A 17-year-old male presents with a 3-month history of heaviness in his right scrotum without a history of trauma. On examination, he has a painless enlargement of the right testis and a palpable intra-abdominal mass. The clinical diagnosis is a painless solid testicular swelling, which is considered a testicular tumor unless proven otherwise. Further investigations including tumor markers, imaging, and staging are required to determine the appropriate multimodal treatment approach using surgery, chemotherapy, and/or radiotherapy.
This document summarizes the natural history and treatment of testicular cancer. It discusses that intratubular germ cell neoplasia in situ can progress to invasive tumor in 50% of cases. Lymphatic spread typically occurs before vascular invasion, following predictable lymphatic pathways. Undescended testes confer an increased risk of testicular cancer. Treatment involves radical orchiectomy followed by risk-stratified use of chemotherapy, radiotherapy, and retroperitoneal lymph node dissection depending on the histology, stage, and tumor markers. Both seminomas and non-seminomatous germ cell tumors are highly chemosensitive and can be cured even in advanced stages with chemotherapy.
Testicular tumors-Cassification, Biomarkers and Staging by Dr RajeshRajesh Sinwer
This document discusses testicular tumors, including:
- Germ cell tumors are the most common type, comprising 95% of cases. Seminomas and non-seminomatous germ cell tumors are the main subtypes.
- Important biomarkers for testicular cancer include AFP, HCG, LDH, and PLAP. Elevated levels can indicate the presence of a non-seminoma.
- Staging is important and is based on whether the cancer is confined to the testis or has spread to lymph nodes or other organs. Spread beyond the retroperitoneum is considered stage III.
- Diagnostic workup involves imaging like ultrasound, CT, MRI and PET scans
Testicular tumors are rare but the most common malignancy in young men aged 15-35. They present as painless swelling of the testis. Ultrasound and tumor markers help diagnose and stage the cancer. The main types are seminomas and non-seminomas. Radical orchidectomy is the first treatment, followed by surveillance, radiotherapy or chemotherapy depending on stage. Multimodal treatment using surgery, chemotherapy and radiotherapy has improved survival rates for testicular cancer.
This document provides a detailed overview of testicular cancer classifications, histology, screening tools, management approaches, and prognostic factors. It discusses the various histologic types of germ cell tumors and sex cord-gonadal stromal tumors. For each type, it describes characteristics such as common age range, histologic features, tumor markers, and treatment approaches. It also summarizes staging evaluations and the role of imaging, tumor markers, surgery, radiation therapy, chemotherapy, and surveillance in testicular cancer management.
Discuss the pathology of bladder cancersJim Badmus
This document discusses bladder cancer including its epidemiology, risk factors, clinical manifestations, pathology, staging, and management. It provides details on the treatment of muscle-invasive bladder cancer including radical cystectomy, partial cystectomy, neoadjuvant and adjuvant chemotherapy, and chemoradiotherapy. It also discusses the prognosis, surveillance, and follow up for bladder cancer patients.
Bladder cancer is the fourth most common cancer in men and tenth most common in women. The recurrence rate for superficial bladder cancer is high, with 80% having at least one recurrence. Staging is based on tumor grade, invasion depth, and presence of carcinoma in situ. Treatment depends on stage, with transurethral resection of bladder tumors as first-line treatment for visible tumors and close surveillance after due to high recurrence rates.
Bladder cancer is a common malignancy with risk factors including smoking, chemicals, and parasites. Most cases are transitional cell carcinoma. Superficial cancers are staged Ta-T1 while muscle-invasive are T2-T4. Treatment depends on stage and risk of recurrence. For superficial disease, transurethral resection and intravesical therapies like BCG are used. Muscle-invasive cancers require radical cystectomy with lymph node dissection and urinary diversion. Neoadjuvant chemotherapy may allow organ preservation in some. Close follow up monitors for recurrence or progression.
Gastrointestinal stromal tumor (GIST) dr ridu kumar sharmaRidu Kumar Sharma
GISTs are the most common mesenchymal tumors of the GI tract. They are driven by mutations in c-Kit and PDGFR genes. Surgery is the main treatment for localized disease, while imatinib is effective systemic therapy for advanced or metastatic GISTs. Imatinib targets the c-Kit mutation to inhibit tumor growth with acceptable toxicity. Tumor size and mitotic index are prognostic factors used for risk stratification. Ongoing research is exploring additional targeted therapies to treat GISTs.
This document summarizes the natural history and treatment of testicular cancer. It discusses that intratubular germ cell neoplasia in situ can progress to invasive tumor in 50% of cases. Lymphatic spread typically occurs before vascular invasion, following predictable lymphatic pathways. Undescended testes confer an increased risk of testicular cancer. Treatment involves radical orchiectomy followed by risk-stratified use of chemotherapy, radiotherapy, and retroperitoneal lymph node dissection depending on the histology, stage, and tumor markers. Both seminomas and non-seminomatous germ cell tumors are highly chemosensitive and can be cured even in advanced stages with chemotherapy.
Testicular tumors-Cassification, Biomarkers and Staging by Dr RajeshRajesh Sinwer
This document discusses testicular tumors, including:
- Germ cell tumors are the most common type, comprising 95% of cases. Seminomas and non-seminomatous germ cell tumors are the main subtypes.
- Important biomarkers for testicular cancer include AFP, HCG, LDH, and PLAP. Elevated levels can indicate the presence of a non-seminoma.
- Staging is important and is based on whether the cancer is confined to the testis or has spread to lymph nodes or other organs. Spread beyond the retroperitoneum is considered stage III.
- Diagnostic workup involves imaging like ultrasound, CT, MRI and PET scans
Testicular tumors are rare but the most common malignancy in young men aged 15-35. They present as painless swelling of the testis. Ultrasound and tumor markers help diagnose and stage the cancer. The main types are seminomas and non-seminomas. Radical orchidectomy is the first treatment, followed by surveillance, radiotherapy or chemotherapy depending on stage. Multimodal treatment using surgery, chemotherapy and radiotherapy has improved survival rates for testicular cancer.
This document provides a detailed overview of testicular cancer classifications, histology, screening tools, management approaches, and prognostic factors. It discusses the various histologic types of germ cell tumors and sex cord-gonadal stromal tumors. For each type, it describes characteristics such as common age range, histologic features, tumor markers, and treatment approaches. It also summarizes staging evaluations and the role of imaging, tumor markers, surgery, radiation therapy, chemotherapy, and surveillance in testicular cancer management.
