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Testicular ultrasound is useful for evaluating a testicular mass and can confirm physical examination findings. A radical orchiectomy is preferred for removing a testicular mass to avoid tumor spread from biopsies. Imaging like chest x-ray, CT scans of the chest and abdomen should be done to evaluate for metastases. Blood markers like BHCG and AFP are elevated in 85% of patients with disseminated germ cell tumors and can help monitor response to chemotherapy treatment. Pathology reports can identify seminoma or non-seminomatous germ cell tumors which have different characteristics and presentations.
Testicular ultrasound is useful for evaluating a testicular mass and can confirm physical examination findings. A radical orchiectomy is preferred for removing a testicular mass to avoid tumor spread from biopsies. Imaging like chest x-ray, CT scans of the chest and abdomen should be done to evaluate for metastases. Blood markers like BHCG and AFP are elevated in 85% of patients with disseminated germ cell tumors and can help monitor response to chemotherapy treatment. Pathology reports can identify seminoma or non-seminomatous germ cell tumors which have different characteristics and presentations.
Testicular ultrasound is useful for evaluating a testicular mass and can confirm physical examination findings. A radical orchiectomy is preferred for removing a testicular mass to avoid tumor spread from biopsies. Imaging like chest x-ray, CT scans of the chest and abdomen should be done to evaluate for metastases. Blood markers like BHCG and AFP are elevated in 85% of patients with disseminated germ cell tumors and can help monitor response to chemotherapy treatment. Pathology reports can identify seminoma or non-seminomatous germ cell tumors which have different characteristics and presentations.
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.