Diagnosis

Question 1

TNM

Answer 1

GCNIS
T1 confined to testicle and epididymis, no vascular, lymphatic invasion, may invade TA, not TV

T2 with LVI or extending into TV

T3 involves cord with/out LVI

T4 scrotal wall with/out LVI

N1 LN mass 2cm or less in greatest dimention, 5 or fewer LN no more than 2cm in greatest dimension

N2 = LN mass more than 2cm but less than 5cm, more than 5 nodes positive, none more than 5cm

N3 = LN mass more than 5cm in greatest dimension

M1a = non regional LN or lung
M1b = distant mets

Question 2

AFP
half life
where from
normal level
increased in NSGCT%

Answer 2

5 days
10 ng/ml
trophoblastic elements
increased in 50-70% NSGCT

Question 3

HCG
half life
normal level

Answer 3

syncitiotrophoblastic elements
half life 3 days
normal level 5mIU/ml
increased in 40-60% NSGCT

can be increased in seminoma, never more than 500

always raised in choriocarcinoma

Question 4

CS 1

1a and 1b

Answer 4

Ia = T1

Ib=T2-4

Question 5

CS II

Answer 5

N1-3

IIa to IIc

Question 6

CS III

Answer 6

M1a to M1b
IIIa = M1a S0-1
IIIb = M1a S2
IIIc = M1a S3 or M1b

Question 7

scandura study bjui testicular lesions small
risk malignancy less than 10mm
risk less than 5mm

Answer 7

2681 testicular masses
<10mm one third malignant
less than 5mm all benign and tumour markers not helpful

Question 8

testicular biopsy what is in Bouin’s solution

Answer 8

Bouin’s solution
picric acid
acetic acid
and formaldehyde

Question 9

when measure tumour markers after orchidectomy

Answer 9

5-7 days

and 14 days

Question 10

causes raised AFP 4

Answer 10

liver
pancreatic
stomach
lung
and benign liver pathology

Question 11

bHCG excretion in
chorio
teratoma
seminoma

Answer 11

100%
10% seminoma
40% teratoma

Question 12

bHCG excretion in
chorio
teratoma
seminoma

Answer 12

100%
10% seminoma
40% teratoma

Question 13

conditions raise bHCG

Answer 13

liver 
pancreas
stomach 
lunch
breast
bladder
kidney
marijuana

Question 14

spuriously high readings in bHCG

Answer 14

high levels of LH in hypogonadic patients

Question 15

usefulness of LDH

Answer 15

elevated in 10% of seminoma and can judge response treatment

Question 16

appearance on US

seminoma
teratoma

Answer 16

heterogenous
hypoechoic

seminoma
homogenous, smooth , hypoechoic

teratoma - irregular, calcifications, necrosis

Question 17

prevalence testicular microlithiasis in population

Answer 17

5%
no difference in TC
De Castro

Question 18

definition of TML

Answer 18

5 or more clacifications each less than 2mm per image field on US

Question 19

how to measure LN

Answer 19

The short axis diameter of a lymph node should be measured as it has been demonstrated that this is constant despite orientation because it is likely to become rounder before it elongates. The short axis diameter is measured perpendicular to the longest diameter of the lymph node.

Question 20

pathological LN size abdomen vs pelvis

Answer 20

In the abdomen, the upper limit of the short axis diameter of normal nodes varies from 6 to 10 mm[8,9]. For example the upper limit of a normal retrocrural node is 6 mm, a retroperitoneal node is 10 mm[10] and 8–10 mm for nodes in the pelvis

Question 21

pathological LN size abdomen vs pelvis

Answer 21

In the abdomen, the upper limit of the short axis diameter of normal nodes varies from 6 to 10 mm[8,9]. For example the upper limit of a normal retrocrural node is 6 mm, a retroperitoneal node is 10 mm[10] and 8–10 mm for nodes in the pelvis

Question 22

CT sens and sepc

Answer 22

67% and 92%

Question 23

LN size and CT

Answer 23

CT reportedly detects around 70–80% of positive retroperitoneal lymph nodes, although this number can fluctuate with different size cut-offs (8,28-32). Discerning size cutoff on CT to delineate malignant versus benign lymph nodes has important clinical ramifications as this determines stage and therefore treatment options, most importantly whether surveillance remains an option or not. A study by Hilton et al. tested various size cut-offs by giving 70 retroperitoneal lymph node dissection (RPLND) patients pre-operative CT scans (29). They reported a sensitivity of 37% and specificity of 100% after labeling lymph nodes 10 mm or larger on CT as positive (29). A more contemporary series by Hudolin et al. performed a similar experiment by correlating lymph node size to presence of positive nodes in 85 RPLND patients. They reported that a 1 cm cut-off would miss 60% of positive lymph nodes, and that decreasing the cutoff to 7–8 mm will provide a specificity and sensitivity of 70% (31).

Furthermore, lowering the cut-off size to >3 mm on CT to indicate a positive node in a tumor landing zone can reportedly increase sensitivity and negative predictive value to >90%, but, predictably, the specificity suffered greatly, falling to 58% (28,29). While still lacking consensus, it is generally recommended that lymph nodes 8–10 mm or larger be considered suspicious, especially in higher risk patients

Question 24

royal marsden classification

Answer 24

stage 1 confied to testis
stage 2 LN invovlement
Stage 3 - supra diaphragmatic and visceral mets with varying tumour markers

Question 25

normal LDH level

Answer 25

140 to 280 U/L

Question 25

normal LDH level

Answer 25

140 to 280 U/L