Editing Germ Cell Tumours (section)

===== Scrotal ultrasound with doppler =====

* '''<span style="color:#ff0000">Important to evaluate both testicles given</span>''' '''<span style="color:#ff0000">2% incidence of bilateral GCT</span>'''
**'''In cases of bilateral GCT, a metachronous lesion is the most common presentation.'''
* '''High-frequency transducers (5 to 10 MHz)''' can readily identify and distinguish intratesticular lesions a few millimeters in size from extra-testicular pathology
* '''<span style="color:#ff0000">Indications in the context of suspected GCT (3)</span>'''
*# '''<span style="color:#ff0000">Scrotal mass</span>'''
*# '''<span style="color:#ff0000">Suspected metastatic GCT with a normal testicular examination</span>'''
*#* '''A small, impalpable scar or calcification indicates a <span style="color:#ff0000">“burned-out” primary testis tumor.</span>'''
*#** '''<span style="color:#ff0000">If sonographic evidence of intratesticular lesions (discrete nodule, stellate scar, coarse calcification), perform radical orchiectomy because GCNIS and residual teratoma are frequently encountered.</span>'''
*# '''<span style="color:#ff0000">Suspected primary extra-gonadal GCT</span>'''
*#* '''<span style="color:#ff0000">Males with advanced GCT with normal testes on physical examination and ultrasound scan are considered to have primary extragonadal GCT.</span>'''
** '''Patients with normal serum tumor markers (hCG and AFP) and indeterminate findings on physical exam or testicular ultrasound for testicular neoplasm should undergo repeat imaging in 6-8 weeks.'''
* '''Imaging findings'''
** '''Typical GCT is hypoechoic'''
** 2 or more discrete lesions may be identified
** INSERT IMAGE
** '''<span style="color:#ff0000">Testicular microlithiasis</span>'''
*** '''Unclear significance''' '''in the general population'''
**** If no history of GCT, risk of GCT is only increased if an additional established risk factor (see above) is present
**** If history of GCT, microlithiasis on ultrasound of the contralateral testis is associated with an increased risk of ITGCN.
*** '''<span style="color:#ff0000">Management</span>'''
**** '''<span style="color:#ff0000">No further evaluation or screening in incidentally detected microlithiasis</span>'''
**** '''<span style="color:#ff0000">If established risk factor and testicular microlithiasis, counsel patient about the potential increased risk of GCT, need for periodic self-examination and follow-up with a medical professional</span>'''
*** insert image