Discuss the pathology of bladder cancersJim Badmus
This document discusses bladder cancer including its epidemiology, risk factors, clinical manifestations, pathology, staging, and management. It provides details on the treatment of muscle-invasive bladder cancer including radical cystectomy, partial cystectomy, neoadjuvant and adjuvant chemotherapy, and chemoradiotherapy. It also discusses the prognosis, surveillance, and follow up for bladder cancer patients.
Bladder cancer is the fourth most common cancer in men and tenth most common in women. The recurrence rate for superficial bladder cancer is high, with 80% having at least one recurrence. Staging is based on tumor grade, invasion depth, and presence of carcinoma in situ. Treatment depends on stage, with transurethral resection of bladder tumors as first-line treatment for visible tumors and close surveillance after due to high recurrence rates.
Bladder cancer is a common malignancy with risk factors including smoking, chemicals, and parasites. Most cases are transitional cell carcinoma. Superficial cancers are staged Ta-T1 while muscle-invasive are T2-T4. Treatment depends on stage and risk of recurrence. For superficial disease, transurethral resection and intravesical therapies like BCG are used. Muscle-invasive cancers require radical cystectomy with lymph node dissection and urinary diversion. Neoadjuvant chemotherapy may allow organ preservation in some. Close follow up monitors for recurrence or progression.
Gastrointestinal stromal tumor (GIST) dr ridu kumar sharmaRidu Kumar Sharma
GISTs are the most common mesenchymal tumors of the GI tract. They are driven by mutations in c-Kit and PDGFR genes. Surgery is the main treatment for localized disease, while imatinib is effective systemic therapy for advanced or metastatic GISTs. Imatinib targets the c-Kit mutation to inhibit tumor growth with acceptable toxicity. Tumor size and mitotic index are prognostic factors used for risk stratification. Ongoing research is exploring additional targeted therapies to treat GISTs.
This document discusses testicular cancer, including:
- 95% of testicular cancers are germ cell tumors known as seminomas or non-seminomas.
- Risk factors include undescended testes, male infertility, and family history.
- Staging involves evaluating tumor size, lymph node involvement, and serum tumor marker levels.
- Treatment depends on cancer type and stage but may include surgery, radiation therapy, platinum-based chemotherapy, and surveillance. Outcomes are generally very good even for metastatic disease.
This document provides information about germ cell tumors, specifically testicular tumors. It discusses the incidence, classification, etiology, spread, clinical staging, clinical features, differential diagnosis, investigations, treatment, and follow up schedule for testicular tumors. Key points include that testicular tumors are most common in men ages 20-40, with seminomas being the most common type. Risk factors include cryptorchidism and intersex disorders. Staging involves assessing the primary tumor, lymph node involvement, distant metastasis, and serum tumor markers. Clinical features may include a lump in the testis or metastatic signs such as cough or bone pain. Differential diagnoses include epididymo-orchitis.
1. Colorectal cancer is the third most common malignancy worldwide, with over 1.2 million new cases annually. The risk increases with age, with most cases occurring after age 50.
2. Screening is recommended for average risk individuals starting at age 50, and earlier for those with risk factors like family history or inflammatory bowel disease. Screening options include annual fecal tests and colonoscopy every 10 years.
3. Treatment depends on the cancer stage and location. Early stage cancers are typically treated with surgery alone, while later stages may involve chemotherapy and radiation in addition to surgery. The goals are curative therapy for early stages and palliative care for metastatic disease.
This document provides information on Wilms tumor (nephroblastoma), the most common malignant renal tumor of childhood. It discusses the epidemiology, genetics, clinical features, staging, histology, management including surgery, chemotherapy and radiation therapy. Key points include that Wilms tumor arises from nephrogenic rests, affects children aged 3-4 years, and is highly curable with multimodality treatment depending on stage, histology and other risk factors. Radiation therapy is an important component of treatment for local and metastatic disease. Ongoing clinical trials continue to refine risk-adapted therapies to improve survival while reducing long-term effects.
This document provides information about testicular tumor (pure seminoma). It discusses that germ cell tumors account for 95% of malignant testicular tumors. Seminomas make up 40% of germ cell tumors and include classical, anaplastic, and spermatocytic subtypes. Staging and treatment options are provided for different stages of seminoma, including surveillance, radiotherapy, or chemotherapy. Follow up protocols depend on the initial treatment and involve tumor marker monitoring and imaging. Outcomes for stage I seminoma with standard treatment are over 99% disease-specific survival.
The document summarizes key anatomical and clinical aspects of the rectum:
1. The rectum is 12-15 cm long, located in the pelvis behind the lower sacrum and coccyx. It has three sections with varying peritoneal coverage and blood supply.
2. Rectal cancer is the third most common cancer in the US. Risk factors include diet, family history, and conditions like ulcerative colitis. Symptoms often include changes in bowel habits or bleeding.
3. Treatment involves surgery like low anterior resection or abdominoperineal resection. Total mesorectal excision improves outcomes by completely removing the mesorectum and reducing local recurrence rates.
Colorectal cancer is the third most commonly diagnosed cancer worldwide. Risk factors include increasing age, family history, inflammatory bowel disease, lifestyle factors like obesity and smoking. Screening is recommended regularly beginning at age 50 to detect cancers early. Staging uses the TNM system and treatment depends on stage but commonly includes surgery along with chemotherapy and radiation for later stages. The document provides detailed information on epidemiology, risk factors, stages, diagnosis, treatment and screening guidelines for colorectal cancer.
Testicular tumors can be divided into germ cell tumors (95% of cases) and non-germ cell tumors such as Leydig and Sertoli cell tumors. Germ cell tumors include seminomas and non-seminomatous germ cell tumors. Risk factors for testicular cancer include cryptorchidism, Klinefelter syndrome, family history, and prior germ cell tumor. Patients typically present with a painless testicular mass, and workup involves tumor markers, ultrasound, and CT imaging. Staging determines need for radical orchidectomy, chemotherapy, retroperitoneal lymph node dissection, and/or radiation therapy.
This document discusses testicular cancer, including:
- Risk factors include history of undescended testes, contralateral testicular tumor, or Klinefelter syndrome.
- Tumors are classified as germ cell tumors (most common), interstitial cell tumors, lymphoma, or other rare tumors.
