Testicular Tumours Flashcards

1
Q

Risk Factors

A
  1. Cryptocorchidism
  2. HIV Infection
  3. Gonadal Dysgenesis
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2
Q

Clinical Presentation

A
  1. Asymptomatic enlarging testicular mass/ dull ache in one testes in young man (15 - 35)
  2. 10% have painful testes (due to infarct or hemorrhage)
  3. May even present as back pain (if para-aortic nodes infiltrated with metastases

-PE-
1. Inseparable from testis, distinct from superfdicial inguinal ring (cant get above mass)
2. Hard, nodular, irregular, non. tender
3. Non transilluminable

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3
Q

DDx

A

Chronic infection with scarring (orchitis/ TB)
Long standing hydrocele with calcification

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4
Q

Investigations

A
  1. No role for perc biopsy - risk of seeding/changing lymphatic drainage
  2. U/S scrotum - seminoma is a hypoechoic intratesticular mass; nonseminoma = inhomogenous lesion
  3. Tumour markers - LDH (assess tumour burden), AFP, B-HCG
  4. Staging
    - CT TAP
    – Styage 1 = testes lesion, nil nodes
    - Stage 2 = Nodes below diaphragm
    - Stage 3 = Nodes above diaphragm
    - Stage 4 = Pulmonary and Hepatic Mets
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5
Q
A
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6
Q

Classification of tumour

A
  1. Germ cell tumours
  2. Sex cord stroma tumours
  3. Secondary Testicular Tumour (lymphoma, leukemia)
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7
Q

According to examples, age, releavnt tumour markers, early treatment, disseminated treatment, prognosis, distinguish the types of germ cell tumours.

A
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8
Q

What is a paraneoplastic presentation of testicular tumours and why?

A

Hyperthyroidism. Tumour marker HCG has a structure similar to TSH

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9
Q

What surgery can be performed for testicular tumouyrs?

A

Radical Orchidectomy via Inguinal Apporach +/- Retroperitoneal LN dissection with combination chemotherapy
- no violation of scrrotal skin as risk of altering the lymphatic drainage of testis
- Intra-op, perform early clumping of testicular artery & vein within the spermatic cord before testis is mobilised out of the scrotum to prevent intraoperative seeding of tumour up testicular vein

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10
Q

What are the types of nonseminomatous germ cell tumours

A
  1. Embryonal Carcinoma - immature primitive cells ; presenting with bulky mass with hemorrhager and necrosis, AFP elevated
  2. Choriocarcinoma: a/w widespread mets at diagnosis; in males 15-20; present as small tumour that has extensive hemorrhage and necrosis, gynaecomastai and ss of hyperthyroid
  3. Yolk Sac Tumours: AFP elevated, in children
  4. Teratoma
  5. Mixed Germ Cell Tumour (worst prognosis)
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11
Q

What are types of sex cord stroma tumours

A
  1. Leydig cell tumour: p/w gynaecomastia in adults; in children with precocious puberty (due to excessive androgen and estrogen pdtn) characterised by golden brown testicular tumour, large uniform cellls with indistincct cell borders; and pale-staining rod-shaped inclusion known as crystals of Reinke
  2. Sertoli cell tumour : a/w gynaecomastia
  3. Granuolsa cell tumour
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