Seminoma
Introduction
Introduction to seminoma Seminoma originates from the primordial germ cells of the testis and is the most common tumor of the testis. It occurs mostly after middle age and is often unilateral, with the right side slightly more than the left side. The incidence of cryptorchidism is several times higher than that of normal testis. The tumor is low in malignancy. From the naked eye, the testicles are swollen, sometimes up to 10 times the normal volume, and in a few cases the testes are normal. Tumors vary in size from small to a few millimeters, and larger to more than ten centimeters, usually 3 to 5 cm in diameter. Any testicular tumor should be preceded by high testicular removal, and then the treatment plan should be selected according to the pathological type and clinical stage. Spermatogonia cells are highly radiosensitive, and lower doses can eliminate metastatic lesions without significant radiation damage. Clinical stage I testicular seminoma, after high testicular removal, should be used for preventive irradiation of ipsilateral axillary lymph nodes and retroperitoneal lymph nodes. Linear accelerator high energy ray, 60Co and kilovolt X-ray can be used as external sources. basic knowledge The proportion of illness: 0.001% Susceptible people: more often after middle age Mode of infection: non-infectious Complications: testicular tumor testicular cancer
Cause
Cause of seminoma
Spermatoblastoma can be divided into two types: germ cell tumor and non-germ cell tumor. The former occurs in the reproductive epithelium of the curved fine tube, accounting for about 95%: the latter is from interstitial cells, accounting for about 5%. More common in the 25-44 years old, with regional differences in ethnicity. The cause of seminoma is unclear and may be related to race, heredity, cryptorchidism, chemical carcinogens, injury, endocrine, etc.
Insufficiency of spermatogonial cells (40%):
This is the main cause of this disease. Testicular local temperature rise, blood supply disorders, endocrine dysfunction, testicular atrophy, spermatogenic disorders, prone to malignant transformation. In addition, congenital testicular dysfunction, incomplete decline, is also prone to malignant transformation.
Genetic factors (10%):
In recent years, some people with semen cell tumors have a family history of oncology in about 16% of their close relatives.
Testicular female syndrome (5%):
According to the World Health Organization (WHO) 1977 classification of spermatogonia, the testicular female syndrome is also prone to seminoma.
Trauma (5%):
It is believed that trauma is not the direct cause of tumorigenesis, but after testicular trauma, local small hematoma formation or blood circulation disorder, tissue degeneration and atrophy, etc., on the basis of this tumor.
Infection (10%):
A variety of viral diseases, such as measles, smallpox, viral mumps and bacterial inflammation, can be complicated by orchitis, resulting in testicular cell deformation and spermatogonia.
Hormone (5%):
Clinical and animal experiments suggest that endocrine is related to the cause of testicular tumors. For example, testicular tumors occur mostly in young adults with strong gonads, or in active endocrine; animal experiments such as long-term administration of estrogen to rats can induce seminoma. Chinese medicine believes that: emotional dysfunction, or angry liver injury, liver qi stagnation, cross-reverse spleen, spleen deficiency and wet, leaving the liver, long-term formation of hard lumps. "Zheng deficiency and evil spirits" is its pathological mechanism.
Prevention
Seminoma prevention
People who eat more dairy products are also at higher risk of developing the disease. Especially those who eat a lot of cheese, the risk of testicular cancer is 87% higher than the average person. Therefore, quitting smoking and adjusting bad eating habits are the key to prevention.
Tobacco contains carcinogenic substances such as arsenic, and smoking can cause changes in sex hormones. Therefore, scientists have long suspected that smoking may be one of the risk factors for disease. Studies have shown that smoking does increase the risk of developing testicular cancer.
1 early treatment of seizure, to avoid testicular trauma and excessive sexual intercourse, has a certain significance in the prevention of seminoma.
2 treatment of cryptorchidism should be 4-6 years old, no more than 7-11 years old; can be treated with endocrine therapy for 2 weeks, testicular fixation is not effective.
Complication
Spermatoblastoma complications Complications testicular tumor testicular cancer
Testicular seminoma spreads in four ways:
1. In the testicular tissue, cancer cells spread in the testis on the side.
2, testicular cancer cells into the lymphatic system growth, called lymphatic metastasis, the chest is next to the bronchi, the hilar, mediastinal lymph nodes; chest outside the clavicle, armpit and upper abdomen lymph nodes.
