Testicular Pathology

Question 1

Where can testicular cancer metastasise to?

Answer 1

Lungs

Bone

Liver

Lymph

Question 2

What are the two types of testicular cancer?

Answer 2

Germ Cell Tumour

Non Germ Cell Tumour

Question 3

What is the most common type of testicular cancer?

Answer 3

Germ Cell Tumour (95%)

Question 4

What are the classifications of Germ Cell Tumour?

Answer 4

Seminomatous

• Mainly affects 30-40 year olds
• Normal AFP and HCG

Non-Seminomatous

• Mainly affects 20-30 year olds

Question 5

What are the classifications of Non Germ Cell Tumours?

Answer 5

Leydig

Sertoli

Lymphoma

Question 6

How common is testicular cancer?

Answer 6

Most common malignancy in men aged 20-30 years

Question 7

Give risk factors for testicular cancer

Answer 7

Testicular maldescent

Infertility

Atrophic testis

Previous cancer in contralateral testis

Trauma

Cryptorchidism

FH

Klinefelter’s syndrome

Mumps orchitis

Question 8

How does testicular cancer present?

Answer 8

Painless lump, sometimes pain in some men

Hydrocele

Gynaecomastia

Question 9

What investigations are used in testicular cancer diagnosis?

Answer 9

Biopsy

• Also of normal contralateral teste if high risk

Tumour markers

• AFP elevated in 60% germ cell tumours
• BHCG elevated in 20% Seminomatous tumours
• LDH elevated in 40% germ cell tumours

Testicular US

Staging CT

Question 10

What tumour markers are associated with testicular cancer?

Answer 10

AFP (Alpha-Fetoprotein)

BHCG (Human-Chorionic Gonadotrophin)

LDH (Lactate Dehydrogenase)

Question 11

What is the management of testicular cancer?

Answer 11

Orchidectomy

Chemotherapy

Radiotherapy

Question 12

What is the prognosis of testicular cancer?

Answer 12

Generally excellent

Question 13

Describe stage 1 of testicular cancer

Answer 13

Disease confined to testis

Question 14

Describe stage 2 of testicular cancer

Answer 14

Infradiaphragmatic nodes involved

Question 15

Describe stage 3 testicular cancer

Answer 15

Supradiaphragmatic nodes involved

Question 16

Describe stage 4 testicular cancer

Answer 16

Extra lymphatic disease

Question 17

What is a variocele?

Answer 17

Abnormal enlargement of the testicular veins associated with infertility

Question 18

What side are varioceles more common in?

Answer 18

Left

Question 19

How does variocele present?

Answer 19

Described as bag of worms

More prominent when standing up

Asymptomatic

Infertility

Question 20

What investigations are used in variocele diagnosis?

Answer 20

Doppler US

Question 21

How is variocele managed?

Answer 21

Usually conservative

Occasionally surgery is required if the patient is troubled by pain

Question 22

What is testicular torsion?

Answer 22

Twist of the spermatic cord resulting in testicular ischaemia and necrosis

Question 23

What are the two types of testicular torsion?

Answer 23

Intravaginal

• Torsion within the tunica vaginalis
• Occurs in teenagers

Extravaginal

• Torsion occurs out with the tunica vaginalis
• Occurs in neonates, is usually a perinatal event

Question 24

What age group is testicular torsion most common in?

Answer 24

Aged between 10 and 30, with peak incidence 13-15 years

Question 25

How does testicular torsion present?

Answer 25

Acute severe lower abdominal pain N&V Swollen, tender testis retracted upwards, the skin may be reddened Cremasteric reflex is lost Prehn's sign * Elevation of the testis does not ease the pain

Question 26

How is testicular torsion managed?

Answer 26

Urgent surgical exploration Intravaginal * Immediate de-torsion surgery and rewarming * 6-8 hours to recover testis Extravaginal * Too late to recover testis as perinatal event so no need for urgent exploration * Orchidopexy

Question 27

What is a hydrocele?

Answer 27

Describes the accumulation of fluid within the tunica vaginalis

Question 28

What are the types of hydrocele?

Answer 28

Communicating * Caused by patency of the processus vaginalis allowing peritoneal fluid to drain down into the scrotum * Common in newborn males and usually resolve within the first few months of life Non-communicating * Caused by excessive fluid production within the tunica vaginalis

Question 29

How do hydroceles present?

Answer 29

Soft, non-tender swelling of the hemi-scrotum * Usually anterior to and below the testicle * Swelling is confined to the scrotum, you can get 'above' the mass on examination * Transilluminates with a pen torch * Lump is not separate to the testis

Question 30

How are hydroceles managed?

Answer 30

Infantile hydroceles are generally repaired if they do not resolve spontaneously by the age of 1-2 years In adults a conservative approach may be taken depending on the severity of the presentation In communicating, surgical operation to remove or ligate the connection between the peritoneal cavity and the hydrocele

Question 31

How do epididymal cysts present?

Answer 31

Separate from the body of the testicle, able to get above lump Found posterior to the testicle Does not transilluminate Painless

Question 32

What conditions are epididymal cysts associated with?

Answer 32

Polycystic kidney disease CF Von Hippel-Lindau syndrome

Question 33

What features of erectile dysfunction favour an organic cause?

Answer 33

Gradual onset of symptoms Lack of tumescence Normal libido

Question 34

What features of erectile dysfunction favour a psychogenic cause?

Answer 34

Sudden onset of symptoms Decreased libido Good quality spontaneous or self-stimulated erections Major life events Problems or changes in a relationship Previous psychological problems History of premature ejaculation