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Diagnosis- Ultrasound.

Most patients with testicular cancer present


with a painless scrotal mass.
This mass may be confused with epididymitis, particularly
when pain is noted.
Careful attention on physical examination, should generally
discern a testicular mass from epididymitis.
Testicular ultrasound will confirm the findings.
Translumination of the testis may determine if the patient has a
hydrocele; however, about 20% of patients with germ cell tumors
of the testis will have a hydrocele.
Testicular ultrasound is one of the most useful tools to evaluate a
testicular mass.

The preferred approach in a patient with a


testicular mass is a radical orchiectomy using
the inguinal approach.
Fine-needle aspiration or trans-scrotal biopsy is
contraindicated because they can cause aberrant
spread of tumor to inguinal and iliac lymph node
chains.
Chest radiography should be performed to rule
out the possibility of pulmonary disease.
If negative, CT of the chest should be performed.

An abdominal CT scan should be done


to evaluate the retroperitoneal
lymph nodes.

BHCG and alpha-fetoprotein (AFP) levels


Are elevated in about 85% of the patients with
disseminated germ cell tumor.
During treatment with chemotherapy, at least a
one log reduction of serum beta-HCG should
occur every 3 weeks.
Patients with elevated AFP have a less
predictable decline.

Pathology:
Seminoma

Pure seminoma accounts for 47% of all testis cancers. These


patients usually present with disease in the fourth or fifth decade.
Approximately 75% of them present with stage I disease. They
may have modest elevations of serum beta-human chorionic
gonadotropin (beta-HCG). Any elevation of alpha-fetoprotein
connotes the presence of nonseminomatous germ cell tumor.
Spermatocytic seminoma accounts for 7% of all seminomas. The
median age of presentation is in the sixth and seventh decade of
life.

Pathology: Non seminomatous Germ Cell Tumors


Embryonal carcinoma

Choriocarcinoma

Yolk sac carcinoma

Teratoma