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Flashcards in Testicular lumps Deck (36)
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what is a hydrocele?

soft, painless collection of fluid in the tunica vaginalis


what are the features of hydrocele?

- transluminates
- can get above it
- can be surgically repaired if it is large and troubles pt


what are the types of testicular lumps?

- noncommunicating
- communicating
- hydrocele of the cord


what is a noncommunicating hydrocele?

- fluid accumulation in processus vaginalis without communication to peritoneum
- usually occurs in older men
- not necessary to treat them
- if tx is wanted, a scrotal incision with inversion of tunica is used


what is a communicating hydrocele?

- patent procesus vaginalis leading to fluid accumulation in tunica vaginalis which communicated with an opening in pertioneum
- often self draining
- can go down by itself
- but is treated by closure of processus vaginalis


what is a hydrocele of the cord?

- accumulation of fluid in remnant of processus vaginalis which is closed both above and below it
- usually smaller than other 2 types


what is a varicocele?

- condition of varicosities of pampiniform plexus of veins
- usually occurs on LEFT
- manifests first in adolescence
- present in nearly 10% of men
- proportion inc with age, higher in infertile men


what is a varicocele due to?

- drainage of L testicular vein at right angles into the L renal vein, unlike the R testicular vein, which drains obliquely into IVC
- pt with varicocele have absent or incompetent valves at junction with L renal vein


what else can a varicocele be due to?

secondary to a tumour or other pathological process blocking the testicular vein e.g. tumour of L kidney


what are the clinical features of a varicocele?

- may cause a dragging sensation in scrotum
- associated with defective spermatogenesis
- pt usually subfertile
- in standing position, varicose veins within scrotum feel like a bag of worms


what is the treatment of a variocele?

- requires no tx apart from reassurance
- if weight of varicocele/ testis causes an acge, closefitting underpants may help
- radiologically = embolizing L testicular vein
- surgically = ligating and dividing all testicular veins as they traverse the inguinal canal


what is an epidydimal cyst?

arise as cystic degeneration of one of the epididymal or para-epididymal strucyures


who are they common in?

middle age and elderly men


what are the characteristics?

- often multiple
- may be bilateral
- produce fluctuant and usually highly translucent swelling in the scrotum


how do epidydimal cysts appear on examination?

- arise from epidiymis so testis is palpable separately and in front of the cyst


what is the contained fluid of an epidydimal cyst?

- contained fluid may by water clear or may be milky and contain sperm


what is the treatment of an epidydimal cyst?

if symptomatic, cysts removed surgically


how does epidydimitis/ orchitis usually arise?

acute infections arise as an ascending infection via vas deferences
spreads first to epididymis and then to testis (UTI or STI)


what are the causes of chronic infection of testes?

- syphilis or TB
- pt will present with nodular thick vas deferens and swelling of epidydimis
- cold abscess usually forms and may rupture = chronic sinus


what is the commonest blood-borne agent to infect the testis?

MUMPs virus
testicular manifestation of which usually follows within a week of onset of parotid enlargement
if both sides are involved, fertility may be impaired


what is an ascending infection usually a consequence of?

- preceding UTI (e.g. with E.coli)
- Urethritis
- Prostatitis from STI e.g. gonorrhoea or chlamydia = epidiymitis


what are the clinical features of epididymitis?

- painful swelling of epididymis
- often secondary hydrocele
- constitutional effects (pyrexia, headache, leucocytosis)
- may be history of: dysuria (UTI), urethral discharge (STI)


what is the treatment of epididymitis?

- best rest
- appropriate antibiotic given over 6 weeks (ciprofloxacin is 1st line)
- if frank abscesses have formed, need drainage


what is important to exclude in DDx of epididymitis?



what can be said about the epidemiology of testicular tumours?

most common solid malignancy in young adult men


what is the aetiology of testicular tumours?

- associated with undescended and ectopic testis
- inc incidence in pt who are infertile, those who have had previous contralateral testicular malignancy


what are the 2 main forms of malignant tumours of the testis?

- seminoma
- non-seminomatous germ cell tumours (teratoma is main type)


what is a seminoma?

- arises from cells of seminiferous tubules
- macroscopically = solid
- microscopically = cells vary from very well differentiated spermacytes to undifferentiated round cells with clear cytoplasm
- associated with production of beta-hCG


what is the epidemiology of a seminoma?

occurs between 30-40 year olds


what is a teratoma?

- arise from primitive totipotential germ cells
- macroscopically: cystic appearance, areas of haemorrhage and infarction are common
- microscopically: cells variable, tumour may contain cartilage, bone, muscle, fat
- associated with production of both beta hCG and alpha fetoprotein