- Seminoma and non-seminomatous germ cell tumors (NSGCT) are the main types of germ cell tumors.
- Diagnostic workup includes scrotal ultrasound, serum tumor markers, chest imaging and lymph node assessment to determine clinical stage according to the TNM system.
1. Testicular cancer is most common in young men aged 20-40 years and 90-95% are germ cell tumors.
2. Survival rates have improved to over 95% for stage I and II seminomas and 90% for stage I non-seminomas due to better understanding of the disease, use of tumor markers, and cisplatin chemotherapy.
3. Treatment involves radical orchidectomy followed by radiotherapy for seminomas or lymph node dissection/chemotherapy for non-seminomas depending on stage.
This document provides information about bladder carcinoma, including:
1. Bladder carcinoma is the most common cancer of the urinary tract, affecting men more than women. It is most common in the elderly, around ages 67-70.
2. Risk factors include family history, chemical exposure, smoking, irradiation, arsenic exposure, and urinary disorders. Preneoplastic abnormalities and carcinoma in situ can develop.
3. Transitional cell carcinoma accounts for 90% of bladder cancers and can range from low to high grade. Staging involves determining if the cancer is superficial, invasive, or metastatic. Treatment depends on the stage and grade.
Transitional cell carcinoma of urinary bladederrezauro
The document provides information on transitional cell carcinoma of the urinary bladder, including:
- It is the second most common genitourinary cancer in the US, more common in men than women and blacks than whites.
- Risk factors include smoking, exposure to chemicals like benzidine and cyclophosphamide, and certain medical conditions.
- Diagnosis involves tests like urine cytology, cystoscopy, and imaging. Staging evaluates extent of invasion and spread.
- Treatment depends on stage but may include transurethral resection, chemotherapy, immunotherapy like BCG, and sometimes radical cystectomy.
Urology gynecology anapath et imagerie c balleyguierJFIM
This document discusses how to assess benignity in rare ovarian tumors using imaging and pathology. It notes that imaging alone can nearly never determine benignity, except for some functional ovarian lesions, fibrous tumors, and mature teratomas. Pathology is nearly always needed to avoid misdiagnosis, especially for functional lesions. The document provides examples of imaging findings that suggest benignity for certain tumor types like ovarian fibromas and dermoid cysts. It also discusses imaging features that may indicate malignancy and provides examples of rare malignant ovarian tumors.
This document provides information about testicular tumors. It discusses that testicular cancer is most common in men aged 15-35 and has three peaks in incidence. The most common types are seminomas and non-seminomas. Risk factors include cryptorchidism, Klinefelter's syndrome, and trauma. Diagnosis involves physical exam, ultrasound, serum tumor markers, and radiology. Treatment depends on the type and stage but generally includes radical orchidectomy followed by chemotherapy, radiation, or surveillance. Prognosis is excellent even for metastatic disease due to chemosensitivity.
This document provides an overview of testicular cancer, including:
1. Testicular cancer most commonly affects men aged 20-40 and is the most common cancer in that age group. It has very good survival rates due to effective diagnostic techniques, tumor markers, and multimodal treatments.
2. Risk factors include cryptorchidism, Klinefelter syndrome, trauma, and genetic factors. Cryptorchidism increases risk by 14-48 times.
3. Types include seminomas, embryonal carcinomas, teratomas, and others. Seminomas and non-seminomas are treated differently.
4. Diagnosis involves physical exam, ultrasound, tumor markers like AFP and H
The document discusses carcinoma of the colon and its management. It provides details on epidemiology, risk factors, staging, diagnostic workup, surgery, adjuvant therapy including chemotherapy and radiation therapy. Surgery is the primary treatment but adjuvant therapy with chemotherapy improves survival outcomes, especially in stage III disease. Chemotherapy regimens like FOLFOX and 5-FU plus leucovorin are commonly used in the adjuvant and metastatic settings.
This patient presented with rectal bleeding and weight loss and was found to have stage III adenocarcinoma. Given his family history of colorectal cancer in a first-degree relative at a young age, he is at high risk for hereditary non-polyposis colorectal cancer (HNPCC). HNPCC accounts for 5-7% of colorectal cancers and results from a mutation in DNA mismatch repair genes. Individuals with HNPCC have an increased lifetime risk of colorectal and other cancers. The patient was counseled on genetic testing and increased screening for relatives is recommended.
2. Sample collection ,transport and acceptance and rejection.pptxMohanSinghDhakad1
This document provides guidelines for collecting, transporting, and testing various clinical specimens for microbiological analysis. It discusses sample types including body fluids, cerebrospinal fluid, blood, urine, respiratory samples, gastrointestinal samples, ear swabs, eye swabs, and abscess or wound samples. For each sample type, it provides information on containers, transport times and temperatures, and appropriate microbiological tests. The document aims to ensure proper specimen collection and handling to optimize pathogen recovery and identification.
The Gram stain is the most widely used staining method for bacteria. It was developed by Christian Gram in 1884 and allows differentiation of bacteria into Gram-positive and Gram-negative types based on differences in cell wall structure. The document describes the original Gram stain procedure and several common modifications. It provides details on preparation of smears, staining solutions, interpretation of results, and the mechanisms of Gram staining. Uses of the Gram stain include bacterial identification and guiding empirical antibiotic treatment.
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Similar to MBBS Class. Testicular tumor. BPSingh.Urology.11.10.2014.pptx
This document discusses testicular cancer, including:
- 95% of testicular cancers are germ cell tumors known as seminomas or non-seminomas.
- Risk factors include undescended testes, male infertility, and family history.
- Staging involves evaluating tumor size, lymph node involvement, and serum tumor marker levels.
- Treatment depends on cancer type and stage but may include surgery, radiation therapy, platinum-based chemotherapy, and surveillance. Outcomes are generally very good even for metastatic disease.
This document provides information about germ cell tumors, specifically testicular tumors. It discusses the incidence, classification, etiology, spread, clinical staging, clinical features, differential diagnosis, investigations, treatment, and follow up schedule for testicular tumors. Key points include that testicular tumors are most common in men ages 20-40, with seminomas being the most common type. Risk factors include cryptorchidism and intersex disorders. Staging involves assessing the primary tumor, lymph node involvement, distant metastasis, and serum tumor markers. Clinical features may include a lump in the testis or metastatic signs such as cough or bone pain. Differential diagnoses include epididymo-orchitis.
