1 – Testicular Cancer
• Incidence: 4 / 100,000 males / year.
• Most common men cancer < 35 yrs.
• 1/10 occur in undescended testis.
− Painless hard testicular lump.
− Signs of inflammation.
− Back pain (in young man suspect metastatic testicular tumor).
• Tumor markers (alpha-feto protein, beta HCG and Alkaline Phosphatase).
• CT scan (? Metastasis).
• Inguinal exploration of testicle & frozen section if in doubt before formal surgery.
To determine stage & extent of tumor spread.
– T Histological examination of the Tumor.
– N Extent of involvement of Lymph Nodes.
– M Metastasis.
Testicular Cancer : Staging
Types of Testicular Cancer
Germ Cells Tumor
i. Seminoma: from germinal epithelium which rarely metastasize.
ii. Non- Seminoma:
a) Embryonal carcinoma: from fetal yolk-sac.
• Teratocarcinoma: A spectrum from most benign-looking adult tissues; e.g. cartilage & hair.
• Choriocarcimoma: The worst & spread rapidly through bloodstream.
B. Non-Germ Cell Tumors
1.Leydig cell tumors: arise from Leydig cells between tubules& produces Testosterone Þ give rise to precocious puberty.
2.Sertoli cell tumors: very rare, seldom metastasize & cause gynaecomastia.
Treatment of testicular tumor
• Early stages :
− Inguinal Orchiectomy ± RPL.
• Late stages :
2 – Hydrocele
• Fluid accumulation in the cavity of tunica vaginalis due to obstruction to lymphatic drainage of testicle, heart failure edema or secondary effusion due to disease of testis or epididymis.
• In neonate associated with hernia .
• Translumination ÞPositive
• Treatment: Hydrocelectomy.
3 – Varicocele
• Results from deficient valves in the deep venous drainage of the scrotal contents.
• Leads to dilatation and tortuosity of the veins.
• More common on the left side.
• Can cause infertility .
• Usually asymptomatic, occasionally dragging pain.
• Treatment: Varicocelectomy.
4 – Spermatocele
• It is a retention cyst of the rete testis or head of the epididymis.
• It contains sperms.
• Treatment: Conservative, excision if symptomatic.
5 – Haematocele
• Direct scrotal trauma may cause bleeding in cavity of tunica vaginalis Þsever tender scrotal swelling Þ pressure atrophy on testis.
• Translumination ÞNegative.
• Treatment: Exploration, clot evacuation& repair of tunica albuginea .
6 – Torsion
• Twist of the testis on it’s stalk.
1. Intravaginal torsion.
2. Extravaginal torsion (rare).
• Symptoms & Signs:
1. Postpubertal period.
2. Pain: Sudden onset.
3. Nausea & Vomiting.
4. Testis lying transversely & high in position.
7 – Inguinoscrotal Hernia
• Patent processus vaginalis.
• Translumination test —> -ve