testicular tumors Flashcards
what is the arterial supply of the testis ?
testicular artery
where do the testis get their collateral supply from ?
cremasteric artery
artery to the ductus deferens
what is the venous drainage of the testis ?
right side - IVC
left side - left renal vein
what are the two types of testicular tumors ?
germ cell tumor - seminoma and nonseminomatous
non germ cell tumor -sex cord stromal and others
what are the commonest type of testicular tumors ?
seminomas
what are the three types of seminomas ?
classical
anaplastic
spermatocytic
what is the presentation of seminomas ?
painless lump in the scrotum
usually more on the right side than the left
heaviness in the lower abdomen
where do teratomas arise from ?
totipotent cells
where do interstitial cells arise from ?
leydig or sertoli cells
what is the presentation of interstitial cell tumors ?
sexual precocity
extreme muscular development
why might regression of the symptoms of interstitial cell tumors be incomplete ?
because of hypertrophy of the contralateral testis
how does a seminoma metastasis ?
1- exclusively through the lymphatics
2- primarily to the para aortic lymph nodes
what are the testicular cancer oncomarkers ?
B-HCG
AFP
LDH
what are the differential diagnosis to testicular tumors ?
testicular torsion
epididymitis
hydrocele
hernia
what investigations are carried out for suspected testicular tumors ?
scrotal ultrasound
CT/MRI/ PET CT
what is the rule regarding the diagnosis of teesticular mass ?
any solid, firm intratesticular mass that cannot be transilluminated should be regarded as malignant until proven otherwise
why is transscrotal testicular biopsy contraindicated ?
may lead to spread to the inguinal lymph nodes draining the scrotal skin
what is the staging of testicular tumors ?
stage 1 - disease confined to testis and epididymis ( no vascular or lymphatic spread )
stage 2 - infra-diaphragmatic lymph node involvement
stage 3 - supra and infra diaphragmatic lymph node involvement
stage 4 - extra lymphatic metastatic spread
what is the management of testicular tumors ?
seminomas are radio sensitive ( stage 1 and 2)
non seminomas are radio resistant and best treated with surgery ( radical inguinal orchiectomy )
advanced or metastatic disease are best treated with systemic therapy - cisplatin
what is the most common predisposing factor for testicular tumors ?
cryptorchidism - absence of at least one testicle from the scrotum
