Testicular cancer is the most common malignancy in men between | Surgery videos & books

Testicular cancer is the most common malignancy in men between the ages of 15 and 35. It typically presents as unilateral scrotal swelling. On examination, it is important to distinguish intraparenchymal masses (usually malignant) from extraparenchymal masses (usually benign). This is easily done with scrotal ultrasound. Upon the diagnosis of an intraparenchymal testicular mass, a staging CT scan of the chest, abdomen, and pelvis should be obtained. It is reasonable to evaluate the serum levels of beta-HCG and AFP as they may be elevated in 80–85% of patients with nonseminomatous germ cell tumors. LDH, on the other hand, can be elevated in patients with seminomas and can be of prognostic significance. Finally, if elevated, these serum markers can serve as a means to monitor the presence of residual disease and should be measured after resection of the tumor. Additionally, the mass should be excised in order to establish a histologic diagnosis. A radical orchiectomy should be performed from an inguinal approach. Less invasive approaches such as biopsies or a scrotal approach to the tumor should be avoided as they can alter the lymphatic drainage and potentially adversely affect overall outcomes. The majority of testicular tumors occurring in young adults are malignant tumors. The tumors may originate from germinal or nongerminal cells. Approximately 95% of testicular tumors are germinal tumors. These include seminomas (the most common), embryonal cell carcinomas, choriocarcinomas, and teratocarcinomas. On the other hand, Leydig cell tumors and androblastomas originate from nongerminal cells and may produce excess testosterone. Benign tumors such as fibroma can occur but are rare.