Testicular mass

Question 1

Percutaneous biopsy of suspected testicular cancer is recommended as primary investigative tool.

True
False

Answer 1

Answer: false.

It increases risk of seeding of the tumour, as testes and scrotum share different lymphatic drainage. Testes drain into para aortic lymph nodes, and scrotum drains into superficial inguinal lymph nodes.

Question 2

What is the nervous innervation of the testes?

Answer 2

Spermatic plexus: continued from renal plexus from aortic plexus

Genital branch of genitofemoral nerve (L1-2): passes through inguinal canal. It supplies scrotal skin, cremasteric muscle and tunica dartos.

Ilioinguinal nerve: (L1) and supplies scrotal skin, penis, groin and medial thigh.

Sensory fibres share the same sympathetic pathway, and testes have no parasympathetic pathway.

Question 3

What is the arterial supply of testes?

Answer 3

1. Testicular artery (originating from L1, below renal arteries), coursing through in front of psoas major muscles, entering spermatic cord at deep inguinal ring. It supplies testes, cremasteric muscles, iliac lymph nodes and ureters.
2. Arteries of vas Deferens which is a branch of inferior vesicular artery
3. Cremasteric artery is branch of inferior epigastric artery from internal iliac

Question 4

What is venous drainage of the testes?

Answer 4

Mainly through pampiniform plexus formed by intercommunicating veins in the spermatic cord.

Left testicular vein joins left renal vein, and right testicular vein drains directly into IVC.

Question 5

Where can testicular cancer typically spread to?

Answer 5

Liver, lung (most common), bone, brain, and local lymph nodes.

Question 6

What are the layers of the scrotum and where do they arise from?

Answer 6

1. Skin
2. Dartos muscle and fascia (Camper’s, Scarpa’s fascia)
3. External spermatic fascia (external oblique fascia)
4. Cremasteric muscle and fascia (internal oblique fascia)
5. Internal spermatic fascia (transversalis fascia)
6. Tunica vaginalis (parietal peritoneum)
7. Tunica albuginea

Question 7

What is the function of the dartos muscle?

Answer 7

Dartos muscle is a sheet of smooth muscle just underneath the skin. It helps to regulate temperature of the scrotum by wrinkling the skin.

Question 8

What is the arterial supply of the scrotum?

Answer 8

It receives arterial supply from anterior and posterior scrotal arteries.

Question 9

What is the nerve innervation to the scrotum?

Answer 9

It is innervated by several nerves, such as:

• Anterior and anterolateral aspect by genital branch of genitofemoral nerve and ilioinguinal nerve
• Posterior aspect by internal pudendal nerve and posterior femoral cutaneous nerve.