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testicular tumor

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common questions
1.Name age address occupation
2.Whats your sufferings
3.How long you are suffering from this
4.How it started
5.Is it painful at all
6.Is there any thing alike any where else
7.Does it go back/changes in size
8.Did you have any treatment before for this

9.family history

10.any other relevant query

both the testis descended at time or not

history of trauma

is there any child

what about the libido

10.examination

 

10.examination

   i.local

 

INSPECTION

Inspection(start with skin condition,end with special tests like caugh,deglutation/potrution of tongue)-7S

 

1.single/multiple
2.site
3.size
4.shape-globular
5.spread(border/edge/extent)-ill defined margin
6.skin condition(colour change,discharge,punctum,hair distribution,scar,visible engorged vein,pulsation)
7.special(caugh impulse,deglutation,potrution of tongue)

 

palpation

Palpation(start with back of hand/temparature and end with lymph node/distal pulse/sensation/joint movement)-11T

1.temparature
2.tenderness
3.Top/surface-
4.texture/consistency-hard
5.temper/flactuation(if soft in consistency)
6.transillumination
7.thrill9expansibility/pulsatality)
8.twiching(compressible/reduciblity)
9.tap
10.tethering(overlying skin/underlying structure at contraction against resistance)
11.special9distal pulse/sensation/joint movement/draining lymph node

inguinal,para aortic,supra clavicular

not separated from testis

get above +ve

caugh -ve

percussion

 

Auscultation

 

ii.other systemic examinations

opposite testis and spermatic cord

abdomen-liver,ascitis

chest-gynaecomastia,auscultation

bone pain

 

11.provisional diagnosis

right testicular swelling (most probably due to testicular tumor in the form of seminoma)

12.differentials

hydrocele

epididymal cyst

13.investigation

a.For confirmation of diagnosis

b.For detection of distant Extension
c.For diagnosis of Co morbidities/end organ damage

d.For Fitness

e.For follow up /prognosis

f.For planning

14.confirmatory diagnosis

15.treatment plan

• a.general management
• b.control of symptom
• c.control of co morbidities
• d.definitive management planning and execution

 

stage seminoma teratoma
I Limited to testis and epididymis No node-follow upNode +ve-radiotherapy Marker -ve-chemo+RPLNDMarker+ve-combination chemo until marker -ve
II Regional LN below diaphragm radiotherapy
III Regional LN abovediaphragm Chemo+radio Combination chemo±RPLNDBleomycin+cisplatin+vimblastin

4-6 cyles

IV Distant metastasis

16.follow up

history-

bone pain(new onset)

examination

inguino scrotal region

LN-(inguinal,para aortic,supra clavicular)

abdomen

chest

investigations

USG(inguinoscrotal and abdomen)

CXR

LFT

markers:

AFP

beta HCG

17.cross

 

 

 

 

 

 

 

 

specimen: jar containing a pathological specimen of testis and spermatic cord

one side is cut open and showing a growth which is regular in shape

1.which operation had been done?

high inguinal orchidectomy

2.why high inguinal?

due to long spermatic cord

3.what may be the pathology?

growth in testis most probably due to testicular tumor (seminoma)

4.why it is seminoma?

uniform in shape

involving whole of the testis

5.classification of testicular tumor?

a.non germ cell tumor

interstitial

leydig cell(pre pubertal)-release testosterone , male precocity

sertoli cell tumor(post pubertal)-release feminizing hormone,female precocity   (gynaecomastia,lost libido,aspermia)

 

b.germ cell tumor

seminomatous(seminoma)

classic

spermatocyte(less potent)

anaplastic(highly potent)

non seminomatous(teratoma)

TD(teratoma differentiate)

MTI(terato carcinoma)

MTA(embryonal carcinoma)-AFP +ve

 

6.causes of testicular tumor?

i.cryptorchidism

20% ipsilateral

10%contralateral

due to

temparature

dyshormonogenesis

impaired blood flow

dysmorphology

ii.trauma

iii.hormonal-mother taking diethylstibosterol

iv.testicular atrophy-mumps

v.Klinefelter syndrome

7.

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