A pt. presented with a hard swelling in his right testis. All are true statements except
Trans-scrotal biopsy is contraindicated. "A painless testicular mass is pathognomic for a testicular malignancy. U/S of the testis is indicated whenever a testicular malignancy is considered and for persistent or painful testicular swelling. If a testicular mass is detected, a radical inguinal orchiectomy should be performed. Because the testis develops from the gonadal ridge, its blood supply and lymphatic drainage originate in the abdomen and descend with the testis into the scrotum. An inguinal approach is taken to avoid breaching anatomic barriers and permitting additional pathways of spread." Thus - U/S scrotum is done for any suspected testicular tumor If a testicular mass found on U/S then high inguinal orchiectomy done to remove the primary as well as know about the histology of the tumor. After orchiectomy fuher inv. done for staging are CT abdomen & pelvis - for retroperitoneal l.n. Chest x-ray - for mediastinal and pulmonary metastasis. Chest CT - if mediastinal or pulmonary metastasis is suspected. Tumour markers - AFP, HCG, LDH AFP (Alpha-fetoprotein) - seen only in Non-seminoma* HCG and LDH - seen in both seminomas & non-seminomas* More about testicular malignancy Most common testicular tumor above 50 yrs of age is - Lymphoma* Non-seminomas are more malignant than seminomas* Treatment of testicular cancer is directed by the tumor histology as described in the previous question but when the tumor contains both seminoma and non-seminoma components pts. Management is directed by the more aggressive non-seminoma component. Chromosomal marker for GCT - isochromosome of the sho arm of chromosome 12.
Inguinal exploration is done
Trans scrotal biopsy is needed
High inguinal exploration is done
Scrotal u/s is done
Urology