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The testis and scrotum /testicular tumors

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الكلية كلية الطب     القسم  الجراحة     المرحلة 4
أستاذ المادة وضاح عدنان عباس المرزوك       08/06/2017 10:25:20
Of primary testicular tumors 90 – 95 % are germ cell tumors ( seminoma & non seminoma), while the remaining 5 % are non germ cell tumour.
Risk factor:
1-Race. The incidence in black is about one fourth in white people.
2-socioeconomic class: The disease is twice more common in high socioeconomic class than in lower class.
3-Cryptorchid testis : 7-10 % of tumors occur in patients with history of cryptorchidism, the risk is also higher in the contralateral normally descended testis. The risk is higher in intraabdonimal ( 1:20) and lower in inguinal (1:80) testis.
4- Exogenous estrogen administration to the mother during pregnancy is also associated with increase risk.
5-Trauma.
6- Infection associated atrophy.
The disease is slightly more common on the right side ( correlate with late descend of the right testis ), 1-2 % of cases are bilateral and most of these are seminoma.
CLASSIFICATION:
Germ cell tumors classified in to:
A-Seminoma (35 %)
Classic seminoma (85 % of seminoma)
Anaplastic seminoma ( 5 -10 %)
Spermatocytic seminoma ( 5 – 10 )
B- Non seminoma:
Emberyonal cell carcinoma (20 %)
Teratoma ( 5 % )
Chorio carcinoma ( less than 1 %)
Mixed tumor up to 25 %
C. carcinoma insitu. 5.2 %
Metastatic spread:
With exeption of choriocarcinoma which charectarized by blood born metastasis early in the caurse of the disease , all other germ cell tumors typically spread by step wise lymph node fashion .LN drainage of the testis extend from T4 to L1 but are concentrated at the level of renal hillum.
The primary riding site of the right testis is interaortocaval area at the renal hillum then spread in step wise fashion to the precaval, preaortic, paracaval, right common iliac and right external iliac LN.The primary landing site of the left testis is the paraaortic area at the level of left renal hillum, and then spread to the pre aortic left common iliac and left external iliac LN in step wise fashion.
In the absence of disease on the left side no crossover metastasis to the right side have ever been identified however right to left crossover metastasis are common.
Scrotal violation or invasion of tunica albuginea may result in inguinal LN metastasis while invasion of epididymis or spermatic cord may allow spread to obturator or distal external iliac LN.
Visciral invasion may include in decreasig frequency the lung, liver, brain, bone, kidney and adrenals
Choriocarcinoma charectarized by early blood born spreed to the lung and have predilection of unusual site of metastsis such as the spleen.
CLINLCAL PRESENTATION:


المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .
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