Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

1410 Testis Tumors

■possible secondary signs: supraclavicular mass, abdominal epigas-

tric mass, back pain, gynecomastia

tests

Diagnostic

■Physical exam alone strongly suggests Dx in most cases

■scrotal ultrasound a helpful adjunct if exam equivocal

■initial biopsy not recommended routinely

■Dx established by inguinal orchiectomy

■positive urine pregnancy test (HCG) proves germ cell tumor in males

(see below under tumor markers)

Staging

■metastasis is common via predictable retroperitoneal lymph nodes

draining testis in all cell types

■hematogenous spread uncommon except in choriocarcinoma

■involved sites in advanced disease (in descending order): lung >>

liver, or bone >> brain

■3-pronged approach to staging:

➣primary pathology predictors for spread

lymphovascular invasion in testis

embryonal carcinoma predominance

invasion into epididymis, rete testis, and/or spermatic cord

➣serum tumor markers

alpha fetoprotein (AFP) in embryonal carcinoma

beta subunit human chorionic gonadotropin (HCG) in chori-

ocarcinoma, some seminoma

lactic dehydrogenase (LDH) in advanced embryonal carci-

noma

➣imaging

CXR in all cases

abdominal CT in all cases

chest CT if positive abdominal CT or positive tumor markers

after orchiectomy

Definition of Clinical Stages

■I: Abd CT, CXR, serum markers all neg

■II: Abd CT pos; CXR and chest CT neg; serum markers pos or neg

➣IIA: 2–5 cm mass

➣IIB:5to9cmmass

➣IIC: >10 cm mass