Diagnosis Flashcards
TNM
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
AFP half life where from normal level increased in NSGCT%
5 days
10 ng/ml
trophoblastic elements
increased in 50-70% NSGCT
HCG
half life
normal level
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
CS 1
1a and 1b
Ia = T1
Ib=T2-4
CS II
N1-3
IIa to IIc
CS III
M1a to M1b
IIIa = M1a S0-1
IIIb = M1a S2
IIIc = M1a S3 or M1b
scandura study bjui testicular lesions small
risk malignancy less than 10mm
risk less than 5mm
2681 testicular masses
<10mm one third malignant
less than 5mm all benign and tumour markers not helpful
testicular biopsy what is in Bouin’s solution
Bouin’s solution
picric acid
acetic acid
and formaldehyde
when measure tumour markers after orchidectomy
5-7 days
and 14 days
causes raised AFP 4
liver pancreatic stomach lung and benign liver pathology
bHCG excretion in
chorio
teratoma
seminoma
100%
10% seminoma
40% teratoma
bHCG excretion in
chorio
teratoma
seminoma
100%
10% seminoma
40% teratoma
conditions raise bHCG
liver pancreas stomach lunch breast bladder kidney marijuana
spuriously high readings in bHCG
high levels of LH in hypogonadic patients
usefulness of LDH
elevated in 10% of seminoma and can judge response treatment
appearance on US
seminoma
teratoma
heterogenous
hypoechoic
seminoma
homogenous, smooth , hypoechoic
teratoma - irregular, calcifications, necrosis
prevalence testicular microlithiasis in population
5%
no difference in TC
De Castro
definition of TML
5 or more clacifications each less than 2mm per image field on US
how to measure LN
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.
pathological LN size abdomen vs pelvis
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
pathological LN size abdomen vs pelvis
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
CT sens and sepc
67% and 92%
LN size and CT
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
royal marsden classification
stage 1 confied to testis
stage 2 LN invovlement
Stage 3 - supra diaphragmatic and visceral mets with varying tumour markers
