Testicular Tumour

Just breifly describe about this uncommon, but important condition

First, we'll talk about the anatomy :

Testes are originally retroperitoneal organs, during intra-uterine life.
Just before guys are born, our balls descends down, through the inguinal canal, and enters the scrotal sac at the perineum.

As it descends, it bring along vessels, nerves, lymphatics, and it's primary drainage duct - the vas deferens
All these structures are kept safely within the spermatic cord, which can be described of having :



3 vessels : Cremesteric artery, Artery to Vas, and Testicular artery

3 nerves : Autonomic nerves, Genital branch of genitofemoral nerve, and illioinguinal nerve

3 structures : Lymphatics, Pampiniform venous plexus, and Vas deferens

3 coverings : Cremesteric fascia, Internal and external spermatic fascia

The anterior aspect of our testis is covered by a closed peritoneal sac, known as the tunica vaginalis, formed as a result of the obliteration of processus vaginalis.
The posterolateral aspect, is where a single, long coiled duct located, which is the epididymis.

2 histopathological types of Testicular tumour :

1) Seminoma - arising from the seminiferous tubules
2) Teratoma - it's a malignant germ cell tumour

History taking

1) Age

For teratoma, it's common among young men, around 20-30 yrs of age.
Seminoma may be more common in individuals around 30-40 yrs of age.

2) Symptoms

Now, the usual scenario is : the only symptom is a scrotal swelling
Since this condition is usually painless.
Occasionally, there might be some amount of dragging, or dull-aching pain.
Especially when the swelling increases in it's size, the patient might complaints of heaviness over the affected testicles.



In advanced malignancy, there might be symptoms suggesting of metastasis, eg : breathlessness, lost of appetite/weight, abdominal pain, etc

Examination

1) Inspection


A scrotal swelling is seen, not extending into the inguinal region
No expansile cough impulse seen
Scrotal skin - stretched but with normal rugosity, but in advanced stage, skin may ulcerate/infected
No lumps, no scars, no sinuses

2) Palpation

Able to get above the swelling (pure scrotal swelling la)
Testis is enlarged, swollen
Hard in consistency, non tender
There's loss of testicular sensation, and it's feels heavier than the normal side
Spermatic cord is normal
Skin may not be pinchable if infiltration had taken place
Non-fluctuant, non-transilluminant

3) Please examine the para-aortic and supraclavicular lymph nodes
4) Examine the abdomen -> any hepatomegaly? any masses?
   Auscultate the lungs -> any signs of metastases?

Investigation

Here I'll try not to be lengthy la har....

1) Blood : Alpha-fetoprotein, B-HCG, and LDH (Tumour markers)
2) Chest X ray (cannon-ball metastases)
3) CT abdomen for staging
4) Orchidectomy and sent specimen for histological analysis

How do we stage it?

Stage I : Only involve the testis
Stage II : Involving the nodes below diagphram
Stage III : Involving the nodes above diagphram
Stage IV : Hepatic/Pulmonary metastasis

Category: Surgery Notes