominal lump* - **Testicular carcinoma** frequently metastasizes to **retroperitoneal (para-aortic) lymph nodes**, which can enlarge and become palpable as an **abdominal mass**. - This is a common presentation in **advanced disease**, particularly with non-seminomatous germ cell tumors. - May be the presenting complaint in some patients before testicular symptoms are noticed.
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