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  #1  
Old 09-26-2012
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Arrow Billy Step 1 Questions #1

A 30-year-old man visits his physician because he has noticed increasing enlargement and a feeling of heaviness in his
scrotum for the past year. On physical examination, the right testis is twice its normal size, and it is firm and slightly tender.
An ultrasound examination shows a 3.5-cm solid mass in the right testis. Abdominal CT scan shows enlargement of the
para-aortic lymph nodes. Multiple lung nodules are seen on a chest radiograph. Laboratory findings include markedly
increased serum levels of chorionic gonadotropin and α-fetoprotein. Which of the following testicular neoplasms is the
most likely diagnosis?
□ (A) Leydig cell tumor
□ (B) Mixed germ cell tumor
□ (C) Pure spermatocytic seminoma
□ (D) Choriocarcinoma
□ (E) Metastatic adenocarcinoma of the prostate gland
□ (F) Large diffuse B-cell lymphoma
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  #2  
Old 09-26-2012
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Oooppsss...Its C...Pure Spermatoystic Seminoma.
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  #3  
Old 09-26-2012
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Quote:
Originally Posted by billy View Post
A 30-year-old man visits his physician because he has noticed increasing enlargement and a feeling of heaviness in his
scrotum for the past year. On physical examination, the right testis is twice its normal size, and it is firm and slightly tender.
An ultrasound examination shows a 3.5-cm solid mass in the right testis. Abdominal CT scan shows enlargement of the
para-aortic lymph nodes. Multiple lung nodules are seen on a chest radiograph. Laboratory findings include markedly
increased serum levels of chorionic gonadotropin and α-fetoprotein. Which of the following testicular neoplasms is the
most likely diagnosis?
□ (A) Leydig cell tumor
□ (B) Mixed germ cell tumor
□ (C) Pure spermatocytic seminoma
□ (D) Choriocarcinoma
□ (E) Metastatic adenocarcinoma of the prostate gland
□ (F) Large diffuse B-cell lymphoma
Might be B
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  #4  
Old 09-26-2012
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Default □ (D) Choriocarcinoma

Confused??
May be choriocarcinoma or mixed germ cell tumor
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  #5  
Old 09-26-2012
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Default □ (B) Mixed germ cell tumor

□ (B) Mixed germ cell tumor
Teratoma
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Old 09-27-2012
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?b might be mixed germ cell tumor.....
Good question....
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  #7  
Old 09-27-2012
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Correct Answer B is the answer

Although a modest elevation of the human chorionic gonadotropin (hCG) concentration can occur when a seminoma
contains some syncytial giant cells, significant elevation of the α-fetoprotein (AFP) level never occurs with pure
seminomas. Elevated levels of AFP and hCG effectively exclude the diagnosis of a pure seminoma and indicate the
presence of a nonseminomatous tumor of the mixed type. The most common form of testicular neoplasm combines multiple
elements; the term teratocarcinoma is sometimes used to describe tumors with elements of teratoma, embryonal
carcinoma, and yolk sac tumor. The yolk sac element explains the high AFP level. Mixed tumors may include seminoma.
Leydig cell tumors are non–germ cell tumors derived from the interstitial (Leydig) cells; they may elaborate androgens.
Choriocarcinomas secrete high levels of hCG, but no AFP. It is unusual for a tumor to metastasize to the testis; this patient
is of an age at which a primary cancer of the testis should be considered when a testicular mass is present. Lymphomas
may involve the testis, usually when there is systemic involvement by a high-grade lesion. Lymphomas do not elaborate
hormones.
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  #8  
Old 10-25-2012
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B is the answer I think....
anyway, is it UW Q? can I know thw source?? @billy bro
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  #9  
Old 02-10-2013
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Quote:
Originally Posted by billy View Post
Although a modest elevation of the human chorionic gonadotropin (hCG) concentration can occur when a seminoma
contains some syncytial giant cells, significant elevation of the α-fetoprotein (AFP) level never occurs with pure
seminomas. Elevated levels of AFP and hCG effectively exclude the diagnosis of a pure seminoma and indicate the
presence of a nonseminomatous tumor of the mixed type. The most common form of testicular neoplasm combines multiple
elements; the term teratocarcinoma is sometimes used to describe tumors with elements of teratoma, embryonal
carcinoma, and yolk sac tumor. The yolk sac element explains the high AFP level. Mixed tumors may include seminoma.
Leydig cell tumors are non–germ cell tumors derived from the interstitial (Leydig) cells; they may elaborate androgens.
Choriocarcinomas secrete high levels of hCG, but no AFP. It is unusual for a tumor to metastasize to the testis; this patient
is of an age at which a primary cancer of the testis should be considered when a testicular mass is present. Lymphomas
may involve the testis, usually when there is systemic involvement by a high-grade lesion. Lymphomas do not elaborate
hormones.
billy, plz also explain the cause of lung nodules..
thanx
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