1. Colorectal cancer is the third most common malignancy worldwide, with over 1.2 million new cases annually. The risk increases with age, with most cases occurring after age 50.
2. Screening is recommended for average risk individuals starting at age 50, and earlier for those with risk factors like family history or inflammatory bowel disease. Screening options include annual fecal tests and colonoscopy every 10 years.
3. Treatment depends on the cancer stage and location. Early stage cancers are typically treated with surgery alone, while later stages may involve chemotherapy and radiation in addition to surgery. The goals are curative therapy for early stages and palliative care for metastatic disease.
This document provides information on Wilms tumor (nephroblastoma), the most common malignant renal tumor of childhood. It discusses the epidemiology, genetics, clinical features, staging, histology, management including surgery, chemotherapy and radiation therapy. Key points include that Wilms tumor arises from nephrogenic rests, affects children aged 3-4 years, and is highly curable with multimodality treatment depending on stage, histology and other risk factors. Radiation therapy is an important component of treatment for local and metastatic disease. Ongoing clinical trials continue to refine risk-adapted therapies to improve survival while reducing long-term effects.
This document provides information about testicular tumor (pure seminoma). It discusses that germ cell tumors account for 95% of malignant testicular tumors. Seminomas make up 40% of germ cell tumors and include classical, anaplastic, and spermatocytic subtypes. Staging and treatment options are provided for different stages of seminoma, including surveillance, radiotherapy, or chemotherapy. Follow up protocols depend on the initial treatment and involve tumor marker monitoring and imaging. Outcomes for stage I seminoma with standard treatment are over 99% disease-specific survival.
The document summarizes key anatomical and clinical aspects of the rectum:
1. The rectum is 12-15 cm long, located in the pelvis behind the lower sacrum and coccyx. It has three sections with varying peritoneal coverage and blood supply.
2. Rectal cancer is the third most common cancer in the US. Risk factors include diet, family history, and conditions like ulcerative colitis. Symptoms often include changes in bowel habits or bleeding.
3. Treatment involves surgery like low anterior resection or abdominoperineal resection. Total mesorectal excision improves outcomes by completely removing the mesorectum and reducing local recurrence rates.
Colorectal cancer is the third most commonly diagnosed cancer worldwide. Risk factors include increasing age, family history, inflammatory bowel disease, lifestyle factors like obesity and smoking. Screening is recommended regularly beginning at age 50 to detect cancers early. Staging uses the TNM system and treatment depends on stage but commonly includes surgery along with chemotherapy and radiation for later stages. The document provides detailed information on epidemiology, risk factors, stages, diagnosis, treatment and screening guidelines for colorectal cancer.
Testicular tumors can be divided into germ cell tumors (95% of cases) and non-germ cell tumors such as Leydig and Sertoli cell tumors. Germ cell tumors include seminomas and non-seminomatous germ cell tumors. Risk factors for testicular cancer include cryptorchidism, Klinefelter syndrome, family history, and prior germ cell tumor. Patients typically present with a painless testicular mass, and workup involves tumor markers, ultrasound, and CT imaging. Staging determines need for radical orchidectomy, chemotherapy, retroperitoneal lymph node dissection, and/or radiation therapy.
This document discusses testicular cancer, including:
- Risk factors include history of undescended testes, contralateral testicular tumor, or Klinefelter syndrome.
- Tumors are classified as germ cell tumors (most common), interstitial cell tumors, lymphoma, or other rare tumors.
- Seminoma and non-seminomatous germ cell tumors (NSGCT) are the main types of germ cell tumors.
- Diagnostic workup includes scrotal ultrasound, serum tumor markers, chest imaging and lymph node assessment to determine clinical stage according to the TNM system.
1. Testicular cancer is most common in young men aged 20-40 years and 90-95% are germ cell tumors.
2. Survival rates have improved to over 95% for stage I and II seminomas and 90% for stage I non-seminomas due to better understanding of the disease, use of tumor markers, and cisplatin chemotherapy.
3. Treatment involves radical orchidectomy followed by radiotherapy for seminomas or lymph node dissection/chemotherapy for non-seminomas depending on stage.
This document provides information about bladder carcinoma, including:
1. Bladder carcinoma is the most common cancer of the urinary tract, affecting men more than women. It is most common in the elderly, around ages 67-70.
2. Risk factors include family history, chemical exposure, smoking, irradiation, arsenic exposure, and urinary disorders. Preneoplastic abnormalities and carcinoma in situ can develop.
3. Transitional cell carcinoma accounts for 90% of bladder cancers and can range from low to high grade. Staging involves determining if the cancer is superficial, invasive, or metastatic. Treatment depends on the stage and grade.
Transitional cell carcinoma of urinary bladederrezauro
The document provides information on transitional cell carcinoma of the urinary bladder, including:
- It is the second most common genitourinary cancer in the US, more common in men than women and blacks than whites.
- Risk factors include smoking, exposure to chemicals like benzidine and cyclophosphamide, and certain medical conditions.
- Diagnosis involves tests like urine cytology, cystoscopy, and imaging. Staging evaluates extent of invasion and spread.
- Treatment depends on stage but may include transurethral resection, chemotherapy, immunotherapy like BCG, and sometimes radical cystectomy.
Urology gynecology anapath et imagerie c balleyguierJFIM
This document discusses how to assess benignity in rare ovarian tumors using imaging and pathology. It notes that imaging alone can nearly never determine benignity, except for some functional ovarian lesions, fibrous tumors, and mature teratomas. Pathology is nearly always needed to avoid misdiagnosis, especially for functional lesions. The document provides examples of imaging findings that suggest benignity for certain tumor types like ovarian fibromas and dermoid cysts. It also discusses imaging features that may indicate malignancy and provides examples of rare malignant ovarian tumors.
This document provides information about testicular tumors. It discusses that testicular cancer is most common in men aged 15-35 and has three peaks in incidence. The most common types are seminomas and non-seminomas. Risk factors include cryptorchidism, Klinefelter's syndrome, and trauma. Diagnosis involves physical exam, ultrasound, serum tumor markers, and radiology. Treatment depends on the type and stage but generally includes radical orchidectomy followed by chemotherapy, radiation, or surveillance. Prognosis is excellent even for metastatic disease due to chemosensitivity.
