Lumps in the groin and scrotum Flashcards
What is a testicular lump until proven otherwise?
Testicular cancer
What is acute, tender enlargement of the testical until proven otherwise?
Testicular torsion
How would you assess a scrotal lump?
- Can you get above it?
- Is it serparate from the testis?
- Is it cystic or solid?
If a scrotal mass was separate from the testicle and cystic, what might be the cause?
Epididymal cyst
If, when examining a scrotal mass, you were unable to get above it, what might be the cause?
- Inguinoscrotal hernia
- Hydrocele extending proximally
What are Epididymal cysts?
Cysts which develop in adulthood and contain clear/milky fluid. They lie above and behind the testis
What is a hydrocele?
Fluid within the tunica vaginalis
- Primary - caused by patent processus vaginalis
- Secondary - tumour/trauma/infection
What is a varicocele?
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
What is a varicocele associated with?
Subfertility
What is a haematocele?
Blood collection in the tunica vaginalis
What is the commonest malignancy in males aged 15-44?
Testicular cancer
What are the different types of testicular cancer?
- Seminoma
- Non-seminomatous germ cell tumour
- Mixed germ cell tumour (teratoma)
- Lymphoma
What is the most common type of testicular cancer?
Seminoma (55%)
What can increase the risk of testicular cancer?
- Undescended testicle - even after orchidopexy
- Infant hernia
- Infertility
How might someone present with a testicular cancer?
- Painless testicular lump
- Secondary hydrocele
- Dyspnoea - if lung mets
- Abdominal mass - nodal involvement
If someone had a lump in their testicle and dyspnoea, what might this be suggestive of?
Testicular cancer with lung mets
Where do seminomas arise from?
Seminiferous tubules
What is the most commonly affected age range for men to get testicular cancer?
15-35
What investigations would you perform in someone with suspected testicular cancer?
- Bloods - tumour markers
- Chest X-ray
- CT/MRI - distant mets
- Excision biopsy
What tumour markers would you investigate for if someone was suspected to have testicular cancer?
- Alpha-fetoprotein (AFP)
- B-human chorionic gonadotrophin
- LDH
What is stage 1 testicular cancer?
No evidence of metastasis
What is stage 2 testicular cancer?
Infradiaphragmatic node involvement
What is stage 3 testicular cancer?
Supradiaphragmatic node involvement
What is stage 4 testicular cancer?
Lung involvement
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
How would you manage someone with testicular cancer?
- Stage 1 seminoma - Radical orchidectomy + radiotherapy
- NSGCT - 3 cycles bleomycin + etoposide + cisplatin
If a lump on the testicle was found to be solid and separate from the testicle, what might be the cause?
- Epididymitis
- Varicocele
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
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
What are symptoms of testicular torsion?
- Sudden onset pain in one testis - can spread to abdomen
- Nausea, vomiting
What are signs of testicular torsion?
- Tender, inflammed, swollen testis
- Scrotal erythema
- Testicle may lie high and transversely
- Absent cremaster reflex
- Thickened cord
What would your differential diagnosis in someone with a rad, swollen, painful testicle?
- Torsion
- Epididymorchitis
- Tumour
- Trauma
- Acute hydrocele
What investigations would you do if you suspected testicular torsion?
Doppler US - only if diagnosis equivocal
How would you manage a testicular torsion?
- Bilateral fixation (orchidopexy) +/- orchidectomy
If surgery is performed within 6 hours of presentation, what is the salvage rate?
90-100%
If surgery for testicular torsion is performed >24 hrs after initial presentation, what is the salvage rate?
0-10%
