Germ Cell Tumours: Difference between revisions

Line 117:

=== History and Physical Exam ===

* '''History~~'''~~

==== History ====

** '''Most common presentation of testicular cancer: painless scrotal mass'''

* '''Most common presentation of testicular cancer: painless scrotal mass'''

** '''At the time of diagnosis, metastasis''' (regional or distant) '''is present in 33% of cases of NSGCT and 15% of cases of pure seminoma,''' and symptoms related to metastatic disease are the presenting complaint in 10-20% of patients

* '''At the time of diagnosis, metastasis''' (regional or distant) '''is present in 33% of cases of NSGCT and 15% of cases of pure seminoma,''' and symptoms related to metastatic disease are the presenting complaint in 10-20% of patients

* '''Physical exam~~'''~~

** '''Genitourinary'''

==== Physical exam ====

*** Palpate for any testicular or extra-testicular masses. Note relative size and consistency of affected and normal contralateral testicle.

* '''Genitourinary'''

****'''A firm intratesticular mass should be managed as a malignant neoplasm until proven otherwise and should be evaluated further with a scrotal ultrasound scan.'''

** Palpate for any testicular or extra-testicular masses. Note relative size and consistency of affected and normal contralateral testicle.

*** '''Differential diagnosis of a scrotal mass (7):'''

***'''A firm intratesticular mass should be managed as a malignant neoplasm until proven otherwise and should be evaluated further with a scrotal ultrasound scan.'''

***# '''Testicular neoplasm'''

** '''Differential diagnosis of a scrotal mass (7):'''

***# '''Epididymoorchitis'''

**# '''Testicular neoplasm'''

***# '''Torsion'''

**# '''Epididymoorchitis'''

***# '''Hematoma'''

**# '''Torsion'''

***# '''Paratesticular neoplasm (benign or malignant)'''

**# '''Hematoma'''

***# '''Hernia'''

**# '''Paratesticular neoplasm (benign or malignant)'''

***# '''Varicocele'''

**# '''Hernia'''

***# '''Spermatocele'''

**# '''Varicocele'''

** '''Sites of metastases'''

**# '''Spermatocele'''

*** '''Supraclavicular lymph nodes'''

* '''Sites of metastases'''

*** Inguinal lymph nodes, if prior inguinal or scrotal surgery

** '''Supraclavicular lymph nodes'''

** '''Gynecomastia'''

** Inguinal lymph nodes, if prior inguinal or scrotal surgery

*** '''Occurs in 2% of males with GCT'''

* '''Gynecomastia'''

*** Results from elevated serum hCG levels, decreased androgen production, and/or increased estrogen levels

** '''Occurs in 2% of males with GCT'''

** Results from elevated serum hCG levels, decreased androgen production, and/or increased estrogen levels

=== Labs ===

@@ Line 117: / Line 117: @@
 === History and Physical Exam ===
-* '''<span style="color:#ff0000">History</span>'''
+==== <span style="color:#ff0000">History</span> ====
-** '''<span style="color:#ff0000">Most common presentation of testicular cancer: painless scrotal mass</span>'''
+* '''<span style="color:#ff0000">Most common presentation of testicular cancer: painless scrotal mass</span>'''
-** '''At the time of diagnosis, metastasis''' (regional or distant) '''is present in 33% of cases of NSGCT and 15% of cases of pure seminoma,''' and symptoms related to metastatic disease are the presenting complaint in 10-20% of patients
+* '''At the time of diagnosis, metastasis''' (regional or distant) '''is present in 33% of cases of NSGCT and 15% of cases of pure seminoma,''' and symptoms related to metastatic disease are the presenting complaint in 10-20% of patients
-* '''<span style="color:#ff0000">Physical exam</span>'''
-** '''Genitourinary'''
+==== <span style="color:#ff0000">Physical exam</span> ====
-*** Palpate for any testicular or extra-testicular masses. Note relative size and consistency of affected and normal contralateral testicle.
+* '''Genitourinary'''
-****'''A firm intratesticular mass should be managed as a malignant neoplasm until proven otherwise and should be evaluated further with a scrotal ultrasound scan.'''
+** Palpate for any testicular or extra-testicular masses. Note relative size and consistency of affected and normal contralateral testicle.
-*** '''<span style="color:#ff0000">Differential diagnosis of a scrotal mass (7):</span>'''
+***'''A firm intratesticular mass should be managed as a malignant neoplasm until proven otherwise and should be evaluated further with a scrotal ultrasound scan.'''
-***# '''<span style="color:#ff0000">Testicular neoplasm</span>'''
+** '''<span style="color:#ff0000">Differential diagnosis of a scrotal mass (7):</span>'''
-***# '''<span style="color:#ff0000">Epididymoorchitis</span>'''
+**# '''<span style="color:#ff0000">Testicular neoplasm</span>'''
-***# '''<span style="color:#ff0000">Torsion</span>'''
+**# '''<span style="color:#ff0000">Epididymoorchitis</span>'''
-***# '''<span style="color:#ff0000">Hematoma</span>'''
+**# '''<span style="color:#ff0000">Torsion</span>'''
-***# '''<span style="color:#ff0000">Paratesticular neoplasm (benign or malignant)</span>'''
+**# '''<span style="color:#ff0000">Hematoma</span>'''
-***# '''<span style="color:#ff0000">Hernia</span>'''
+**# '''<span style="color:#ff0000">Paratesticular neoplasm (benign or malignant)</span>'''
-***# '''<span style="color:#ff0000">Varicocele</span>'''
+**# '''<span style="color:#ff0000">Hernia</span>'''
-***# '''<span style="color:#ff0000">Spermatocele</span>'''
+**# '''<span style="color:#ff0000">Varicocele</span>'''
-** '''Sites of metastases'''
+**# '''<span style="color:#ff0000">Spermatocele</span>'''
-*** '''Supraclavicular lymph nodes'''
+* '''Sites of metastases'''
-*** Inguinal lymph nodes, if prior inguinal or scrotal surgery
+** '''Supraclavicular lymph nodes'''
-** '''Gynecomastia'''
+** Inguinal lymph nodes, if prior inguinal or scrotal surgery
-*** '''Occurs in 2% of males with GCT'''
+* '''Gynecomastia'''
-*** Results from elevated serum hCG levels, decreased androgen production, and/or increased estrogen levels
+** '''Occurs in 2% of males with GCT'''
+** Results from elevated serum hCG levels, decreased androgen production, and/or increased estrogen levels
 === Labs ===