Qamar Jamal ( Department of Pathology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. )
Naeem A. Jafarey ( Department of Pathology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. )
S. Mahmood Alam ( Department of Pathology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. )
Histological analysis of 65 testicular tumours received in the Department of Pathology, over 27 years (1962-1988), is being presented. Diagnosis of these cases was based upon light microscopic findings only.
MATERIALS AND METHODS
Sixty five testicular tumours in 27 years accounted for an average of 2-3 cases (specimens) per year. The estimated frequency was therefore 0.04% out of total 165,000 biopsies received during this period. Specimens were sent from surgical units of various hospitals of Karachi be sides Jinnah Postgraduate Medical Centre (JPMC). Sections prepared were stained with routine haematoxylin and eosin; periodic acid schiff, reticulin and trichrome were used in selected cases.
OBSERVATIONS AND RESULTS
Sixty three germ cell tumours constituted the largest group (97%) of the testicular neoplasms. Seminoma was the most frequently encountered germ cell tumour and was seen in 37 cases (54%). The other germ cell tumours were: 9 eases of embryonal carcinomas (14%), 8 teratocareinomas (12.5%), 6 endodermal sinus tumours (9%), 3 teratomas (4.5%) and 1 gonadoblastoma (1.5%). No choriocarcinoma or specialised stromal cell tumours were seen. Ages of the patientts varied from few months to 85 years with clustering of cases in 0 to 20, 21 to 40 and 51 to 60 age groups (trimodal age distribution). However, the age of peak incidence was between 21 and 40 years (Table-I).
Testicular tumours are rare1-3. The reported frequency is 1-2% of all malignant diseases in white male population4 and 0.5-0.8% amongst African Negroes5. Data from some of the Departments of Radiotherapy and Pathology compiled in the multicenteric tumour report a frequency of 1.8-4.4% from various centres in Pakistan6-8. Thus the frequency reported from Jinnah Postgraduate Medical Centre, Karachi, Liaquat Medical College, Hyderabad, King Edward Medical College, Lahore, and Armed Forces Institute of Pathology, Rawalpindi were 1.8%, 4.2%, 3.9% and 4.0% respectively. The prevalence reported from JPMC was thus the least-perhaps based on the recial difference (Table-II).
Similar results were obtained when the frequency of germ cell tumours were compared. Collins3 and Mostofi9,10 reported 95% frequency compared to 97% reported in the present series. Contrarily, in African series5,11,12 the frequency was less (74%). Similarity of results with the Caucasian, and different from African series also support the genetic basis of the disease (Table-III).
Testicular tumours are seen often in patients with dysgenetic gonads and maldescent of the testis. The same is true for repeated infection1-3. Though correlation of these factors was not possible in the present series yet a higher frequency of testicular lymphoma and endemic viral infection in these territories appears concomitant5. Modern methods of treatment have revolutionised the prognosis of these patients. Pertinent histological diagnosis and serum AFP (alpha feto protein) and HCG (human chorionic gonadotrophins) estimation13 are important steps in choosing the line of treatment and assessing the prognosis. Routine screening of individuals in susceptible age group would help earlier detection and thereby better management of cases.
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