Other testicular pathology and tumours Flashcards
How common are undescended testes?
3% at birth 1% at 1yr
Unilateral is 4x more common than bi
Should have genetic testing if bi
more common in prems
Normal descent of testes?
Remain in abdomen until 7mo, testes descends through inguinal canal to scrotum with outpouching of the peritoneum, processus vaginalis
Classification of undescended testes?
Cryptorchidism: complete absence from scrotum
Retractile: Normal development but excessive cremasteric reflex
Maldescended: anywhere along parh, often patent processus vaginalis
Ectopic testes: outside line of descent, usually in inguinal pouch
Complications of undescended testes?
Infertility 10x risk of malignancy incr. risk of trauma incr. risk of torsion associated with hernias
Perks of Mx of Undescended testes?
restores potential for spermatogenesis and makes Ca easier to Dx
Dartos pouch proceedure?
Perform before 2, mobilises testes and cord
hormonal methods of Mx?
B HCG can be tried if testes is in inguinal canal
Presentation of Testicular Ca?
Painless testicular lump Often noticed after trauma Haematospermia 2O hydrocele Mets: SOB from lung mets Abdo mass: para-aortic lymphadenopathy Hormones: gynaecomastia, virilisation Contralateral tumour in 5%
Risk factors of Tumours?
Undescended testis, infant hernia, infertility
Pathology of testicular tumours??
seminomatus or non seminomatous
Pure seminomas have what features?
Commonest subtype, 30-40 yrs, very radio sensitive
Non seminomatous tumours have what features?
Teratomas arise from all three germ layers, common and benign in children but malignant in adults: b hcg or AFP secretion
chemosensitice
Commmonest type of NSGCT?
Mixed
other tumours of testes?
Sex cord stromal: leydig/sertoli, mostli benign
Lymphom/leukamia
Staging of T Tumours?
Royal marsden 1- only in testis 2 - para aortic nodes 3- supra and infradiaphragmatic LN 4- extra lymphatic spread
