This document discusses the clinical features and investigation of testicular tumors. It covers topics such as: - Common symptoms of primary tumors include painless testicular lumps and sensation of heaviness. Secondary symptoms from metastasis can include abdominal/back pain, dyspnea, and bone pain. - Examination involves inspecting the testicles for size, shape, consistency and assessing for lymph node involvement. - Investigations include blood tests to measure tumor markers like AFP, HCG, LDH. Imaging tests like scrotal ultrasound, chest X-ray, abdominal CT scan are also used to detect primary tumors and metastasis. - Frozen section biopsy during surgery can quickly confirm diagnosis. Role of tumor

1. HUSSAIN BANGI
DEPARTMENT OF SURGERY
AL-AMEEN MEDICAL COLLEGE
BIJAPUR
CLINICALFEATURES
AND
INVESTIGATION OF
TESTICULAR
TUMORS

2. CLINICAL FEATURES
1.Due to the primary tumour
‣
‣ Enlargement of testis
‣ Painless testicular lump
‣ Sensation of heaviness if size > then 2.3times
‣ Rarely dragging pain is complaint of ( 1/3rd of
cases) ie . 30% of cases

3. PAINLESS
TESTICULAR LUMP

4. ‣ Secondary hydrocele is common
‣ Cremaster is hypertrophied and thickened
‣ May mimic -epididymo-orchitis
‣ Sudden pain and enlargement due to
hemorrhage-mimicking Torsion of testis
‣ Vas , prostate and seminal vesicles are Normal

5. 2. DUE TO METASTASIS
▸Abdominal or lumbar pain ( lymphatic spread )
▸Often in epigastric region , para -aortic lymph nodes , may be
, palpable , as hard , nodular, non- tender , non mobile ,
vertically placed , resonant mass ie , ( Doesn't move with
respiration)
▸Dyspnaea, hemoptysis , and chest pain with lung mets
▸Bone pain , tender , due to secondaries
▸Jaundice with liver mets

6. PALPABLE PARA-AORTIC LYMPH
NODE

7. ▸Hydronephrosis by para aortic lymph node enlargement
▸Pedal oedema by IVC obstructions
▸Troisers sign
▸Inguinal nodes are involved if Tumour breaches the tunica
Albugenia
▸CNS/Spinal cord - May also be involved by secondaries

8. NOTE :
HURRICANE
TYPE -
‣ Is a very aggressive,
highly malignant,
testicular tumour which
is more often fatal in
weeks .

9. 3. CLINICAL EXAMINATION
HISTORY
‣ Age of the patient - Teratoma usually occur -between 20-
30yrs of age and Seminoma- 30-40yrs of age
‣ H/o about the swelling- onset , progressive or any H/o of
injury
‣ Any pain over the swelling

10. ▸Testicular tumors are usually painless to start with or there
may be dragging pain in the scrotum, or sometimes may be
acute resembling acute epididymo-orchitis
▸Any swelling in the Abdomen & Neck
▸Any h/o of loss of appetite, weight or generalised weakness,
jaundice, cough , hemoptysis
▸Any h/o of undescended testis or orchidopexy
▸H/o of Gynecomastia

11. EXAMINATION -INSPECTION / PALPATION
▸Examination of swelling, possible to get above the swelling
▸Site , & extent , size , shape surface , margin and
consistency
▸Asses the testicular sensation
▸Examination of spermatic cord
▸Examination of abdomen -for any mass , palpate liver ,
spleen

12. INVESTIGATION
A. LABORATORY STUDIES
CBC , LFT , RFT , ELECTROLYTES,
B. SERUM ASSAY
Alpha fetoprotein (AFP)
Beta Human chorionic gonadotropin
Lactate dehydrogenase
Placental Alkaline phosphatase

13. TUMOUR MARKER
▸Onco-fetal substance : AFP & HCG
▸AFP -Trophoblastic cells
▸HCG - Syncytiotrophoblastic cells
▸AFP ,HCG & LDH are included in TNM staging of testicular
cancers

14. HUMAN CHORIONIC GONADOTROPIN (HCG)
▸Has alpha & beta polypeptide chain
▸Normal : <1ng/ml
▸Half life : 24 to 36 hrs
Raised B-HCG
100% - Choriocarcinoma
60% -Embryonal carcinoma
55% -Non - seminomatous germ cell Tumour (teratoma)
25% - Yolk cell tumours
7%- Elevated in advanced cases of seminomas

15. ALPHA FETOPROTEIN (AFP)
▸Normal level : <16ngm/ml
Half life : 5 to 7days
Raised AFP
‣ Non seminomatous germcell Tumour (teratoma )-65%
‣ Raised AFP always indicates teratomatous tumors
‣ AFP level is not increased in pure seminomas

16. ▸LDH level depends on growth rate/ cellular
proliferation/Tumour burden
LDH is increased in 80% of advanced seminomas & 60% of
non - seminomatous germ cell Tumour
Placental alkaline phosphatase is increased in seminomas

17. ROLE OF TUMOUR MARKERS
▸Helps in Diagnosis - 80 to 85% of testicular Tumour have +ve
markers
▸Most of the Non - Seminomatous have increased markers.
INDICATION OF HISTOLOGY OF TUMOUR
‣ If AFP elevated in seminomas - means Tumour,has Non
seminomatous element
‣ Degree of Marker elevated appears to be directly proportional to
Tumour burden

18. RESPONSIVENESS OF TREATMENT
▸The level of beta -HCG should decrease by 90% or more
every 21 days of treatment cycle
▸Normalisation of Tumour Marker after high inguinal
orchidectomy doesn't ensure disease removed , however
after orchidectomy , if the markers elevated mean
RESIDUAL DISEASES
▸Negative Tumour markers becoming positive on follow up
usually indicates- Recurrence of Tumour

19. Q. WILL YOU DO A FNAC OR INCISIONAL
BIOPSY ?
?

20. FROZEN SECTION
BIOPSY
▸ This procedure is done on the table
when the patient is being operated
▸ It take hardly 5-10min to confirm the
diagnosis
Q. WHAT CAN BE DONE
..?

21. SCROTAL USG
USG of the scrotum is rapid & reliable technique to
exclude A. Solid & Cystic swelling.
B. Testicular & other scrotal swelling
C. Hydrocele & epididymis
On sonogram, we see , hypoechoic area within the
tunica albuginea is markedly suspicion testicular
cancer
Seminomas are often more homogeneous than Non-
seminomatous Tumour

22. DIAGNOSTIC
RADIOLOGY
▸ Chest X-ray to look for lung
secondaries (HRCT - ideal )
▸ USG abdomen -
▸ CT abdomen -
▸ CT -scan for chest - Non
seminomatous and stage 2
seminomas
▸ Don't forget to do USG of
contralateral testis 😂😅

23. "HOPE SEE THE INVISIBLE,
AND ACHIEVE THE
IMPOSSIBLE" -THANK YOU