This document provides an overview of testicular cancer, including:
1. Testicular cancer most commonly affects men aged 20-40 and is the most common cancer in that age group. It has very good survival rates due to effective diagnostic techniques, tumor markers, and multimodal treatments.
2. Risk factors include cryptorchidism, Klinefelter syndrome, trauma, and genetic factors. Cryptorchidism increases risk by 14-48 times.
3. Types include seminomas, embryonal carcinomas, teratomas, and others. Seminomas and non-seminomas are treated differently.
4. Diagnosis involves physical exam, ultrasound, tumor markers like AFP and H
The document discusses carcinoma of the colon and its management. It provides details on epidemiology, risk factors, staging, diagnostic workup, surgery, adjuvant therapy including chemotherapy and radiation therapy. Surgery is the primary treatment but adjuvant therapy with chemotherapy improves survival outcomes, especially in stage III disease. Chemotherapy regimens like FOLFOX and 5-FU plus leucovorin are commonly used in the adjuvant and metastatic settings.
This patient presented with rectal bleeding and weight loss and was found to have stage III adenocarcinoma. Given his family history of colorectal cancer in a first-degree relative at a young age, he is at high risk for hereditary non-polyposis colorectal cancer (HNPCC). HNPCC accounts for 5-7% of colorectal cancers and results from a mutation in DNA mismatch repair genes. Individuals with HNPCC have an increased lifetime risk of colorectal and other cancers. The patient was counseled on genetic testing and increased screening for relatives is recommended.
2. Sample collection ,transport and acceptance and rejection.pptxMohanSinghDhakad1
This document provides guidelines for collecting, transporting, and testing various clinical specimens for microbiological analysis. It discusses sample types including body fluids, cerebrospinal fluid, blood, urine, respiratory samples, gastrointestinal samples, ear swabs, eye swabs, and abscess or wound samples. For each sample type, it provides information on containers, transport times and temperatures, and appropriate microbiological tests. The document aims to ensure proper specimen collection and handling to optimize pathogen recovery and identification.
The Gram stain is the most widely used staining method for bacteria. It was developed by Christian Gram in 1884 and allows differentiation of bacteria into Gram-positive and Gram-negative types based on differences in cell wall structure. The document describes the original Gram stain procedure and several common modifications. It provides details on preparation of smears, staining solutions, interpretation of results, and the mechanisms of Gram staining. Uses of the Gram stain include bacterial identification and guiding empirical antibiotic treatment.
This document discusses coagulation and coagulation disorders. It defines coagulation as the process by which blood forms clots. Coagulation is important for hemostasis and stopping blood loss from damaged vessels. Disorders can lead to increased bleeding or clotting. Coagulation involves platelet plug formation and the blood coagulation cascade that converts fibrinogen to fibrin. Laboratory tests evaluate coagulation factors and pathways, including platelet count, bleeding time, prothrombin time, and activated partial thromboplastin time. Inherited and acquired bleeding disorders involve vessel defects, platelet disorders, or coagulation factor deficiencies.
The catalase test detects the presence of the catalase enzyme in bacteria. Catalase breaks down toxic hydrogen peroxide into oxygen and water. If bubbles form when hydrogen peroxide is added to a bacterial sample, it indicates the presence of catalase and a positive result. The test is used to identify certain bacteria like staphylococci that produce catalase.
This document provides information on differential leukocyte counting (DLC). It defines DLC as the relative proportion of different white blood cells expressed as a percentage. The main types of white blood cells (WBCs) are described along with normal ranges. Methods for manually counting WBCs using a microscope and automated counting are outlined. Various abnormalities in WBC counts and differentials such as neutrophilia, neutropenia, lymphocytosis, lymphopenia, monocytosis, eosinophilia, eosinopenia, and basophilia are defined and their potential causes are listed.
This document discusses erythrocyte sedimentation rate (ESR), packed cell volume (PCV), and blood indices. It provides details on performing and interpreting ESR using the Westergren and Wintrobe methods. Average ESR values are 3-5 mm/hr for males and 4-7 mm/hr for females using Westergren method. For Wintrobe method values are 0-9 mm/hr for males and 0-20 mm/hr for females. PCV is measured using the Wintrobe method and expressed as a percentage. Blood indices - MCV, MCH, MCHC are also discussed along with their clinical significance.
The document discusses basic histopathological techniques including tissue fixation, grossing, tissue processing, microtomy, and staining. Tissue processing involves dehydration, clearing, infiltration, embedding and section cutting. Sections can be cut using a microtome from paraffin blocks or frozen on a cryostat. Staining is usually done using hematoxylin and eosin to visualize tissue structures under the microscope. Proper labeling, fixation, sectioning and staining are essential for histopathological examination.
Reticulocytes are immature red blood cells that contain RNA. A reticulocyte count involves staining a blood sample with new methylene blue to visualize the RNA-containing reticulum in reticulocytes. Reticulocytes are counted under a microscope and the percentage is calculated to assess bone marrow function. An increased reticulocyte count indicates the bone marrow is responding to blood loss or hemolysis by increasing red blood cell production, while a decreased count may indicate bone marrow suppression.
The document describes the parts and use of a compound microscope. It discusses the history of microscope development starting in the 16th century. The key parts of a microscope are the mechanical support system, optical system, illumination system, and adjustment system. The mechanical support holds the microscope together and stages the sample. The optical system includes objective lenses that magnify the sample and eyepieces the user looks through. Focusing is achieved using coarse and fine adjustments on the stage and objective lenses. Different objectives and condenser/light adjustments are used depending on the desired magnification level.
1. Seminoma and teratoma testis are the two most common malignant tumors of the testis. Seminoma typically occurs in men aged 25-55 years and constitutes about 90% of testicular germ cell tumors.
2. Classic seminoma appears as an enlarged, solid, grey-white testis and microscopically contains large round cells with clear cytoplasm and lymphocytic infiltration. Spermatocytic seminoma comprises 5% of cases and has an excellent prognosis.
3. Teratoma testis is composed of tissues from more than one germ layer and can be mature, immature, or undergo malignant transformation. It presents as a large testis with heterogeneous and
This document discusses lipids and fat cells. It describes how lipids are structural components of cell membranes and how they store energy. It outlines the two main types of fat cells - white and brown fat cells. Various histological staining techniques are described that can identify different lipid types, such as oil red O for neutral lipids and Sudan black B for phospholipids. Pathological conditions involving abnormal lipid deposition or accumulation are also summarized, such as fatty degeneration, lipoma, and Tay-Sach's disease.
