testicular tumors

Question 1

what is the arterial supply of the testis ?

Answer 1

testicular artery

Question 2

where do the testis get their collateral supply from ?

Answer 2

cremasteric artery
artery to the ductus deferens

Question 3

what is the venous drainage of the testis ?

Answer 3

right side - IVC
left side - left renal vein

Question 4

what are the two types of testicular tumors ?

Answer 4

germ cell tumor - seminoma and nonseminomatous
non germ cell tumor -sex cord stromal and others

Question 5

what are the commonest type of testicular tumors ?

Answer 5

seminomas

Question 6

what are the three types of seminomas ?

Answer 6

classical
anaplastic
spermatocytic

Question 7

what is the presentation of seminomas ?

Answer 7

painless lump in the scrotum
usually more on the right side than the left
heaviness in the lower abdomen

Question 8

where do teratomas arise from ?

Answer 8

totipotent cells

Question 9

where do interstitial cells arise from ?

Answer 9

leydig or sertoli cells

Question 10

what is the presentation of interstitial cell tumors ?

Answer 10

sexual precocity
extreme muscular development

Question 11

why might regression of the symptoms of interstitial cell tumors be incomplete ?

Answer 11

because of hypertrophy of the contralateral testis

Question 12

how does a seminoma metastasis ?

Answer 12

1- exclusively through the lymphatics
2- primarily to the para aortic lymph nodes

Question 13

what are the testicular cancer oncomarkers ?

Answer 13

B-HCG
AFP
LDH

Question 14

what are the differential diagnosis to testicular tumors ?

Answer 14

testicular torsion
epididymitis
hydrocele
hernia

Question 15

what investigations are carried out for suspected testicular tumors ?

Answer 15

scrotal ultrasound
CT/MRI/ PET CT

Question 16

what is the rule regarding the diagnosis of teesticular mass ?

Answer 16

any solid, firm intratesticular mass that cannot be transilluminated should be regarded as malignant until proven otherwise

Question 17

why is transscrotal testicular biopsy contraindicated ?

Answer 17

may lead to spread to the inguinal lymph nodes draining the scrotal skin

Question 18

what is the staging of testicular tumors ?

Answer 18

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

Question 19

what is the management of testicular tumors ?

Answer 19

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

Question 20

what is the most common predisposing factor for testicular tumors ?

Answer 20

cryptorchidism - absence of at least one testicle from the scrotum