MISC - Common Px of testicular & scrotal disease Flashcards
22yo man, 1 week Hx of a painless lump in his scrotum.
DDx?
Testicular cancer
Epididymorchitis
Hydrocoel
Varicoceal (dilation of venous plexus)
Risk factors for testicular cancer
Cryptochordism (mal-descended testes): missed in 20-30%
Risk factors for epididymorchitis
- STI
- UTI
How do you examine for varicoceal?
- Stand up to aid with gravity
- Cough/Valsalva manoeuver
The valves are incompetent in varicoceal.
What tumour markers do testes secrete?
alpha-fetoprotein
beta hCG
LDH
Ix for testes
US (best)
Describe physical exam for the scrotal/testicular disease
Focused scrotal exam:
- inspection: erythema, oedema, transillumination
- palpation: size, shape, position, consistency, tenderness
General:
- abdo: masses, hernia, liver, spleen
- lungs: effusion, consolidation
- lymph nodes
- neuro if necessary
Where do testicular cancers metastasise to?
Lymph nodes: retroperitoneal (lymphatics follow the vascular supply, for which the testicles, they come from high up where they developped)
Which testicular cancer does not produce tumour markers?
Seminomas usually do not produce tumour markers but sometimes produces a low level of beta hCG
How does “can get above it” differentiate your diagnosis in scrotal mass?
Can hold above scrotum near inguinal ligament: indicates that the mass origin is intrascrotal. e.g. hydrocoel
Cannot hold above scrotum near inguinal ligament: indicates that the mass origin is ABOVE scrotum. e.g. inguinal hernia.
Classify scrotal conditions:
- (5) benign intrascrotal
- (3) malignant intrascrotal
- (3) extrascrotal
Intrascrotal - Benign:
- hydrocoele
- epididymal cyst
- varicocoele
- benign tumour
- idiopathic scrotal oedema
Intrascrotal - malignant:
- testicular cancer
- lymphoma
- other
Extrascrotal:
- inguinal hernia
- ascites
- generalised oedema
Scrotal lump is [what] until proven otherwise
Testicular cancer
What are the investigations of choice for testicular cancer?
Urgent scrotal US & tumour markers (alpha-fetoprotein, LDH, beta hCG)
Where do testicular cancers metastasise first to?
Retroperitoneal lymph nodes & chest (mediastinal LN & lungs)
Describe the clinical syndrome of the acute scrotum. What are its possible causes?
New onset scrotal pain +/- swelling, tenderness, erythema
MANY causes. Sources include appendage torsion, spermatic cord torsion, epididymitis, scrotal edema/erythema, orchitis, trauma, hernia/hydrocoele, varicocele, intrascrotal mass, other.