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.
pathology of round cell tumours of osseo articular system like ewings sarcoma, mesenchymal chondrosarcoma,small cell osteosarcoma, plasma cell neoplasms and other hematopoietic malignancies. how immunochemistry os playing pivotal role in differential diagnosis.
pathology of round cell tumours of osseo articular system like ewings sarcoma, mesenchymal chondrosarcoma,small cell osteosarcoma, plasma cell neoplasms and other hematopoietic malignancies. how immunochemistry os playing pivotal role in differential diagnosis.
various cutaneous lymphomas though having low incidence but need to be diagnosed accurately. they can be mimiced by many non neoplastic conditions of skin. so discussing both T and B cell lymphomas
Testicular tumors are rare.
1 – 2 % of all malignant tumors.
Most common malignancy in men in the 15 to 35 year age group.
Benign lesions represent a greater percentage of cases in children than in adults.
Most curable solid neoplasm
various cutaneous lymphomas though having low incidence but need to be diagnosed accurately. they can be mimiced by many non neoplastic conditions of skin. so discussing both T and B cell lymphomas
Testicular tumors are rare.
1 – 2 % of all malignant tumors.
Most common malignancy in men in the 15 to 35 year age group.
Benign lesions represent a greater percentage of cases in children than in adults.
Most curable solid neoplasm
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
3. Skin
DARTOS Muscle
External Spermatic Fascia
Cremastric Muscle
Internal Spermatic Fascia
Tunica Vaginalis
Tunica Albuginea
Coverings of testis
4. Structure of testis
• 200-300 lobules
• Each lobule has 2-3 seminiferous tubules
• Each seminiferous tubules lined by cell in
different stages of spermatogenesis
• Among the seminiferous tubules are Sertoli
cells.
• Between the loops of the seminiferous
tubules are interstitial cells, produce
testosterone.
6. Lymphatic Drainage
Drain into the retroperitoneal lymph glands between the
levels of T11 and L4, but they are concentrated at the level
of the L1 and L3 vertebrae
7. Testicular Tumor
INTRODUCTION
Testicular cancer forms about 1 -1.5% of all malignancies in males
Incidence – 0.6 per 100000
Mortality – 0.3 per 100000
Cure rate increased with introduction of platinum based chemotherapy from 10 to 80%
8. EPIDEMOLOGY OF TESTICULAR CANCER
• Age: for GCT: median age at diagnosis is 34 years.
• Age - 3 peaks
2 – 4 yrs
20 – 40 yrs
above 50 yrs
In a man age: 50 years or older solid testicular mass is usually
lymphoma
• Race: more common in young white men ,less in African .
10. Predisposing Factors
1. Cryptorchidism
2. Klinefelter syndrome
3. Positive family history
4. Contralateral germ cell tumor
5. Trauma
6. Viral infection
7. Hormonal factors
8. Exposure to environmental oestrogen
11. Predisposing Factors
1. Cryptorchidism
• This risk is further increased if the testis is intra-abdominal.
• Abdominal testis is more likely to be seminoma, testis brought to
scrotum by orchiopexy is more likely to be NSGCT.
• There is still an increased risk of developing a tumour in the
contralateral normally descended testicle in pt. with cryptorchidism
• Prepubertal orchidopexy fails to prevent the subsequent development
of malignancy
14. Seminoma
The commonest variety of testicular tumour
Adults are the usual target (4th and 5th decade); never seen in infancy
Starts in the mediastinum: compresses the surrounding structure.
Patients present with painless testicular mass
30 % have metastases at presentation, but only 3% have symptoms related to
metastases
15. Seminoma
• Serum alpha fetoprotein is normal
• Beta HCG is elevated in 30% of patients with Seminoma
• Classification
a) classical
b) Anaplastic
c) Spermatocytic
16. Gross appearance of seminoma. The tumor in A is very small,
whereas that in B has replaced most of the testis
17. Embryonal Carcinoma
2nd most common germ cell tumor 90% of NSGCT
Most men present in their 20s to 30s with a testicular mass
Highly malignant tumours; may invade the cord stuctures.epidydymis
High degree of metastasis
Serum AFP is positive in 33%, & beta HCG is elevated in 20% of cases
19. Yolk Sac Tumour
Most common germ cell tumor ( & most common testicular tumor ) in children,
• 60% of GCT in children. First 2 years of life.
• #<2% of testicular tumors in adults
• Elevated serum levels of alpha-fetoprotein.
• Microscopically, Schiller-Duval bodies are a characteristic feature
Testicular mass the most usual presentation.
20. YOLK SAC TUMOR
• MACROSCOPIC :
white to tan masses,
with myxoid & cystic
changes
22. The cut surface of this adult yolk sac tumor shows areas of hemorrhage and cystic change.
23. Choriocarcinoma
A rare and aggressive tumour (5yrs survival is 5%)
Typically elevated hCG
Primary is very small and often exhibit NO TESTICULAR
ENLARGEMENT
Small palpable nodule may be present
Presents with disseminated disease.
Prone to hemorrhage.
25. Teratoma
Teratoma in greek means “monster tumor”
Contain all three germ layers with varying degree of
diffrentiation
Occurs in its pure form in pediatric age group.
In adults, occur as a component of mixed germ cell tumor.
Normal serum marker
◦ Mildly elevated AFP levels
26. Interstitial cell tumors
1. Leydig cell tumors
Presents with painless testicular mass
A masculinising tumor, produces androgens
Precocious puberty
Prominent external genitalia
Deep masculinised voice
Pubic hair
Gynacomastia and decreased libodo due to oestrogen production by
increased peripheral conversion
27. LEYDIG CELL TUMOR
• MACROSCOPIC :
1. Leydig cells impart a
golden brown colour.
tumor is solid &
lobulated
2. Necrosis can be seen in
malignant tumors
28. Interstitial cell tumors
2. Sertoli Cell Tumor
can occur in any age group including infants
It is a faminising tumor
Excess estrogen production
Gynacomastia in 1/3rd of cases
10 % are malignant
29. Interstitial cell tumors
3. Gonadoblastoma
Mixed germ cell.