3, testicular cancer cells into the blood system growth, called blood transfer, lung transfer is most common, followed by growth in the liver, bones, etc.
4, iatrogenic transfer, is the Western medicine surgery, cancer cells are planted in the abdominal cavity or in the incision, more common.
Infertility
Spermatoblastoma is the most common testicular tumor in adults, accounting for 60% to 8% of testicular germ cell tumors. The accepted treatment for seminoma is the in vitro radiotherapy of retroperitoneal lymph nodes after orchiectomy, with a 5-year survival rate approaching 95%. Spermatogonia cells are extremely sensitive to radiation, but may cause infertility after irradiation. The treatment of infertility caused by radiotherapy of seminoma cells, especially azoospermia, has few clinical reports. Traditional Chinese medicine method is used to diagnose and treat azoospermia caused by postoperative radiotherapy in patients with right spermatogonia. The spouse is successfully conceived by intracytoplasmic perfusion (ICSI).
Adult men have a total testicular weight of about 30g, and can produce 10 million sperm per gram of testicular tissue per day, producing about 200-300 million sperm per day. The sperm is shaped like a scorpion and has a length of about 60 m. It is divided into four parts: the head, the neck, the body and the tail. The head is large, the neck and the body are equal to the length of the head, and the tail is 10 times the length of the head. The head of the sperm has acrosome and nucleus. The acrosome covers 2/3 of the nucleus. There are many enzymes in the head. These are called acrosome enzymes. They are substances that break through the "shell" of the egg and the transparent band during fertilization. There are chromosomes in the nucleus of the head, which are substances that carry the genetics of the father. The neck and body are mainly cytoplasmic components, which are the parts that maintain sperm life and provide energy for sperm activity. The tail is very long and consists of some proteins. When these protein fibers shrink, the sperm tail can be swung in all directions, and sperm movement occurs. Generally, the forward movement speed of sperm is about 50 to 60 m per second. Sperm with strong fertility can climb up to a height of about 5cm.
Sperm production requires a suitable temperature, and the temperature inside the scrotum is about 2 °C lower than the temperature in the abdominal cavity, which is suitable for sperm production. During embryonic development, for some reason, the testicle does not fall into the scrotum and stay in the abdominal cavity or in the groin, called cryptorchidism, the seminiferous tubules can not develop normally, and no sperm is produced. If the mature testicular testicles are warmed or experimental cryptorchidism is performed, the spermatogenic cells may be degraded and atrophied.
The newly released sperm is released into the luminal lumen of the curve, and it does not have the ability to exercise itself. Instead, it is transported into the epididymis by the contraction of the peripheral muscle-like cells of the small tube and the movement of the lumen fluid. In the epididymis, the sperm further matures and gains exercise capacity. A small amount of sperm can be stored in the epididymis, and a large amount of sperm is stored in the inferior tube and its ampulla. In sexual activity, sperm is transported to the urethra by peristalsis of the vas deferens. Sperm is mixed with the secretions of the epididymis, seminal vesicles, prostate and urethral glands to form semen, which is injected outside the body during orgasm. Normal men shoot about 3-6ml of semen each time. Each milliliter of semen contains about 20 to 400 million sperm, less than 20 million sperm, and it is not easy to fertilize the egg.
Symptom
Symponia cell symptoms Common symptoms Testicular tenderness Testicular pain Testicular pain
Clinical stage
The pathological type of seminoma is associated with prognosis, and the extent of tumor spread and the extent of metastasis also affect prognosis. Therefore, the clinician should not only understand the pathological type of the tumor, but also develop a corresponding treatment plan according to the difference of the extent of the disease. Therefore, it is practical to determine the stage of disease in each patient. The most commonly used staging methods today are:
Stage I: The tumor is confined to the testis and epididymis, but has not broken through the capsule or invaded the spermatic cord, and has no lymph node metastasis.
Stage II: Physical examination, X-ray examination confirmed that there has been metastasis, can spread to the spermatic cord, scrotum, and inguinal lymph nodes, but did not exceed the retroperitoneal lymphatic area. Those with clinical metastasis of metastatic lymph nodes were stage IIa, and those with clinical examination of abdominal and abdominal lymph nodes were stage IIb.
Stage III: There have been lymph node metastasis or distant metastasis above the diaphragm. Some researchers have also classified distant distant people into stage IV.
