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Approach

• As for scrotal examination

1. Inspect
   • May look normal
   • Often enlarged testis visible
2. Palpate
   • Usually inseperable from the testis
   • Irregular, nodular
   • Non-tender
   • Not-transilluminable
   • Distinct from supericial ring - can get above it
3. Percuss
4. Auscultate

Completion

1. Examine contralateral scrotum
2. Examine for abdominal lymphadenopathy
3. Examine abdomen (for splenomegaly)
4. Examine chest (for "metastases")

Differential diagnosis

1. Testicular tumours
2. Old infection
3. Calcified hydrocoele
4. Scrotal skin tumours

Presentation of testicular tumours

1. Mass
   • Painless lump / dull ache in one testis
2. Secondary metastases
   • Back pain if para-aortic node infiltration
3. Paraneoplastic

Removal of testicular tumour

1. Inguinal approach
2. Early clamping of testicular artery and vein within spermatic cord (prevents seeding)

Classification of testicular tumours

1. Embryonal - from primitive germ cell
2. Choriocarcinoma
3. Yolk-sac tumour
4. Leydig cell tumours - associated with gynaecomastia, only 10% malignant
5. Sertoli cell tumours - also produce gynaecomastria
6. Lymphoma - most commonly in patients who have generalised lymphoma elsewhere; poor prognosis