This document discusses hyperemia and congestion in the lung, liver, and spleen. It defines hyperemia as an active process of increased blood flow due to arteriolar dilation, while congestion is a passive process resulting from impaired venous outflow. In chronic venous congestion of the lung, liver, and spleen, long-standing accumulation of deoxygenated blood damages the tissues. The liver develops a "nutmeg" appearance from alternating red and yellow zones, while the lungs become heavy and brown with thickened fibrotic septa. The spleen also enlarges from congestion.
This document provides guidance on grossing techniques for pathology specimens. It discusses proper specimen identification, labeling, collection, fixation and storage. The ideal properties of fixatives are outlined, including preventing autolysis and bacterial growth while maintaining tissue morphology. Common fixatives like neutral buffered formalin are described along with their advantages and limitations. The key steps of gross examination involve describing the location, size, shape and abnormalities seen in specimens before selecting portions for microscopic analysis.
This document discusses lipids and fat cells. It describes how lipids are structural components of cell membranes and how they store energy. It outlines the different types of fat cells and lipids. It then discusses various histological staining techniques used to identify lipids, such as using solubility, polarized light, osmium tetroxide reduction, and fat-soluble dyes. Potential lipid pathologies like fatty degeneration, lipoma, liposarcoma, and atheroma are also summarized.
This document provides an overview of coagulation and tests used to evaluate coagulation function. It discusses how coagulation maintains hemostasis and the mechanisms involved. Factors that can cause bleeding disorders are described, including vessel defects, platelet disorders, and factor deficiencies. Key tests for evaluation of coagulation are outlined, including platelet count, bleeding time, clotting time, prothrombin time, and activated partial thromboplastin time. Specific coagulation factor deficiencies like hemophilia A, hemophilia B, and von Willebrand disease are explained. Causes of acquired bleeding disorders like anticoagulant therapy and liver disease are also summarized.
The document discusses the basic techniques used in histopathology for tissue processing. It describes the key steps of tissue processing which include dehydration, clearing, infiltration, embedding and section cutting. Various methods are covered such as paraffin section cutting, frozen section technique, cryostat sectioning, ultracryotomy and freeze drying. Important equipment used at each step like microtome, cryostat, slide warmer and floatation bath are also mentioned. The goal of tissue processing is to prepare tissues for microscopic examination by maintaining the cellular structure.
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPTblessyjannu21
Prepared by Prof. BLESSY THOMAS, VICE PRINCIPAL, FNCON, SPN.
Emphysema is a disease condition of respiratory system.
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1. Testicular tumor
Dr Bhupendra P. Singh
MCh(Urology), FRCS(Edin), DNB, MS
Associate Professor, Urology
King George’s Medical University
Lucknow
2. A 17 yrs male presents with heaviness in Rt. Scrotum for 3
months, without a definite h/o testicular trauma.
O/E: painless enlargement of Rt testes with a palpable
intraabdominal mass in paraumblical region.
What is your clinical Diagnosis ?
3. Painless solid testicular swelling in male
Is testicular tumor unless proven otherwise.
Between 15 -34 yrs age most common.
Increased risk in undescended testes.
May have secondary hydrocele : lax & -ve transillumination
Examine : abdomen and supraclvicular LN, lung/liver/bones
DDx : calcified hydrocele / organised hematocele
4. Clinical presentation
Age :
- most common solid tumor in young men b/w 20 -35 years age
- smaller peak in men > 60
Painless testicular enlargement, Heaviness/dull ache in few
History of testicular trauma – purely incidental
Gynaecomastia : in ledig cell tumor
5. Natural History of disease
• Intratubular germ cell neoplasia in situ (CIS) – confined by BM of
seminiferous tubules 50% CiS progress to Invasive tumor
• Lymphatic spread before vascular invasion except ChorioCa
- First LN on Lt side is Para-Aortic
- First LN on Rt side is Inter-AortoCaval
- Rt to Lt spread Yes, but not from Lt to Rt (implication in RPLND)
around & above
Umblicus
6. Natural History of disease
• - Mediastinal LNs Supraclav. LNs (Lt side:Virchow’s node)
- Lower Para-aortic & iliac LNs spread : Retrograde spread
due to blockage of higher LNs/ aberrent lymphatics
- Inguinal LNs : due to Local spread / scrotal violation
• Blood borne metastasis to – lung, liver & bone
• Vascular invasion is more in ChorioCA – Lung most common
7. Testicular tumor &
Undescended testes (UDT) :
Cause : germinal dysplasia and genetic changes
8 X increased risk (5-15 times) of testicular malignancy
8-9 % tumors have prior h/o undescended testis (7-12%)
Increased risk in normal contralateral testis also
8% will develop tumor in normal contralateral testis if there
occurred a tumor in undescended testis
8. Lower abdominal / groin mass with empty ipsilateral scrotum
Age of tumor present. : same as in normally descended testis.
Most common tumor : seminoma.
Both UDT and testicular tumor slightly more on Right side.
Higher the testis in location, higher is the risk.
Malignancy risk isn’t decreased by bringing down the testis .
