Testicular tumors

Posted by e-Medical PPT Monday, September 3, 2012
Testicular tumors are rare.
1 – 2 % of all malignant tumors.
Most common malignancy in men in the 15 to 35 year age group.
Benign lesions represent a greater percentage of cases in children than in adults.
Testicular cancer is one of the few neoplasms associated with accurate serum markers.
Most curable solid neoplasms and serves as a paradigm for the multimodal treatment of malignancies.


Etiology
Cryptorchidism
Intersex disorder
Testicular atrophy
Trauma- prompts medical evaluation
Chromosomal abnormalities -  loss of chromosome 11, 13, 18, abnormal chromosome 12p.
Sex hormone fluctuations, estrogen administration during pregnancy

CLASSIFICATION
Primary Neoplasms of Testis.
   Germ Cell Tumor.    
   Non-Germ Cell Tumor .
Secondary Neoplasms.
Paratesticular Tumors

Lymphatic drainage
The primary drainage of the right testis is within the interaortocaval region.
Left testis drainage , the para-aortic region in the compartment bounded by the left ureter, the left renal vein, the aorta, and the origin of the inferior mesenteric artery.
Cross over from right to left is possible.
Lymphatics of the epididymis drain into the external iliac chain.
Inguinal node metastasis may result from scrotal involvement by the primary tumor, prior inguinal or scrotal surgery, or retrograde lymphatic spread secondary to massive retroperitoneal lymph node deposits.
Testicular cancer spreads in a predictable and stepwise fashion, except  choriocarcinoma.

Clinical features
Painless Swelling of One testis
Dull Ache or Heaviness in Lower Abdomen
10% - Acute Scrotal Pain
10% - Present with Metatstasis
    - Neck Mass / Cough / Anorexia / Vomiting / Back Ache/ Lower limb swelling
5% - Gynecomastia
Rarely - Infertility

Differential Diagnosis
Testicular torsion
Epididymitis, or epididymo-orchitis
Hydrocele,
Hernia,
Hematoma,
Spermatocele,
Syphilitic gumma.

Scrotal ultrasound
Ultrasonography of the scrotum is a rapid, reliable technique to exclude hydrocele or epididymitis.
Ultrasonography of the scrotum is basically an extension of the physical examination.
Hypoechoic area within the tunica albuginea is markedly suspicious for testicular cancer.      
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