Testicular Disorders Flashcards
(41 cards)
Types of testicular tumors
Primary testicular tumors:
Germ cell tumors ( 95 % ) ; seminoma , non seminoma
Stromal tumors ( 5% ) : Leyding cell tumor, Sertoli cell tumor, granulosa cell tumor
Other tumors ( rare ) : gonadoblastoma
Risk factors of testicular tumors
Cryptorchidism = urdesended testis
² HIV infection
² Gonadal dysgenesis autogas genitalia
² Family history
² Personal history of testis cancer of one testis
² Infertility
Testicular tumors presentation
Most tumors present with painless mass ( firm and non-tender mass ). hard
Testicular pain in 10% if hemorrhage or infection occur.
Gynecomastia ( mainly with Sertoli or Leydig cell tumor )
Back or abdominal pain with bulky retroperitoneal metastasis
Testicular tumors work up
History and Physical examination
Scrotal US Test ( the best )
Serum tumor markers ( AFP , B HCG , LDH )
Chest x ray
CT abdomen and pelvis with contrast
Seminoma usaual age of onset ?
30 - 40 years . Rare old age > 50 year
Seminoma tumor markers?
10 % has high B HCG and always normal AFP
Seminoma TTx
Surgery
Radiosensitive and chemo sensitive = both has 2nd line of management after surgery
On histology it has large uniform cell with clear cytoplasm and the nucleus has 2 nucleoli or eccentric nucleolus.
Types of non seminoma
- Embryonal carcinoma
- Yolk sac tumor
- Choriocarcioma
- Teratoma
Embryonal carcinoma
Usual age of onset 25-35 years
May secret both AFP and β-HCG or maybe normal
Yolksac tumor
Pediatric tumor
Usual age of onset < 10 years
May secret both AFP and β-HCG
Choriocarcinoma
Usual age of onset 20 - 30 years
Always secrete B HCG and AFP
Has the worst prognosis of all testers tumors
Teratoma
Usual age of onset 25 - 35 years
Doesn’t secrete AFP or BHCG
Resistance to chemotherapy or radiation
Only ttt is surgery
Treatment of testicular tumors general role
Offer sperm banking prior to cancer treatment
Avoid trans scrotal biopsy and trans scrotal surgey
Radical inguinal orchidectony
Testis sparing is reasonably for
Tumor in solitary testis
Bilateral testes tumors
Seminoma ttt
Surveillance follow up
When patient has no L.N metastasis and compliant for surveillance ,if non compliant he should receive chemotherapy or radiation .
Radistion - In presence of L.N metastasis < 5 cm Retroperitoneal radiation
Chemotherapy - In presence of L.N metastasis > 5 cm or non nodal metastasis , followed by RPLND if L.N does not shrink
Non seminoma ttt
RPLND or chemotherapy
If no L.N metastasis or L.N metastasis <5cm
Chemotherapy
If L.N metastasis > 5cm or non nodal metastasis. ( note: after chemotherapy if L.N metastasis does not shrink , do my choice RPLND )
Definition of varicocele
Dilatation of veins in the pampiniform plexus of spermatic cord
Found in 15% of men in the general population.
…. of males presenting with primary
infertility and …. of men with secondary
infertility.
- 20 - 40%
- 45 - 80 %
Left side affected in …%
90%
Etiology of varicocele
Incompetent valves in the internal spermatic
veins lead to retrograde blood flow, vessel
dilatation, and tortuosity of the pampiniform
plexus.
The left internal spermatic (testicular) vein
enters the left renal vein at right angles and is
under a higher pressure than the right vein which
enters the vena cava obliquely at a lower level.
Patho physiology of varicocele
- Testicular venous drainage is via the pampiniform plexus, a meshwork of veins encircling the testicular arteries
- This arrangement normally provides a countercurrent heat exchange mechanism which cools arterial blood as it reaches the testis.
- Varicoceles adversely affect this mechanism, resulting in elevated scrotal temperatures and consequent deleterious effects on spermatogenesis.
Presentation of varicocele
- The majority are asymptomatic.
- large varicoceles may cause pain or a heavy feeling in the scrotal area.
Examination of varicocele
- Examine, both lying and standing, and ask the patient to perform the Valsalva manoeuvre (strain down)
- Varicocele is identified as a mass of dilated and
tortuous veins above the testicle (‘bag of worms’)
which decompress on lying supine.
Grading of Varicocele
Investigation of varicocele
