This document discusses cryptorchidism, testicular torsion, and testicular neoplasms. Cryptorchidism is the failure of one or both testes to descend into the scrotum. It affects 1% of males and increases the risk of testicular cancer and infertility. Testicular torsion occurs when the spermatic cord twists, cutting off blood flow to the testis. It requires urgent surgery to untwist the cord. Testicular tumors are most often painless enlargements of the testis. Seminomas and non-seminomatous germ cell tumors are the main types and differ in aggressiveness and spread. Treatment involves surgery and chemotherapy with good cure rates.

1. Testis

2. Cryptorchidism
• failure of testicular descent into scrotum.
• Normally, testes descend from abdominal cavity into
pelvis by 3rd month of gestation & then through
inguinal canals into scrotum during the last 2 months
of intrauterine life.

3. • Diagnosis of cryptorchidism is only established with certainty
after the age of 1 year, particularly in premature infants,
because testicular descent into scrotum is not always complete
at birth.
• By 1 year of age, cryptorchidism affects 1% of male population.
• bilateral in 10% of affected pts.
• In the vast majority of cases, the cause of cryptorchidism is
unknown.
• Because undescended testes become atrophic, bilateral
cryptorchidism causes sterility.
• failure of descent is associated with 3- 5 fold increased risk of
testicular cancer

4. • Surgical placement of undescended testis into scrotum
(orchiopexy) before puberty decreases likelihood of
testicular atrophy & reduces but does not eliminate
risk of cancer & infertility.

5. Testicular Torsion
• Twisting of spermatic cord.
• Typically results in obstruction of testicular
venous drainage while leaving thick-walled &
more resilient arteries patent,
so that intense vascular engorgement &
venous infarction follow,
unless the torsion is relieved

6. • Neonatal torsion
occurs either in utero or shortly after birth.

7. • Adult torsion
• Typically seen in adolescence.
• sudden onset of testicular pain.
• bilateral
• often occurs without any inciting injury
• sudden pain heralding the torsion may even
awaken the patient from sleep.

8. • Urologic emergency.
• If the testis is explored surgically & cord can be
manually untwisted within 6 hours,
there is a good chance that testis will remain viable.
• To prevent the catastrophic occurrence of torsion in
contralateral testis, the unaffected testis typically is
surgically fixed within scrotum (orchiopexy).

9. Testicular Neoplasms

17. Clinically,
Testicular germ cell tumors can be divided into
two groups:
1. Seminomas
2. Non-seminomatous tumors
• occur with increased frequency in association with
undescended testis and with testicular dysgenesis.

18. Clinical Features
• Pts with testicular germ cell neoplasms present most
frequently with a painless testicular mass
• that (unlike hydroceles) is non-translucent.
• Testicular tumors are the most common cause of
painless testicular enlargement

19. • Biopsy of testicular neoplasm is associated with a risk
of tumor spillage, which would necessitate excision
of the scrotal skin in addition to orchiectomy.

20. • The standard management of a solid testicular mass
is radical orchiectomy.
based on the presumption of malignancy
• Some tumors, esp. non-seminomatous germ cell
neoplasms, may metastasized widely by the time of
diagnosis in the absence of palpable testicular lesion.

21. Seminomas & non-seminomatous tumors differ
in their behavior and clinical course:
• Seminomas often remain confined to testis for long intervals
& may reach considerable size before diagnosis.
• Metastases most commonly in iliac & para-aortic lymph
nodes, particularly in upper lumbar region.
• Hematogenous metastases occur late in the course of
disease.

22. • By contrast, non-seminomatous germ cell neoplasms
tend to metastasize earlier, by lymphatic as well as
hematogenous routes.
• Hematogenous metastases are most common in liver &
lungs.

23. Assay of tumor markers secreted by germ cell
tumors is important in two ways:
1. helpful diagnostically.
2. more valuable role in following response of
tumors to therapy after diagnosis is established.

24. • HCG is produced by syncytiotrophoblasts and is always
elevated in pts with choriocarcinomas and those with
seminomas containing syncytiotrophoblasts
• AFP in the setting of testicular neoplasm indicates a yolk
sac tumor component
• The levels of LDH correlate with tumor burden.

25. Treatment of testicular germ cell
neoplasms
• Lance Armstrong !
• after being treated for widely metastatic testicular
cancer, won the grueling Tour de France bicycle race
a record seven times !

26. • Seminoma are radiosensitive
& tends to remain localized for long periods, has the best prognosis.
• > 95% of pts with early-stage disease can be cured.
• Non-seminomatous tumors; aggressive chemotherapy
• Pure choriocarcinoma carries a dismal prognosis

27. • With all testicular tumors, recurrences, typically
in the form of distant metastases, usually occur
within the first 2 years after treatment.