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Renal > Testicular Pathology > Flashcards

Testicular Pathology Flashcards

1
Q

Where can testicular cancer metastasise to?

A

Lungs

Bone

Liver

Lymph

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2
Q

What are the two types of testicular cancer?

A

Germ Cell Tumour

Non Germ Cell Tumour

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3
Q

What is the most common type of testicular cancer?

A

Germ Cell Tumour (95%)

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4
Q

What are the classifications of Germ Cell Tumour?

A

Seminomatous

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

Non-Seminomatous

  • Mainly affects 20-30 year olds
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5
Q

What are the classifications of Non Germ Cell Tumours?

A

Leydig

Sertoli

Lymphoma

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6
Q

How common is testicular cancer?

A

Most common malignancy in men aged 20-30 years

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7
Q

Give risk factors for testicular cancer

A

Testicular maldescent

Infertility

Atrophic testis

Previous cancer in contralateral testis

Trauma

Cryptorchidism

FH

Klinefelter’s syndrome

Mumps orchitis

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8
Q

How does testicular cancer present?

A

Painless lump, sometimes pain in some men

Hydrocele

Gynaecomastia

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9
Q

What investigations are used in testicular cancer diagnosis?

A

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

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10
Q

What tumour markers are associated with testicular cancer?

A

AFP (Alpha-Fetoprotein)

BHCG (Human-Chorionic Gonadotrophin)

LDH (Lactate Dehydrogenase)

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11
Q

What is the management of testicular cancer?

A

Orchidectomy

Chemotherapy

Radiotherapy

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12
Q

What is the prognosis of testicular cancer?

A

Generally excellent

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13
Q

Describe stage 1 of testicular cancer

A

Disease confined to testis

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14
Q

Describe stage 2 of testicular cancer

A

Infradiaphragmatic nodes involved

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15
Q

Describe stage 3 testicular cancer

A

Supradiaphragmatic nodes involved

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16
Q

Describe stage 4 testicular cancer

A

Extra lymphatic disease

17
Q

What is a variocele?

A

Abnormal enlargement of the testicular veins associated with infertility

18
Q

What side are varioceles more common in?

A

Left

19
Q

How does variocele present?

A

Described as bag of worms

More prominent when standing up

Asymptomatic

Infertility

20
Q

What investigations are used in variocele diagnosis?

A

Doppler US

21
Q

How is variocele managed?

A

Usually conservative

Occasionally surgery is required if the patient is troubled by pain

22
Q

What is testicular torsion?

A

Twist of the spermatic cord resulting in testicular ischaemia and necrosis

23
Q

What are the two types of testicular torsion?

A

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
24
Q

What age group is testicular torsion most common in?

A

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

25
Q

How does testicular torsion present?

A

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
26
Q

How is testicular torsion managed?

A

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
27
Q

What is a hydrocele?

A

Describes the accumulation of fluid within the tunica vaginalis

28
Q

What are the types of hydrocele?

A

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
29
Q

How do hydroceles present?

A

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
30
Q

How are hydroceles managed?

A

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

31
Q

How do epididymal cysts present?

A

Separate from the body of the testicle, able to get above lump

Found posterior to the testicle

Does not transilluminate

Painless

32
Q

What conditions are epididymal cysts associated with?

A

Polycystic kidney disease

CF

Von Hippel-Lindau syndrome

33
Q

What features of erectile dysfunction favour an organic cause?

A

Gradual onset of symptoms
Lack of tumescence
Normal libido

34
Q

What features of erectile dysfunction favour a psychogenic cause?

A

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

Renal (10 decks)

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