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Fibrocystic breast changes
Paget disease of the breast
Intrauterine growth restriction
Pelvic inflammatory disease
Gestational trophoblastic disease
Germ cell ovarian tumor
Polycystic ovary syndrome
Premature ovarian failure
Sex cord-gonadal stromal tumor
Surface epithelial-stromal tumor
Congenital cytomegalovirus (NORD)
Congenital rubella syndrome
Neonatal herpes simplex
Preeclampsia & eclampsia
Female sexual interest and arousal disorder
Genito-pelvic pain and penetration disorder
Fetal alcohol syndrome
Fetal hydantoin syndrome
Androgen insensitivity syndrome
Hypospadias and epispadias
Benign prostatic hyperplasia
Male hypoactive sexual desire disorder
Amenorrhea: Pathology review
Benign breast conditions: Pathology review
Breast cancer: Pathology review
Cervical cancer: Pathology review
Complications during pregnancy: Pathology review
Congenital TORCH infections: Pathology review
Disorders of sex chromosomes: Pathology review
Disorders of sexual development and sex hormones: Pathology review
HIV and AIDS: Pathology review
Ovarian cysts and tumors: Pathology review
Penile conditions: Pathology review
Prostate disorders and cancer: Pathology review
Sexually transmitted infections: Vaginitis and cervicitis: Pathology review
Sexually transmitted infections: Warts and ulcers: Pathology review
Testicular and scrotal conditions: Pathology review
Testicular tumors: Pathology review
Uterine disorders: Pathology review
Vaginal and vulvar disorders: Pathology review
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Testicular Carcinoma Assessment
Yolk Sac Tumor
25-year-old Kyle comes to the office after palpating a lump on his left testicle while showering this morning. On physical examination, there is a nontender, round, firm, rubbery mass in the left testicle that does not transilluminate with light. Scrotal ultrasound shows a 1.4-cm solid mass with no cystic components. Laboratory tests reveal normal serum human chorionic gonadotropin or hCG level, and normal α-fetoprotein or AFP level. Later that day, 32-year-old William comes to the physician's office complaining of heat intolerance, excessive sweating, palpitations, frequent bowel movements and recent weight loss despite increased appetite. His past medical history is insignificant. On examination, the thyroid gland is normal with no signs of goiter or nodules. However, a hard nodule is palpated in the right testicle which does not transilluminate with light and appears solid on scrotal ultrasound. Laboratory studies show increased serum T4 and T3 levels as well as extremely elevated hCG levels.
Based on the initial presentation, Kyle and William both have some form of testicular mass. In fact, testicular tumors are the most common solid malignancy in males between 20 and 35 years old.
Okay, now, for your exams, it’s important to know that the main risk factors for developing testicular cancer, especially the germ cell variety, include cryptorchidism, which is when the testicles fail to descend to the scrotum or get stuck in the inguinal canal, as well as Klinefelter syndrome, where biological male individuals inherit more than one X chromosome leading to small, undeveloped testicles.
For symptoms, a testicular tumor most often comes up as a small, firm lump that is typically painless, but can sometimes cause a sharp or dull pain in the testicles and lower abdomen. In more severe cases, symptoms may arise from a malignant tumor metastasizing to other organs. This is most commonly hematogenous to the lungs, leading to dyspnea or hemoptysis, which is the coughing of blood, or to the brain, leading to headache, nausea, vomiting or seizures. Another way for the cancer cells to metastasize is by the testicular lymphatic system that drains into retroperitoneal lymph nodes. Metastasis to these lymph nodes leads to symptoms like lower back pain.
Testicular tumors are abnormal growths that can develop in one or both testicles. Most testicular tumors are germ cell tumors and can be classified into seminomas, which are the common ones and have a better prognosis; and non-seminomas, which have a worse prognosis.
Non-seminomas include yolk sac tumors, which are the most common type in children; choriocarcinomas, which are associated with hyperthyroidism and gynecomastia; teratomas, which are usually benign in children and malignant in adults; and embryonal carcinomas, which are rare as pure carcinomas but a common element of mixed germ cell tumors. Non-germ cell testicular tumors come from the Sertoli cells, which don't produce hormones, or the Leydig cells which can secrete excess male and female sex hormones. Diagnosis is made primarily with physical examination, ultrasound findings, and determination of serologic tumor markers, including PLAP, AFP, hCG, and LDH. Treatment is radical orchiectomy, chemotherapy, or radiotherapy.
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