Dr.

Ricardo Isip March 26, 2021

Diagnosis of Testicular Tumors

Arevalo, Jaranilla, Loreno, Jazareno, Luciano, Raro, Cuajao, Madera, Malaiba,

Chito, Marco, Mausisa, Najito, Picones, Villones, Carillo, Galvez, Tan, Utod
 Dr. Ricardo Isip March 26, 2021

NOTES
- If patient’s complain points
towards genitourinary system,
thorough examination of genitalia
is warranted.

Arevalo, Jaranilla, Loreno, Jazareno, Luciano, Raro, Cuajao, Madera, Malaiba,

Chito, Marco, Mausisa, Najito, Picones, Villones, Carillo, Galvez, Tan, Utod
 Dr. Ricardo Isip` March 26, 2021

NOTES

Arevalo, Jaranilla, Loreno, Jazareno, Luciano, Raro, Cuajao, Madera, Malaiba,

Chito, Marco, Mausisa, Najito, Picones, Villones, Carillo, Galvez, Tan, Utod
 Dr. Ricardo Isip` March 26, 2021

NOTES

Arevalo, Jaranilla, Loreno, Jazareno, Luciano, Raro, Cuajao, Madera, Malaiba,

Chito, Marco, Mausisa, Najito, Picones, Villones, Carillo, Galvez, Tan, Utod
 Dr. Ricardo Isip` March 26, 2021

NOTES
- TAKE NOTE OF THIS ALGORITHM!

Arevalo, Jaranilla, Loreno, Jazareno, Luciano, Raro, Cuajao, Madera, Malaiba,

Chito, Marco, Mausisa, Najito, Picones, Villones, Carillo, Galvez, Tan, Utod
 Dr. Ricardo Isip` March 26, 2021

NOTES
- TAKE NOTE OF THIS ALGORITHM!

Arevalo, Jaranilla, Loreno, Jazareno, Luciano, Raro, Cuajao, Madera, Malaiba,

Chito, Marco, Mausisa, Najito, Picones, Villones, Carillo, Galvez, Tan, Utod
 Dr. Ricardo Isip` March 26, 2021

NOTES

Arevalo, Jaranilla, Loreno, Jazareno, Luciano, Raro, Cuajao, Madera, Malaiba,

Chito, Marco, Mausisa, Najito, Picones, Villones, Carillo, Galvez, Tan, Utod
 Dr. Ricardo Isip` March 26, 2021

NOTES
This is a transillumination test using a
standard dermatoscope.

A pen light can be used as an

alternative for dermatoscope.

A positive transillumination test -

reddish hue with fluid-filled mass →
HYDROCOELE

Put the light underneath the scrotum

then switch it on.

Arevalo, Jaranilla, Loreno, Jazareno, Luciano, Raro, Cuajao, Madera, Malaiba,

Chito, Marco, Mausisa, Najito, Picones, Villones, Carillo, Galvez, Tan, Utod
 Dr. Ricardo Isip` March 26, 2021

NOTES
A testicular mass should be
considered malignant unless
proven otherwise.

Arevalo, Jaranilla, Loreno, Jazareno, Luciano, Raro, Cuajao, Madera, Malaiba,

Chito, Marco, Mausisa, Najito, Picones, Villones, Carillo, Galvez, Tan, Utod
 Dr. Ricardo Isip` March 26, 2021

NOTES
Initial studies for a patient with scrotal
mass must include tumor markers such
as AFP, β-hCG, and LDH to diagnose
testicular tumors.

Elevated tumor markers are found

exclusively in non-seminoma germ cell
tumors. Although, up to 10% of patient
with localized seminomas and 25%
with metastatic seminoma. A modest
rise in β-hCG in metastatic seminoma
as well.

Arevalo, Jaranilla, Loreno, Jazareno, Luciano, Raro, Cuajao, Madera, Malaiba,

Chito, Marco, Mausisa, Najito, Picones, Villones, Carillo, Galvez, Tan, Utod
 Dr. Ricardo Isip` March 26, 2021

NOTES
A representative chest imaging of a patient
with testicular tumor with metastasis to the
lung.

Cotton ball appearance = metastatic tumors

Chest and abdominal imaging must be

performed in order to evaluate the
metastasis.

