Scrotrum

Question 1

Risk factors for testicular GCTs

Answer 1

• Undescended testis 10-40X (10% of tumours); including increased risk in normally descended testicle
• Extranumerary testicle
• Klinefelters
• Previous tumour in contralateral testicle
• Fhx of GCT
• Testicular microlithiasis (debatable: increased risk in symptomatic patient)
• Other: infection (HIV, orchitis)
• Immunosuppression

Question 2

Most common testicular malignancy

Answer 2

Seminoma

Question 3

List the subtypes of non-seminomatous GCTs

Answer 3

• Mixed (usu embryonal + teratoma) –> MOST COMMON
• Embryonal cell carcinoma
• Teratoma (usu malignant in adults, benign in kids)
• Yolk sac (AFP elevated)
• Choriocarcinoma (most aggressive, rare, b-hcg elevated, hemorrhagic mets)

Question 4

Most common testicular tumour of infancy

Answer 4

Endodermal sinus or yolk sac tumour

Question 5

Demographics and imaging appearance NSGCT

Answer 5

Younger, more aggressive
Solid and cystic components, calcs
Local invasion, distant mets

Question 6

Management of testicular microlithiasis

Answer 6

No RFs - monthly testicular self examination
+ RFs - referral to Urology to determine F/U

RFs include: Personal or FHx of testicular malignancy (brother or father), maldescent or cryptorchidism, testicular atrophy

Question 7

Most common testicular mets

Answer 7

Lymphoma and leukemia (most common)

Diffuse testicular enlargement

Question 8

Most common benign testicular tumours

Answer 8

Epidermoid - onion-ring appearance

Sex-cord stromal tumours (90% benign)
Leydig - hormonally active - gynecomastia
Sertoli - syndromes - Klinefelter and Peutz-Jegher
Juvenile granulosa cell
Fibrothecoma

Question 9

Testicular tumour mimics

Answer 9

Congenital adrenal rests (CAH)

Polyorchidism/supernumerary testis

Question 10

Ddx bilateral testicular masses

Answer 10

Leukemia
Lymphoma
Mets (prostate, colon, etc) 
Adrenal rests ***
Granulomatous disease: sarcoid, TB

Question 11

Ddx extra-testicular masses

Answer 11

Most benign;
Spermatic cord lipoma
Adenomatoid tumour (arise from epididymis, tunica or cord)
Fibrous pseudotumour (rare)
Other: leiomyoma, liposarcoma, mets, neurofibroma

Question 12

Tumour in epididymis occurring in pt with VHL

Answer 12

Papillary cystadenoma

Question 13

Most common side of varicocele

Answer 13

85% occur on left

If on right, need to exclude retroperitoneal mass!

Question 14

DDx for testicular calcs

Answer 14

Microlithiasis
Granulomas (prior TB)
Burnt out GCT