Bone Pain and testicular lump - 138

Question 1

What kind of tumour is testicular cancer most commonly due to?

Answer 1

Germ cell tumours - these represent 95% of testicular tumours.

Question 2

What 2 types of tumour can GCTs be?

Answer 2

Seminomas (45%)

Non-seminomas, e.g. teratomas (50%)

Question 3

When are seminomas rare?

Answer 3

Before 10 years and after 60 years

Question 4

What are the risk factors for GCTs?

Answer 4

Cryptochidism, testicular atrophy, inguinal hernia, hydrocoele, syndromes with adnormal testicular development (e.g. klinefelters)

Question 5

What virus is associated with testicular cancer?

Answer 5

Mumps -> 10% of men with GCTs had mumps

Question 6

Name some signs and symptoms of GCTs

Answer 6

Painless swelling/lump, dull ache/heavy sensation, acute testicular pain, metastases, gynaecomastia

Question 7

How is a GCT of the testis diagnosed?

Answer 7

Physical examination. Scrotal USS -> sensitivity is almost 100%. Serum tumour markers -> these can be prognostic and help staging

Question 8

Name some serum tumour markers associated with a testicular cancer and when they might be raised

Answer 8

• a-FP -> Raised in 50-70%. Suggests a non-seminomas tumour ONLY (also produced in liver damage)
• b-hCG -> produced by seminomas and non-seminomas (and some other cancers). Raised 30% of time
• LDH -> this is an indicator of relapse

Question 9

What is a hydrocoele?

Answer 9

A collection of fluid within the tunica vaginalis. It is usually benign (unless it’s underlying a secondary pathology). Occurs in over 70s or infants

Question 10

What is the most common aeitology of a hydrocoele in over 70s and infants?

Answer 10

Adults - Excessive fluid production or inflammation/infection
Infants - patent processus vaginalis

Question 11

What is an epididymal cyst?

Answer 11

Extra-testicular fluid filled benign cyst. Usually in head of epididymis.

Question 12

What is a spermatocoele?

Answer 12

A sperm filled benign cyst, distended tubule from rete testis or epididymis.

Question 13

What investigations would be done for an epididymal cyst or spermatocoele? How would they be managed?

Answer 13

Transillumination. USS.

Managed conservatively if asymptomatic. If cyst infected tetracycline can be given to shrink cyst. `

Question 14

What is a varicocoele?

Answer 14

An abnormal dilatation of veins of pampiniform plexus. Can be associated with infertility.

Question 15

Why is a varicocoele more common on the L side?

Answer 15

Due to the 90* angle and inadequate valves as the L testicular vein enters the L renal vein -> can cause a back pressure.

Question 16

Would you examine a varicocoele whilst the patient is sitting or standing?

Answer 16

Standing -> pressure and dilatation. Cough also increases pressure.

Question 17

What is the most common cause of epididymitis?

Answer 17

Ascending infection from the urethra. Could be due to an STI.
Gram -ve infection (E.coli) most common in under 35s.

Question 18

What are risk factors for torsion of the testicle?

Answer 18

Bell-clapper deformity (tunica vaginalis attaches at top of testis, no scrotal wall attachment), cryptoorchidism (partially descended testis)

Question 19

How would a patient with torsion of the testis present? How would it be managed?

Answer 19

Acute pain, radiation to abdomen and back, vomiting, swollen, tender and retracted testicle, scrotal colour change.
Medical emergency - immediate surgical exploration and management