painless scrotal swelling

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TT, TEO, CH & Gumma

By: Ismah Haron

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Testicular tumor

• Seminoma• Teratoma• Combined • Interstitial tumors

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History

• Painless lump at private area

• Testicle feel heavy (diagnostic)

• Malaise, loss of weight-symptoms 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

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Management

Staging;• Ultrasound (confirm)• Tumor marker

(monitoring)• CXR (mets)• Orchidectomy • CT and MRI

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• Stage 1; testis lesion only• Stage 2; nodes below

diaphragm only• Stage 3; nodes above

diaphragm• Stage 4; pulmonary or

hepatic mets

7Source: Bailey & Love’s Short Practice of Surgery

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Teratoma

• Arise from totipotent cells in rete testis

• 3 layers of germ layers• Variety of cell

9Source: Bailey & Love’s Short Practice of Surgery

10Source: Bailey & Love’s 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/orchidectomy

Chronic haematocele• Occur when acute episode

is not treated.• Characteristic:

– Hard mass– Non-tender– Not fluctuant

17Source: Bailey & Love’s Short Practice of Surgery

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Management

• Ultrasound • Orchidectomy• Testis is often compressed

and relatively useless

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.

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Examination

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

enlargement

21Source: Browse’s Introduction to the Symptoms and Signs of Surgical Disease

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THANK YOU