Testicular Disorders Flashcards
What age group is typically affected by a testicular seminoma?
Those aged 30-50
What age group is typically affected by a testicular teratoma?
Those aged 20-30
Which type of testicular tumour may occur before puberty?
Teratoma
What are the main risk factors for the development of testicular cancer?
Undescended testes, infertility, family history, mumps orchitis
What genetic syndrome comes with an increased risk of developing testicular cancer?
Klinefelter’s syndrome
90% of testicular tumours are what histological type?
Germ cell tumours
Which type of testicular tumour has a solid, homogenous, pale macroscopic appearance?
Seminoma
What type of testicular tumour has a variable macroscopic appearance including solid areas, cysts, haemorrhage and necrosis?
Teratoma
Testicular cancers spread via the lymphatics to which lymph nodes?
Para-aortic nodes
Testicular cancers spread haematogenously to where?
Liver and lungs
If an older male was to present with a primary testicular tumour, what type of cancer would this be most likely to be?
Lymphoma
What is the most common primary cancer to metastasise to the testicle?
Prostate
How do testicular tumours tend to present?
Painless testicular swelling or lump
What is the first line investigation for a suspected testicular cancer?
Ultrasound
What tumour marker is produced by trophoblastic elements and is elevated in both seminomas and teratomas of the testicle?
Beta hCG
What tumour marker is produced by yolk sac elements and is elevated in teratomas of the testicle?
AFP
What is the initial treatment for all testicular cancers?
Inguinal orchidectomy
Which type of testicular tumour is incredibly radiosensitive?
Seminomas
What adjuvant therapy is given in addition to surgery in those with testicular seminomas?
Radiotherapy +/- chemotherapy
When is adjuvant therapy required in addition to surgery for testicular teratomas? What is this therapy?
If stage II or higher, chemotherapy is given
Which testicular swellings will transilluminate?
Hydroceles and spermatoceles
If you cannot feel above a scrotal mass, what is the mass most likely to be?
Inguino-scrotal hernia
In which decade is the peak incidence of testicular torsion?
2nd decade of life
How does testicular torsion typically present?
Acute unilateral testicular pain +/- nausea/vomiting
Where else may pain be felt by someone with testicular torsion, other than the testicle itself?
Abdomen
Absence of the cremasteric reflex on examination of a testicle is suggestive of what diagnosis?
Testicular torsion
What investigation can be used to demonstrate testicular torsion, but is usually not performed at the expense of surgical exploration?
Doppler ultrasound
The management for testicular torsion is urgent surgery. What surgical procedures are patients consented for?
Bilateral ochidopexy and possible orchidectomy
The outcome is best if testicular torsion is surgically fixed within what timeframe?
< 6 hours
Torsion of the appendage testis (hydatid of Morgagni) is typically seen in individuals of what age?
7 - 12
How may torsion of the appendage testis (hydatid of Morgagni) be differentiated clinically from testicular torsion?
Less pain, present cremasteric reflex, possible blue dot sign
How is torsion of the appendage testis (hydatid of Morgagni) managed?
It will resolve spontaneously
Where does an epididymal cyst lie in relation to the testis?
Above and behind
When should an epididymal cyst be removed?
Only if symptomatic
The presence of milky fluid in the testis suggests the development of what?
Spermatocele
What is the most likely cause of epididymo-orchitis in those aged < 35? How should this be treated?
Chlamydia infection (+/- gonorrhoea) - treat with PO doxycycline and IM ceftriaxone
What is the most likely cause of epididymo-orchitis in those aged > 35? How should this be treated?
E. coli infection - treat with PO ofloxacin/ciprofloxacin
Along with testicular pain, what are some other symptoms that may be present in epididymo-orchitis?
Frequency and dysuria
What imaging investigation can be used to identify epididymo-orchitis? What will it show?
Doppler US - will show increased blood flow
What additional investigation should be performed in those aged < 35 with epididymo-orchitis?
First pass urine sample PCR for chlamydia
How long should antibiotics be given for for epididymo-orchitis?
2-4 weeks
What is a varicocele?
A dilation of veins of the pampiniform plexus
95% of varicoceles occur on which side?
Left
A ‘bag of worms’ appearance of the testis is suggestive of what diagnosis?
Varicocele
When do varicoceles require treatment?
Only when they are symptomatic
Having an undescended testis comes with a 40x increased risk of developing testicular cancer. This risk may be reduced if orchidopexy is performed before what age?
10 years
