Testicular Pathology Flashcards
Where can testicular cancer metastasise to?
Lungs
Bone
Liver
Lymph
What are the two types of testicular cancer?
Germ Cell Tumour
Non Germ Cell Tumour
What is the most common type of testicular cancer?
Germ Cell Tumour (95%)
What are the classifications of Germ Cell Tumour?
Seminomatous
- Mainly affects 30-40 year olds
- Normal AFP and HCG
Non-Seminomatous
- Mainly affects 20-30 year olds
What are the classifications of Non Germ Cell Tumours?
Leydig
Sertoli
Lymphoma
How common is testicular cancer?
Most common malignancy in men aged 20-30 years
Give risk factors for testicular cancer
Testicular maldescent
Infertility
Atrophic testis
Previous cancer in contralateral testis
Trauma
Cryptorchidism
FH
Klinefelter’s syndrome
Mumps orchitis
How does testicular cancer present?
Painless lump, sometimes pain in some men
Hydrocele
Gynaecomastia
What investigations are used in testicular cancer diagnosis?
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
What tumour markers are associated with testicular cancer?
AFP (Alpha-Fetoprotein)
BHCG (Human-Chorionic Gonadotrophin)
LDH (Lactate Dehydrogenase)
What is the management of testicular cancer?
Orchidectomy
Chemotherapy
Radiotherapy
What is the prognosis of testicular cancer?
Generally excellent
Describe stage 1 of testicular cancer
Disease confined to testis
Describe stage 2 of testicular cancer
Infradiaphragmatic nodes involved
Describe stage 3 testicular cancer
Supradiaphragmatic nodes involved
Describe stage 4 testicular cancer
Extra lymphatic disease
What is a variocele?
Abnormal enlargement of the testicular veins associated with infertility
What side are varioceles more common in?
Left
How does variocele present?
Described as bag of worms
More prominent when standing up
Asymptomatic
Infertility
What investigations are used in variocele diagnosis?
Doppler US
How is variocele managed?
Usually conservative
Occasionally surgery is required if the patient is troubled by pain
What is testicular torsion?
Twist of the spermatic cord resulting in testicular ischaemia and necrosis
What are the two types of testicular torsion?
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
What age group is testicular torsion most common in?
Aged between 10 and 30, with peak incidence 13-15 years
How does testicular torsion present?
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
How is testicular torsion managed?
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
What is a hydrocele?
Describes the accumulation of fluid within the tunica vaginalis
What are the types of hydrocele?
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
How do hydroceles present?
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
How are hydroceles managed?
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
How do epididymal cysts present?
Separate from the body of the testicle, able to get above lump
Found posterior to the testicle
Does not transilluminate
Painless
What conditions are epididymal cysts associated with?
Polycystic kidney disease
CF
Von Hippel-Lindau syndrome
What features of erectile dysfunction favour an organic cause?
Gradual onset of symptoms
Lack of tumescence
Normal libido
What features of erectile dysfunction favour a psychogenic cause?
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