Composed of seminoma like germ cells and Sertoli cells.
Exclusively in patients with dysgenic gonads and intersex syndromes
80% are phenotype females with primary amenorrhoea
20% are males with crytochordism and dysgenic gonads and hypospadias
Bilateral orchidectomy because of risk of bilateral tumours.
30. LYMPHOMA
• CLINICAL :
1. Lymphoma most often result of secondary spread; occasionally ,
primary lymphoma may occur
2. Most men are in their 60s
3. Involvement is bilateral in 20 % of all cases
32. Spread
1. Direct spread
2. Lymphatic spread
They drain primarily to para-aortic lymph nodes
No inguinal nodes until scrotal skin involvement
Seminoma metastasize exclusively through
lymphatics
3. Blood Spread
NSGCT spread through blood route
Lungs, liver, bones and brain are the usual sites usually involved
33. CLINICAL FEATURES
Painless Swelling of Testes
Dull Ache or Heaviness in Lower Abdomen
10% - Acute Scrotal Pain
10% - Present with Metatstasis
• - Neck Mass / Cough / Anorexia / Vomiting / Back Ache/ Lower limb swelling
5% - Gynecomastia
Rarely - Infertility
December 16 33Recent advances in the management of Testicular tumor
34. Clinical Features
2. Due to metastasis
Abdominal or lumbar pain (lymphatic spread)
Dyspnoea, hemoptysis and chest pain with lung mets
Jaundice with liver mets
Hydronephrosis by para-aortic lymph nodes enlargement
Pedal oedema by IVC obstruction
35. Clinical Features
3. Clinical examination:
a) Enlarged testis (except choriocarcinoma)
b) Nodular testis
c) Firm to hard in consistency
d) Loss of testicular sensation
e) Secondary hydrocele
36. INVESTIGATIONS
1. Scrotal Ultrasound
2. CT Scan Abdomen & Pelvis
3. CT Thorax / Chest X-Ray - PA and lateral views
4. Tumour Markers
- AFP
- HCG
5. MRI/PET Scan
December 16 36Recent advances in the management of Testicular tumor
37. Human Chorionic
Gonadotropin
NORMAL VALUE: < 1 ng / ml
HALF LIFE of HCG: 24 to 36 hours
RAISED HCG -
100 % - Choriocarcinoma
60% - Embryonal carcinoma
55% - Teratocarcinoma
25% - Yolk Cell Tumour
7% - Seminomas
normal value: below 16 ngm / ml
half life of AFP – 5 and 7 days
Raised AFP :
Pure embryonal carcinoma
Teratocarcinoma
Yolk sac Tumor
Combined tumors,
AFP not raised in pure choriocarcinoma & in
pure seminoma
AFP –Alfa feto protein
38. ROLE OF TUMOUR MARKERS
• Helps in Diagnosis - 80 to 85% of Testicular Tumors have Positive Markers
• Most of Non-Seminomas have raised markers.
• Degree of Marker Elevation Appears to be Directly Proportional to Tumor Burden
• Normalization of tumor marker after high inguinal orchidectomy does not
ensure complete disease removal however after Orchidectomy if Markers
Elevated means Residual Disease
• Negative Tumor Markers becoming positive on follow up usually indicates -
Recurrence of Tumor
• Markers become Positive earlier than radiological studies
41. SURGICAL TREATMENT
Scrotal Exploration and orchidectomy for suspected
testicular tumor
• Radical orchiectomy
• Diagnostic and Therapeutic treatment of choice.
• Complete removal of ipsilateral epididymis and spermatic cord to the level
of the internal inguinal ring.
• Partial orchiectomy
• Considered in patient with polar tumor measuring 2 cm or less.
• Adjuvant radiotherapy is given postoperatively.
41
42. CHEMOTHERAPY
• Indications
• As an alternative to adjuvant RT for stages I–II seminoma
• Adjuvant therapy for stages II–IV seminoma
• Regimens
• Regimens including BEP, EP, PVB, and VIP for stages II–IV diseases
Drug/ combination Dose and schedule
Bleomycin 30 IU IV bolus on days 2,9,16
Etoposide 100 mg/m2 IV over 30 mins on
days 1-5
Cisplatin 20 mg/m2 IV over 15-30 mins
on days 1-5
Repeat cycle every 21 days for 3 or 4 cycles
December 16 42Recent advances in the management of Testicular tumor
43. RETROPERITONEAL LYMPH NODE DISSECTION
• The rationale for primary RPLND is that, in contrast to most malignancies, testicular GCT is
surgically curable in most patients with low volume regional metastases.
43
44. Fig. 8 Laparoscopic RPLND Port Placement
December 16 44Recent advances in the management of Testicular tumor
45. Fig. 9 Robotic assisted RPLND Port Placement
December 16 45Recent advances in the management of Testicular tumor
46. RADIATION THERAPY
• Seminoma is extremely radiosensitive. Radiation therapy is often used for adjuvant therapy for
early-stage seminoma, and its use in non-seminoma germ cell tumors (GCT) is limited.
December 16 46Recent advances in the management of Testicular tumor
47. • Fig. 10 Paraaortic and ipsilateral
inguinal field for stage II
left testicular seminoms,
with inclusion of the
renal hilus.
December 16 47Recent advances in the management of Testicular tumor