Arevalo, Jaranilla, Loreno, Jazareno, Luciano, Raro, Cuajao, Madera, Malaiba,

Chito, Marco, Mausisa, Najito, Picones, Villones, Carillo, Galvez, Tan, Utod
 Dr. Ricardo Isip` March 26, 2021

NOTES
The most common site for testicular
tumor is at the retroperitoneal lymph
nodes and extending from the common
iliac vessels to the renal vessels hence,
abdominal imaging should be
performed in all patients.

Arevalo, Jaranilla, Loreno, Jazareno, Luciano, Raro, Cuajao, Madera, Malaiba,

Chito, Marco, Mausisa, Najito, Picones, Villones, Carillo, Galvez, Tan, Utod
 Dr. Ricardo Isip` March 26, 2021

NOTES
● Percutaneous Biopsy has NO
ROLE in testicular mass due to
↑ risk of seeding the scrotal
wall and spreading the cancer to
other parts of the scrotum and
it may change the natural
retroperitoneal lymphatic
drainage of the testicle.
-

Arevalo, Jaranilla, Loreno, Jazareno, Luciano, Raro, Cuajao, Madera, Malaiba,

Chito, Marco, Mausisa, Najito, Picones, Villones, Carillo, Galvez, Tan, Utod
 Dr. Ricardo Isip` March 26, 2021

NOTES
● Open testicular biopsy is the most
recommended approach.
● Opening the patient from inguinal
area from the external inguinal ring
extending down the inguinal canal
to your internal ring then take out
the testes from there.
● Lymphoma Cases: involved both
testis.
● Unilateral testis: most probably a
testicular tumor.

Arevalo, Jaranilla, Loreno, Jazareno, Luciano, Raro, Cuajao, Madera, Malaiba,

Chito, Marco, Mausisa, Najito, Picones, Villones, Carillo, Galvez, Tan, Utod
 Dr. Ricardo Isip` March 26, 2021

NOTES
● Scrotal Ultrasound- use to
differentiate other scrotal
pathology.

Arevalo, Jaranilla, Loreno, Jazareno, Luciano, Raro, Cuajao, Madera, Malaiba,

Chito, Marco, Mausisa, Najito, Picones, Villones, Carillo, Galvez, Tan, Utod
 Dr. Ricardo Isip` March 26, 2021

● Testicular Torsion- Absence of blood

-
flow
- in color doppler as seen in the
left image.
● Patients with hydrocele and other
cystic lesion of scrotal contents
should undergo duplex/doppler
ultrasound.

Arevalo, Jaranilla, Loreno, Jazareno, Luciano, Raro, Cuajao, Madera, Malaiba,

Chito, Marco, Mausisa, Najito, Picones, Villones, Carillo, Galvez, Tan, Utod
 Dr. Ricardo Isip` March 26, 2021

NOTES
● Testis tumor patient should
undergo complete metastatic
workup and evaluation (Complete
laboratory [w/ tumor markers] ,
chest and abdominal imaging) →
done prior to surgical intervention
(Orchiectomy, Biopsy)

Arevalo, Jaranilla, Loreno, Jazareno, Luciano, Raro, Cuajao, Madera, Malaiba,

Chito, Marco, Mausisa, Najito, Picones, Villones, Carillo, Galvez, Tan, Utod
 Dr. Ricardo Isip` March 26, 2021

NOTES
● Bone and Brain Imaging
● Brain Imaging should be performed
in all choriocarcinomas
● Bone imaging can be performed in
other testicular tumors

Arevalo, Jaranilla, Loreno, Jazareno, Luciano, Raro, Cuajao, Madera, Malaiba,

Chito, Marco, Mausisa, Najito, Picones, Villones, Carillo, Galvez, Tan, Utod
 Dr. Ricardo Isip` March 26, 2021

NOTES
SELF EXAMINATION IS
THE KEY FOR EARLIER
DIAGNOSIS

Arevalo, Jaranilla, Loreno, Jazareno, Luciano, Raro, Cuajao, Madera, Malaiba,

Chito, Marco, Mausisa, Najito, Picones, Villones, Carillo, Galvez, Tan, Utod