Male External Genitalia

Question 0

Features of testicular tumour

Answer 0

Firm mass continuous with testis, painless
Surface may be smooth or craggy
Does not transluminate
Can have a small hydrocele 2o to testicular ca
Gynaecomastia
Weight loss (10% present with metastatic disease)
Lymphatic spread NOT inguinal (unless scrotum involved)
Spreads to para-aortic group
50X increased risk in undecended testes
Rare tumour, but commonest solid tumour in men <40 yrs

Question 1

Scrotum findings

Answer 1

Testicular tumours
Varicocoele
Hydrocele
Epididymal cyst

Question 2

Seminoma VS Teratoma

Answer 2

Age: typically in 30’s VS typically in 20’s
Raised serum AFP: not seen VS 75%
Raised serum HCG: 7% VS 60%
Txt of early disease: Radiotherapy VS Chemotherapy
5 yr survival rate: 95% VS 75%

Question 3

Investigations for testicular tumour

Answer 3

FBC, U&E, LFT
Serum markers - HCG & AFP
Scrotal ultrasound
CXR
CT of abdomen and chest
Laparoscopy for nodes if CT positive or equivocal

Question 4

Early spread to lymph nodes

Answer 4

Initially via spermatic cord lymphatics to para-aortic nodes
Not in inguinal unless tunica vaginalis or scrotum involved
Later haematogenous spread to liver and lung
Stage 1- confined to scrotum
Stage 2- nodes under diaphragm
Stage 3- nodes above diaphragm or spread to liver/lung

Question 5

Varicocoele

Answer 5

Examine standing, disappears on lying
Feels like a bag of worms
Left spermatic vein drains into left renal vein
Right drains direct to inferior vena cava
Left sided valves often absent or incompetent
May be associated with infertility
Very rarely due to left sided carcinoma

Question 6

Hydrocoele

Answer 6

Not separate from testis but soft, smooth and transilluminate
May rarely be secondary to a tumour or an infected testis (Orchitis)

Question 7

Epididymal cyst

Answer 7

Very common
Separate from testis
Easy to transilluminate