Question

1. Why did AJ’s doctor place the small flashlight behind AJ’s scrotal mass? Discuss?
2. A testicular malignancy spreads early to? Discuss?

   Testicular cancer is the most common malignant tumor affecting adolescent young men. Testicular tumors are solid growths of malignant cells and are not fluid-filled cystic structures, a characteristic that figures into the patient’s initial evaluation. Testicular cancers have several histological appearances, but almost all are curable if detected early. AJ is a 26-year-old, recent college graduate who has just begun working for a startup software company and really likes the job. When not behind a computer, he’s either on his bike or out hiking. Several months ago, while showering, he noticed that his left testicle seemed slightly larger than his right. There was no pain and no obvious mass, so he decided to wait and see if things would change. About a month later, it had become obvious that his left testicle had continued to increase in size, but still there was no pain or redness. As a fan of Lance Armstrong, he knew of Lance’s testicular malignancy so he called his doctor. After mentioning the reason for his call, he was given an appointment the next day.

The doctor’s examination confirmed that AJ’s left testicle was larger than the right and a distinct mass was evident. Then the doctor did an interesting thing. He took a small flashlight and placed it behind AJ’s scrotal mass so as to shine light through the area of testicular enlargement. With the room lights turned off, the flashlight made a powerful beam. However, the mass did not glow (transilluminate). The doctor was checking to see if the mass was a fluid-filled cyst (almost certainly benign), or a solid growth (highly suspicious for malignancy). The complete lack of any transmission of light indicated the mass was indeed a solid tumor. (Photo shows an example of transillumination of a benign scrotal cyst in a young child.) AJ’s doctor arranged for an ultrasound of the scrotal mass, which showed it to be a solid tumor largely replacing the left testicle. A detailed ultrasound of the right testis showed no abnormality. Three days later, AJ had his left testis and about six inches of his left spermatic cord surgically removed. Microscopic examination of the tumor confirmed it was malignant. AJ’s tumor proved to be one of the more common types, a seminoma, and a computerized tomography (CT) scan of his abdomen did not show evidence of lymphatic spread. Because the testes develop within the abdomen, and during embryogenesis migrate to the scrotum, they pull their vascular and lymphatic supply along with them. This means that tumors arising in a testis will spread by lymphatic channels that go directly into the abdomen and retroperitoneum.

  

Answer 1

Testicular Cancer

Cancer of the testicles is called Testicular Cancer. Testicles are the male organ that make sperm and male hormones and are located inside the Scrotal sac , just below the penis.

1. Mr. AJ's Doctor placed a small flsh light behind AJ's scrotal mass for identifying the presence of a hydrocele and also to ensure that the mass present in the scrotal sac is a cyst or a solid mass. A thorough scrotal examination ( during physical examination) includes the checking with the flash light to identify the presence of hydrocele. The examination method is using the Principle of Transillumination( The examination of a body part or a tisdue sampleby shining light through it.) Hydrocele is the abnormal build -up of fluids at a site in the body especially in the membrane around a testicle. If the light shines through the mass , it is a cyst and if the light is blocked by the mass , then it is a solid one. Solid mass mass indicate a tumour that may be benign or Malignant.

2. Testicular Malignancy

Testicular Cancer or Testicular Malignancy is a rare , but more cases found in American males ( age between 15 to 3o years). It can spread easily to lymph nodes, as many lympatic channels are connected to testicles. Seminoma usually spreads through lymphatics. It can easily spread to the lymph nodes of pelvis, armpit, para aortic lymph node and  lungs. Lymphatics found in the Testicles drain into para aortic lymph nodes. So the risk of spreading is high. During the more advanced stages , testicular malignancy can spread to bones and liver.

Ultrasound, CT or MRI, blood tests and chest X- ray can reveal the metastasis of testicular cancer. Sugical removal of the tumour, chemotherapy and radiation therapy may help the patient to survive for years. If the Testicular cancer detect at the early stage, it is highly treatable and curable.