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Renal and Urology > Lumps in the groin and scrotum > Flashcards

Lumps in the groin and scrotum Flashcards

1
Q

What is a testicular lump until proven otherwise?

A

Testicular cancer

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2
Q

What is acute, tender enlargement of the testical until proven otherwise?

A

Testicular torsion

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3
Q

How would you assess a scrotal lump?

A
  • Can you get above it?
  • Is it serparate from the testis?
  • Is it cystic or solid?
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4
Q

If a scrotal mass was separate from the testicle and cystic, what might be the cause?

A

Epididymal cyst

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5
Q

If, when examining a scrotal mass, you were unable to get above it, what might be the cause?

A
  • Inguinoscrotal hernia
  • Hydrocele extending proximally
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6
Q

What are Epididymal cysts?

A

Cysts which develop in adulthood and contain clear/milky fluid. They lie above and behind the testis

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7
Q

What is a hydrocele?

A

Fluid within the tunica vaginalis

  • Primary - caused by patent processus vaginalis
  • Secondary - tumour/trauma/infection
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8
Q

What is a varicocele?

A

Dilated veins of the pampiniform plexus - left side more commonly affected. Patients often describe feeling like a bag of worms, and can also describe a dull ache

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9
Q

What is a varicocele associated with?

A

Subfertility

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10
Q

What is a haematocele?

A

Blood collection in the tunica vaginalis

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11
Q

What is the commonest malignancy in males aged 15-44?

A

Testicular cancer

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12
Q

What are the different types of testicular cancer?

A
  • Seminoma
  • Non-seminomatous germ cell tumour
  • Mixed germ cell tumour (teratoma)
  • Lymphoma
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13
Q

What is the most common type of testicular cancer?

A

Seminoma (55%)

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14
Q

What can increase the risk of testicular cancer?

A
  • Undescended testicle - even after orchidopexy
  • Infant hernia
  • Infertility
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15
Q

How might someone present with a testicular cancer?

A
  • Painless testicular lump
  • Secondary hydrocele
  • Dyspnoea - if lung mets
  • Abdominal mass - nodal involvement
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16
Q

If someone had a lump in their testicle and dyspnoea, what might this be suggestive of?

A

Testicular cancer with lung mets

17
Q

Where do seminomas arise from?

A

Seminiferous tubules

18
Q

What is the most commonly affected age range for men to get testicular cancer?

19
Q

What investigations would you perform in someone with suspected testicular cancer?

A
  • Bloods - tumour markers
  • Chest X-ray
  • CT/MRI - distant mets
  • Excision biopsy
20
Q

What tumour markers would you investigate for if someone was suspected to have testicular cancer?

A
  • Alpha-fetoprotein (AFP)
  • B-human chorionic gonadotrophin
  • LDH
21
Q

What is stage 1 testicular cancer?

A

No evidence of metastasis

22
Q

What is stage 2 testicular cancer?

A

Infradiaphragmatic node involvement

23
Q

What is stage 3 testicular cancer?

A

Supradiaphragmatic node involvement

24
Q

What is stage 4 testicular cancer?

A

Lung involvement

25
What characteristics on tumour marker investigation indicate that a testicular tumour could be a seminoma?
* **Raised LDH** * **Possible mildly raised HCG** * **Never a raised AFP**
26
How would you manage someone with testicular cancer?
* **Stage 1 seminoma** - Radical orchidectomy + radiotherapy * **NSGCT** - 3 cycles bleomycin + etoposide + cisplatin
27
If a lump on the testicle was found to be solid and separate from the testicle, what might be the cause?
* **Epididymitis** * **Varicocele**
28
If a lump on the testicle was found to be attached/within the testicle and solid, what could be the cause?
* **Tumour** * **Haematocele** * **Granuloma** * **Orchitis**
29
What is testicular torsion?
Occurs when the spermatic cord (from which the testicle is suspended) twists, cutting off the testicle's blood supply, a condition called ischemia
30
What are symptoms of testicular torsion?
* **Sudden onset pain in one testis** - can spread to abdomen * **Nausea, vomiting**
31
What are signs of testicular torsion?
* **Tender, inflammed, swollen testis** * **Scrotal erythema** * **Testicle may lie high and transversely** * **Absent cremaster reflex** * **Thickened cord**
32
What would your differential diagnosis in someone with a rad, swollen, painful testicle?
* **Torsion** * **Epididymorchitis** * **Tumour** * **Trauma** * **Acute hydrocele**
33
What investigations would you do if you suspected testicular torsion?
Doppler US - only if diagnosis equivocal
34
How would you manage a testicular torsion?
* **Bilateral fixation (orchidopexy) +/- orchidectomy**
35
If surgery is performed within 6 hours of presentation, what is the salvage rate?
90-100%
36
If surgery for testicular torsion is performed \>24 hrs after initial presentation, what is the salvage rate?
0-10%

Renal and Urology (51 decks)

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