Testicular disorders Flashcards
Causes of intratesticular lump
Testicular tumour
- Malignant
- Benign: cyst, epidermoid
Causes of inflammatory lesion on scrotum
Epididymo-orchitis
Viral orchitis
Epididymo-orchitis
- Description
- Causes
- Presentation
Inflammation of the epididymis/ and testes.
Causes
- STI: chlamydia, gonorrhoea
- UTI (less common)
- Vasculitis, amiodarone
Presentation
- Painful testicles
- Tender, warm and swollen scrotum
- fever
- Hydrocele
- Urethral discharge if STI, UTI
Varicocele
- Definition
Congested veins in scrotum
- Bag of worms appearance
- Enlargement of venous plexus of the spermatic cord
Hydrocoele
- Description
- Causes
- Classifications
Collection of serous fluid between layers of tunica vaginalis
Causes
- Congential
- Secondary to infection, torsion, epididymis, trauma, tumour.
Communicating
- Connects to peritoneum, f bowel enters= inguinal hernia.
Investigate with USS
Testicular cancer
- Presentation
Painless, irregular lump in testicle
- Does not transilluminate
- Rarely painful
- Mass is fixed and firm
May show hydrocele, gynaecomastia
If mets
- Abdominal pass due to para-aortic lymphadenopathy/ hepatomegaly
- Supraclavicular lymphadenopathy for lung and neurological spread
Classifications of testicular cancer
Germ cell type= Seminoma and non-seminoma
- Seminoma= most common
- Non-seminoma= teratoma, yoolk sac, embryonal, choriocarcinoma
Non-germ cell
- Leydig
- Sarcoma
Diagnosis of testicular cancer
First line= Ultrasound
CT Chest and abdomen for metastasis analysis
- CT head if indicated
Markers
- hCG is increased in some seminomas
- AFP
- LDH
Staging= Marsden
Marsden staging of testicular cancer
- Localised to testicle
- Spread to abdominal lymphatics
- Extra-abdominal lymphatics
- Non-lymphatic spread
Testicular cancer
- Risk factors
Male 20-30 (esp white)
Family Hx
Klinefelter syndrome
Cryptorchidism
Infertility
Mumps orchitis
Management of testicular cancer
Seminomas are radiosenstive, NSGCT are chemosensitive.
Stage 1
- Radical orchidectomy, inguinal approach
- May be treated with prophylactic iliac/ para-aortic radiotherapy or chemotherapy
Stage 2
- Orchidectomy + radiotherapy/ chemotherapu
