Testicular Tumour

Testicular tumour ( surgical pathology)

Testicular tumour

Stem: A 35 year old male presents to surgical out-door with the complain of right sided inguinal mass for one month. On examination he has single palpable testis. He is otherwise healthy. Consider this surgical pathology station & answer the following questions.

  • Q. What is your differential diagnosis?
    A–  —UDT,
    — Malignancy of testis e.g. seminoma, teratoma etc,
    — Inguinal hernia
    — Varicocoele,
    — Inguinal lymph node enlargement (due to primary or secondary cause)

 

  • Q. Why do you think this will be testicular tumour/Ca ?

 

  • Q. Types/Classification of testicular tumour?

 

  • Q. If this patient would be a 60 year old male, what would be the most common type of testicular tumour in this patient?
    A-     Lymphoma.

 

  • Q. How would you proceed to reach a diagnosis?
    A– To start with I will take history from the patient & followed by clinical examination. I will proceed further by advising USG & blood investigations for tumour markers (β-hcg, α-fetoprotein, LDH).

 

  • Q. What would you expect to find on Ultrasound?
    A– USG will show consistency of the maas/lesion (solid or cystic), tissues of different origin like from ectoderm, mesoderm or endoderm e.g. in teratoma & information about lymphovascular invasion.
  • Q. USG shows UDT with solid & cystic components & pathology report is given. Give your comment.
    A-     Teratoma, positive margin, & Lymphovascular invasion; stage- T4,Nx,Mx.
  • Q. Now, as histopathology confirms testicular carcinoma, what will you do next?
    A-    Staging of the disease with CT-TAP (CT  scan of Thorax, Abdomen & Pelvis).
  • Q. CT-TAP shows RPLN (retroperitoneal lymph node) compressing on IVC (inferior vena cava). How will this lead to thrombosis?
    A-     Virchow’s triad: stasis, hypercoagulability, endothelial injury

 

 

  • Q. Enumerate Etiology/Causes of Cryptorchidism?
    A-

 

  • Q- Difference between UDT & Ecopic testis?
    A-

 

  • Q- How would you treat this patient?
    A- Diagnosis, staging, Discuss with MDT-multidisciplinary team, with the pt & pt-carer

For the …

 

 

  • Q- What are the markers would you ask for?
    A-

 

  • Q. In which type of tumour these markers will be raised?
    A-

 

  • Q. Now, imagine the patient has been operated & he developed haematoma. Describe the stages of haematoma resolution?

A-

  • Q. After few months the pt develops small pneumothorax, what would you think of diagnosis/ how would you interpret this situation?
    A- It could be due to metastasis to lungs for which I will advise CT scan chest

 

  • Q. Define Metastasis?
    A-

 

  • Q. What is the cell of origin of seminoma?
    A-

 

  • Q. Histopathology shows papillary thyroid tissue & GIT adenocarcinoma. Why?

 

  • Q. Can you describe the testicular tumour classification…?

A-