10. Testicular Cancer Flashcards
Risk factor for Testicular Cancer
- Cryptorchidism (for both testicles
- Gonadal Dysgenesis
- Klinefelters
- Trauma
- Orchitis
- Testicular microlithiasis
MAle + 18-35 + Undescended testicle =
Seminoma
Nonpalpable testicle =
undescended testicle
Subtypes of TEsticular Cancer
- Germ Cell (90%)
a. Seminoma
b. Non Seminoma
- Teratoma
- Yolk Sac
- Mixed germ Cell - Non germ Cell (10%)
- Sertoli
- Leydig
Most testicular tumors met via Via the lymphatics (retroperitoneal at the renal hilum) EXCEPT
Choriocarcinoma (Hematogeneous)
Mass in the ball sac + Intratesticular + Solid =
Likely Malignant
Mass in the ball sac + Intratesticular + Cystic =
Likely Benign
Mass in the ball sac + Extratesticular + Cystic =
Benign
his is the most common testicular tumor, and has the best prognosis as they are very radiosensitive
Seminoma
Age 25 + mass in ballsac + homogeneous hypoechoic round + Microcalcifications - “replaces” the entire testicle + Dark T2 =
Seminoma
Mass in ballsac + Heterogeneous + cystic spaces and calcification +
Non-Seminomatous Germ Cell Tumor
Heterogeneous mass —> shrinks + calcifications =
Buned-out Testicular tumor (Shrinking tumor)
Unilateral + Diffusely large ill-defined testicle / Multiple hypoechoic masses + 60 y.o. + Immunosuppresed + =
Testicular Lymphoma (CAn be bilateral
Most common bilateral testicular tumor =
Testicular Lymphoma
Although it is usually unilateral (60%)
Testicular lymphoma is usually this subtype =
Diffuse B-Cell
Homogenous and Microcalcifications =
Seminoma
Cystic Elements and Macrocalcifications =
Mixed Germ Cell Tumor / Teratoma
Most testicular tumors met via =
the lymphatics to the retroperitoneal nodes
Gynecomastia can be seen with
Sertoli Leydig Tumors
Peutz-Jeghers Syndrome can be seen with
Sertoli Tumors
Bilateral testicular cancer =
Lymphoma
Bilateral hypoechoic masses =
Lymphoma
Bilateral solid testicular masses + congenital adrenal hyperplasia =
Adrenal Rests
Bilateral solid testicular & epididvmal masses =
Testicular Sarcoid
Bilateral 1-6-mm, hyperechoic, avascular masses + Cowden Syndrome =
Focal Lipomatosis
Elevated Beta hCG
Seminoma
Choriocarcinoma (Non-Seminoma)
Elevated AFP
Mixed Germ Cell (Non-S)
Yolk Sac (Non-S)
Male age 18-35, pelvic mass with an ipsilateral draining vein that empties into the inferior vena cava (if right sided) or left renal vein (if left sided) =
+ scrotum with only one testicle
Think of Cancer of the undescended testicle - whisper “nice try assholes”
Lung probles + Uveitis + Multiple small hypoechoic testicle lesions that don’t change over time =
Sarcoid of the balls
Testicular mets should spread to
Para-aortic
Aortic
Caval region
N1-N3
Non regional metastasis =
Mets to the pelvic, external iliac and inguinal nodes (M1 disease)
Pain + No trauma + No blood flow =
Infarct
History of Acute pain + No increased internal flow on Dopper wihtin the masses
Hematoma
Epidermoid Cyst
“Onion skin”
alternating hypoechoic and hyperechoic rings
Relatively non-vascular - benign
Tubular ectasia of teh Rete Testis
Cystic dilatation next to the mediastinum testis - normal variant
From obliteration (complete or partial) of the efferent ducts.
