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Testicular Case Presentation |
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Case Presentation
Sports Medicine Rounds
February 26, 2004
Dr. Paul Baumert
UI
Student Health
Case
•
19 y/o white
male recreational runner (3-5 miles, 3-5 times/week) with 2 to 3 week hx
of left testicular discomfort. Sensation of heaviness with running,
feels slightly more swollen than right testicle. Is sexually active, no
dysuria, dyspareunia. Partner asx. No hx of STI, UTI, hernia, previous
similar problems. Feels well in general.
Case
•
Past medical
history
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Fx nasal bone – surgically
repaired
•
EIA as a child – no recent
problems
•
Social history
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Sophomore elementary education
major
•
Denies tobacco use
•
Consumes alcohol once a week
•
Medications
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MVI, vitamin C, vitamin E,
glucosamine
Differential diagnosis
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Hernia
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Varicocele
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Epididymitis
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Spermatocele
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Hydrocele
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Hematoma
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Other
Physical exam
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Circumcised
penis, no visible lesions
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No varicocele
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No hernia
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Epididymis
nontender without palpable tenderness or abnormalities
•
Left testicle
smooth, slightly larger than right (about 6 cm vs. 5 cm)
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No inguinal
lymphadenopathy
Scrotal ultrasound
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Ordered on the
day of the exam
Urology
consultation
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Performed on the
day following initial presentation
Recommendations
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Chest xray
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Labs
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AFP
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Beta HCG
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Routine pre-op
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Left radical
orchiectomy
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CT
abdomen/pelvis to follow after surgery
Testicular cancer
•
1% of all
cancers in men
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7,500 new
diagnoses in U.S. annually
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Most common form
of cancer in men ages 20-34
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More common in
whites, than all other races
Risk factors
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Undescended
testicle (cryptorchidism)
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Abnormal
testicular development
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Klinefelter’s
syndrome
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Personal history
of testicular cancer
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Family history
of testicular cancer
Possible
Signs/Symptoms
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Painless lump or
swelling in a testicle
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Any enlargement
of a testicle or change in the way it feels
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Feeling of
heaviness in the scrotum
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Dull ache in
lower abdomen, back, or groin
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Sudden
collection of fluid in the scrotum
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Pain or
discomfort in a testicle or in the scrotum
Not-so worrisome
signs/symptoms
•
Pimple, ingrown
hair or rash on the scrotal skin
•
Free, floating
lump in the scrotum, seemingly not attached to anything
•
Lump on the
epididymis or tubes coming from the testicle
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Pain or burning
during urination
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Blood in the
urine or semen
Survival rates
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Five year
relative survival rate for all races is 96% (79% just 20 years ago)
•
Statistics by
stage at diagnosis
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99.1% (local)
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95.0% (regional)
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73.1% (distal)
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Emphasizes the
importance of early detection
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