Testicular tumor &
Undescended testes (UDT) :
9. Tumor risk till Middle age only so :
Councel UDT repair patients for regular self palpation of
testis till middle age : for early tumor detection
If a UDT Patient presents after 40 yrs age : no need to remove
UDT testis for tumor risk
Testicular tumor &
Undescended testes (UDT) :
12. Seminoma
85% are pure/classic seminoma: No specific tumor marker
- LDH is used as marker for tumor bulk assessment and
treatment response
15% have some syncytiotrophic component: some b-HCG
secretion
Higher S. Alpha feto-protein excludes diagnosis of seminoma
13. Less aggressive than NSGCT :
- 2/3 to 3/4 patients present in stage 1
- No poor risk categeory in IGCC classification based on
level of TMs , Primay mediastinal tumor & Non Pulmonary
Viceral mets
Highly Radiosensitive: RT can cure LNs upto 5 cm
Highly Chemosensitive tumor : can be curative in stage IV
Seminoma
14. Seminoma : special types
• Anaplastic :
- 10 % of seminomas, accounts for 30% deaths due to seminoma
- High mitotic activity/faster spread : presents in advanced stage
- Stage to stage prognosis is equal to typical seminoma
• Spermatocytic seminoma : 1-2% of seminomas, elderly male
- Best prognosis of all testicular tumors
- No metastasis reported, so Radical orchiectomy is an enough Tt
15. NSGCTs
• A Group of variuos histologies:
- usually Mixed germ cell tumor
• Yolk sac tumor/ endodermal sinus tumor:
- is the most common testicular tumor in children
• Teratoma ( +/- malignant transformation):
- second most common testicular tumor in children
16. NSGCTs
Younger age of presentation than seminoma (by5 yrs)
More aggressive than Seminoma :
- 2/3 present with nodal (stage 2 ) or higher disease
Highly Chemosensitive : can be curative in stage IV
Surgery sensitive tumor : RPLND can cure LNs upto 5 cm
No role of Radiotherapy
17. Ledig cell tumors : 1% of total , 10% malignant
- Gynaecomastia, Reinke crystals
- never malignant in prepubertal boys
- histology cannot diagnose malignancy so labelled
malignant only when metastasis is seen
Sertoli cell tumors : < 1%, 10% malignant
- malignancy is diagnosed by metastasis
Other Tumors
18. Tumor markers
HCG : comes from SynCytiotrophoblasts, elevated in :
- in all Choriocarcinomas
- 50% of embryonal carcinomas
- 5-10% of pure seminomas
levels in male : < 1 ng/ml ( 10 mIU/ml)
half life : 24 Hr ( of beta subunit – 1 Hr )
19. Tumor markers
Alpha – fetoprotein : by Yolk Sac, it’s presence rules out :
- Pure Seminoma &
- Pure horiocarcinoma
- Half life(T1/2) : 5-7 days
LDH : marker of bulk of disease, is used to monitor :
- Advanced Seminoma
- Marker Negative NSGCT
21. Investigations
USG scrotum : if doubt in Dx for confirmation
Tumor markers : alfa fetoprotein, B- HCG, LDH
Chest Xray : for metastasis , LFTs
CECT scan abdomen for RP-LNs , if +nt do CT
chest also in same sitting
23. Staging
Clinical :
Boden & Gibb
A(1)- Confined to testes only
B(2)- Retroperitoneal LNs
C(3)- Extranodal disease
Skinner subdivided stage 2 into three subdivisions:
1 – testes only
2A- retroperitoneal LNs seen on imaging only
2B – Palpable LN mass
3 – supradiaphragmatic/medistinal/cervical LNs
4- Viceral mets
24. Staging
AJCC : TNMS staging
TNM + Risk groups according to TM levels ( Sx, S0, S1, S2 , S3)
IGCC risk groups : based on 1) TM 2) testicular /
retroperitoneal vs Mediatinal primary 3) Nonpulmonary
viceral Mets :
Seminoma – good and intermediate risk groups only
NSGCT – good , Intermediate and poor Risk groups
25.
26.
27. Stage grouping
T N M S
Stage 0 pTis N0 M0 S0
Stage 1 T1-4 N0 Mo S0
Stage Is Any T N0 M0 S1-3
Stage 2a Any T N1 M0 S0-1
2b Any T N2 M0 S0-1
2c Any T N3 M0 S0-1
Stage 3a Any T Any N M1 S0-1
3b Any T Any N M1 S2
3c Any T Any N M1 S3
28. • Subdivides stage I disease into stages Ia and Ib
depending on the T stage, as well as into stage Is
according to serum tumor marker levels.
• Stage II is subdivided into stages IIa, IIb, and IIc
depending on volume of retroperitoneal lymph
node involvement.
AJCC TNMS
29. • Stage III is subdivided into stages IIIa, IIIb, and IIIc
according to the degree of metastatic involvement
and serum tumor marker levels.
32. Initial Management in all
Don’t do FNAC / don’t give incision on scrotum
High inguinal ochiectomy (Radical orchiectomy ):
- to avoid local tissue violation
- to get the most proximal lymphatics
33.
34.
35. Role of Radical Orchiectomy
Diagnostic : Histology & Local Staging
Therapeutic :
• Decreasing the tumor burden
• A sufficient treatment ( curative ) in :
- CIS
- Spermatocytic seminoma
- Typical seminoma – if low risk & stage 1 ( smaller tumor,
no vascular & rete testis invasion ) with close surveillance
36. Principals of LN management
Seminoma : early stages can respond to RT- highly
radiosensitive tumor , Late stage – Chemotherapy
NSGCT : surgery ( RPLND) in early stage, in late stage
chemotherapy is mainstay of Tt – monitor by imaging and
tumor markers
Postchemotherapy residual LNs :
NSGCT – RPLND,
Seminoma - if <3cm and no hot spot on PET – can observe
37. Seminoma:
• Stage 1 seminoma (T1-3, N0, M0, S0)
Spermatocytic Typical/ Anaplastic
No adjuvant therapy
Surveillance- no risk factors
Radiation- low dose
abdominal and pelvic
Chemotherapy- Carboplatin
38. Risk factors in stage 1 seminoma
• Primary tumor > 6 cm
• Vascular or lymphatic invasion
• Rete testis invasion
• Anaplastic type
39. Stage 2a, 2b (T1-3 N1-2, M0)
• Radiation - abdominal and pelvic.
(ipsilateral external iliac, bilateral common
iliac, the paracaval, para-aortic nodes
including the cisterna chyli) – Dog Leg RT field
• 150 cGy/day, 5 days per week.
