TT, TEO, CH & Gumma

Testicular tumor
Seminoma Teratoma Combined Interstitial tumors

History
Painless lump at private area Testicle feel heavy (diagnostic) Malaise, loss of weightsymptoms of metastases Associated with incomplete descended testis
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Examination
Swelling confined to scrotum, non tender Spherical shape Smooth surface Hard in consistency Dull on percussion Not fluctuant, not translucent

Management
Staging; Ultrasound (confirm) Tumor marker (monitoring) CXR (mets) Orchidectomy CT and MRI

 Stage 1; testis lesion only Stage 2; nodes below diaphragm only Stage 3; nodes above diaphragm Stage 4; pulmonary or hepatic mets

Source: Bailey & Loves Short Practice of Surgery

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Teratoma
Arise from totipotent cells in rete testis 3 layers of germ layers Variety of cell

Source: Bailey & Loves Short Practice of Surgery

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Source: Bailey & Loves Short Practice of Surgery

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 Stage 1 - Monitor level of tumor marker & repeat CT Stage 2-4 - Chemotherapy - Retroperitoneal lymph node dissection

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Interstitial cells tumors

Leydig and Sertoli cells Prepubertal; masculinises Postpubertal; feminises Benign Orchidectomy

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Tuberculous epididymo-orchitis
Lump in scrotum associated with dull, aching pain +/- systemic or urinary symptoms of TB Develop slowly Blood stream or from lower urinary tract

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Examination
Epididymis hard, knobbly, 2-3x larger Thickened spermatic cord Vas deferens - irregular, swollen and feel like a string of bead (diagnostic) Secondary hydrocele Tuberculous abscess

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Management
Urine and semen IVU and CXR Treat primary focus Anti tuberculous is less effective. So, if No response in 2 months epididymectomy/orchidec tomy

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Chronic haematocele
Occur when acute episode is not treated. Characteristic:
Hard mass Non-tender Not fluctuant

Source: Bailey & Loves Short Practice of Surgery

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Management
Ultrasound Orchidectomy Testis is often compressed and relatively useless

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Gumma
A small rubbery granuloma that is characteristic of an advanced stage of syphilis Gummas principally form in the liver, bones, and testes but may affect any organ.

Examination
Round and hard mass Billiard ball testis Painless Lump/whole organ enlargement

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Source: Browses Introduction to the Symptoms and Signs of Surgical Disease

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THANK YOU

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