Clinical features
Seminoma, posterior anterior and lateral spermatogonia are the most common mediastinal malignant blastomas, accounting for 2% to 4% of mediastinal tumors, 13% of mediastinal malignancies, and accounting for mediastinal malignant germ cell tumors. 50%. Almost all young men, the peak age of onset is 20-40 years old, located in the anterior mediastinum, 80% have symptoms.
20%-30% of patients are asymptomatic, symptomatic patients with symptoms of chest pain, cough, difficulty breathing, hemoptysis, etc., can have lethargy, weight loss. Superior vena cava obstruction syndrome occurs in 10% to 20% of patients. These clinical symptoms are often associated with oppression and invasion of the mediastinal structure of the tumor. A portion of the seminoma is grown in the trachea and locally spreads to the adjacent mediastinum and lungs. Generally, the mediastinal seminoma is metastasized by lymphatic metastasis, and hematogenous metastasis can also occur. Bone and lung are the most frequently metastatic sites.
Chest radiographs often have large anterior mediastinal tumors, and sometimes tumors can be found growing along the trachea. Most of the CTs are large masses with uniform density, and 50% of the chest can be seen to metastasize or expand beyond the anterior mediastinum and cannot be operated. CT and MRI help determine the extent of the tumor and the violation of the mediastinal structure. The first visit removal rate was less than 25%.
Blood alpha-FP, -hCG levels should be measured in all young men with pre-mediastinal tumors. There is almost no increase in AFP and hCG in pure seminoma, and hCG is elevated in 7%-10%, but often does not exceed 100 ng/ml, and AFP does not increase.
CA125 may also be a biological marker. Chromosomal analysis of tumor tissue reveals characteristic isometric arm chromosomes on chromosome 12, which is useful for identifying germ cell tumors and other types of tumors.
Examine
Examination of seminoma
Abnormal immune response: The immune response that does not occur in normal tissues and cells is expressed in the corresponding tumor tissues, and all are abnormal immune responses. If CK occurs in a variety of mesenchymal tumors, desmin can be expressed in hemangioendothelioma and cancer.
Epithelioid sarcoma Keratin, Vimentin, CEA, NSE, S-100 and 1-AT can be positive; Ewing sarcoma Keratin, Vimentin positive for a long time, S-100, NSE, neurofilament (NF) and Leu-7 can be Positive; malignant fibrous histiocytoma except for 1-AT and -ACT positive, Vimentin, Desmin and NF can be positive. All of these indicate that the above tumors are characterized by multi-directional differentiation.
Diagnosis
Diagnosis and diagnosis of seminoma
Electron microscopy observation of the differential diagnosis of soft tissue malignant tumors, electron microscopy observation is of great significance, especially some diagnostic ultrastructure, has a decisive role in determining the diagnosis. For example, clear cell sarcoma can be diagnosed as soft tissue melanoma by containing melanin bodies or pre-melanin bodies in electron microscopic tumor cells.
Especially in the differential diagnosis of spindle cell type, round, oval cell type tumors, specific ultrastructural features, see the various tumors described below. A large number of immunohistochemical studies have shown that various markers are useful in determining the diagnosis, but are not completely specific. For example, a group of muscle markers, originally thought to be specific for skeletal muscle, smooth muscle type tumors, but both desmin and actin can react with myofibroblastic and fibrous tissue cell tumors.
It has now been found that HMB45 is also available in non-melanocyte tumors. Therefore, a correct diagnosis can not be judged only based on the results of positive expression of immunohistochemical antibodies. It is necessary to integrate the patient's condition, tumor location, tumor cell morphology and growth type with marker staining results for synthesis. Analyze, judge, and finally determine the diagnosis.
Abnormal immune response: The immune response that does not occur in normal tissues and cells is expressed in the corresponding tumor tissues, and all are abnormal immune responses. If CK occurs in a variety of mesenchymal tumors, desmin can be expressed in hemangioendothelioma and cancer.
Epithelioid sarcoma Keratin, Vimentin, CEA, NSE, S-100 and 1-AT can be positive; Ewing sarcoma Keratin, Vimentin positive for a long time, S-100, NSE, neurofilament (NF) and Leu-7 can be Positive; malignant fibrous histiocytoma except for 1-AT and -ACT positive, Vimentin, Desmin and NF can be positive. All of these indicate that the above tumors are characterized by multi-directional differentiation.