40. Seminoma : Stage IIc & III ( N3 / M1-2)
• Cisplatin based chemotherapy:
- A major breakthrough in treatment of testicular tumor
- 3 or 4 cycles depending on response
PEB
VIP
VEIP
41. PEB
• Cisplatinum : 20 mg/m2
• Etoposide : 100 mg/m2
• Bleomycin : 30 units once a week X 3 wks
I.V. D1-D5
21 Days Cycle
42. Residual retroperitoneal mass after
chemotherapy in Seminoma
• Diffuse desmoplastic plaque < 3 cm & no hot spot on PET
scan : observation
• Discrete mass > 3 cm: surgical resection
Histology
necrosis/ fibrosis germ cell tumor
No further Tt CT- VIP : 2-3 cycles
44. NSGCT- Stage IIa, IIb (T1-3,N1-2,M0,S0-1)
• Bilateral nerve sparing RPLND
Or
• Primary CT- BEP 3 cycles
45. NSGCT- Stage IIc, III ( N3 / M1-2 )
Good risk – BEP
x 3 cycles
Resolution -
observation
Residual
retroperitoneal
disease
B/L RPLND &
Tumorectomy
Residual visceral
mets
Surgical excision
Persistent
elevation of
tumor markers
Salvage CT- VIP
46. Treatment after RPLND or Residual mass resection
After Primary modified RPLND for N0 disease :
Node <2 cm observation
Node >2cm Adjuvant CT(BEPx3)
After Primary B/L nerve sparing RPLND for N1-2 :
No further Tt, FU with TM & CT
Post-Chemo residual mass resection :
If RM show only Fibrosis/Necrosis no further Tt
If RM shows Viable tumor cells further CT needed:
If RMS was after 1st line CT : BEP x 2
If RMS was after 2nd line CT : VEIP x2 ? Increased survival
47. NSGCT- Stage IIc, III ( N3 / M1-2 )
Poor risk
patient
High dose
CT and
ABMT or
stem cell
support
Poor
response-
salvage CT
Desperation
surgery
48. CT Refractory Testicular tumor
• If TM still high after 3 ( low & intermediate risk disease) to 4
( high risk disease) cycles go to 2nd line CT : VIP X 4 cycles
if TMs still high go for:
- ABMT + High dose CT
or
- Desperation Surgery
49. Desperation Surgery
Some times TMs may not respond at all /poorly respond
even after 2nd line CT ; then assess the resectability of
whole residual disease in abdominal, mediastinal &
supraclavicular region and lung lesions ( if <2 sites &
completely resectable ) remove them
- if TMs become normal: give 2 cycle of CT & FU
- If TMs still high – poor prognosis , uncontrollable disease –
very rare situation
50. Tumor markers : therapeutic implications
Sustained Elevation of TMs or slower decrease after
orchiectomy / RPLND means residual disease
Post-orchiectomy Chemotherapy is continued in
treatment of Treatment of testicular tumor till tumor
markers become –ve & then decide for any residual LNs
Normalization of marker is not definite evidence of
complete surgical cure
51. Highly radiosensitive Tumor : RT used as
1) Prophylactic RT - to abd. LNs for : High risk stage 1 disease
(No LNs) – to prevent recurrence
2) Prophylactic RT - to Hemiscrotum and inguinal LNs if scrotal
violation
3) Therapeutic RT - to LNs for : LN < 5 cm size ( stage 2b)
Seminoma : Therapeutics
52. Highly Chemosensitive Tumor : CT used as
1) Prophylactic CT :
for high risk stage 1 disease – one cycle of plantinum
2) Therapeutic CT :
for >5 cm LNs - 3 cycles PEB
3) Salvage CT : - if HPE of Residual masses if +ve
- as second line CT if first line CT fails.
Seminoma : Therapeutics
53. NSGCT : therapeutics
Surgery Sensitive Tumor: RPLND used as
1) Prophylactic / Elective RPLND : for N0 (stage 1) disease
if high risk ( pT2 & LVI) + 2 x BEP also after RPLND
2) Therapeutic RPLND: for < 5 cm LNs (stage 2a& 2b)
3) Desperation Surgery : in chemoresistant resectable disease
54. NSGCT : therapeutics
Highly Chemosensitive Tumor : used as
1) Prophylactic CT :
for stage 1 ( no LN) disease – 1 or 2 cycles
2) Therapeutic CT : for > 5 cm LNs
3) Salvage CT :
- if HPE of Residual masses if +ve
- as second line CT if first line CT fails
55. • A 17 yrs male present with painless Rt.
testicular swelling and palpable abd. LNs
• Investigations show high TMs (alpha FP and
beta HCG), CT scan shows - 12 cm para-aortic
abdominal mass & no liver and chest mets
• After Radical Orchiectomy- TMs remain high
Case study
56. Q1. HPE of specimen is NSGCT stage T3.
What is the next most appropriate Tt for this
patient ?
1. Chemotherapy
2. Retroperitoneal Lymphnode dissection
3. Radiotherapy
4. Desperation surgery
57. Q2. Patient undergoes 2 cycles of PEB, there is
no significant fall of TMs, however abdominal
LNs become smaller on palpation, what is next
course of treatment ?
1. Continue PEB till 4 cycles
2. Start 2nd line of CT ( VEIP)
3. Plan for HD-CT + ABMT
4. Do desperation surgery
58. Q3. Patient undergoes 4 cycles of PEB, TMs fall,
however they are still above the normal ranges.
Abdominal LNs become nonpalpable. What is
the next plan of action ?
1. Continue PEB for 6 cycles
2. Start 2nd line of CT ( VEIP)
3. Paln for HD-CT + ABMT
4. Do desperation surgery
59. Q4. Patient started on 2nd line CT VEIP, after 3
cycles TMs become normal. Now abdominal CT
shows 2 paraortic masses , one 1 cm in size and
another 2 cm. what should be the next course of
action ?
1. Get a abdominal PET scan
2. Do abdominal residual masses resection
3. Continue VEIP to 4 cycles
4. Observe the masses and keep pt in FU
60. Q5. Patient undergoes Residual masses
resection. Histopathology of the resected
masses show only fibrotic/necrotic material
without any viable tumor cell. What is the next
course of action?
1. Observation and FU with TM and CT scans
2. Observation and FU with TM,CT and PET
scans
3. VEIP x 2 more cycles
4. Radiotherapy
61.
62. MCQs
Q1. Most common testicular tumor in infants and
children is :
1. Yolk sac tumor
2. Seminoma
3. Teratoma
4. Choriocarcinoma
63. Q2. Not a risk factor for testicular Tumor :
1. Contralateral testicular cancer
2. Family history
3. Somatosexual ambiguity
4. Orchitis
64. Q3. Gold standard for diagnosing Testicular
Carcinoma in situ (CIS) :
1. Testicular USG
2. Testicular biopsy
3. Testicular FNAC
4. Semen analysis
65. Q4. Tumor marker for pure seminoma is :
1. beta HCG
2. Alpha-Feto-Protein
3. LDH
4. Placental alkaline phosphatase
5. None of the above
66. Q5. “Nerve sparing RPLND” is done to preserve :
1. Erection
2. Ejeculation
3. Urinary continence
4. Fecal continence