<prompt> A pt. presented with a hard swelling in his right testis. All are true statements exceptInguinal exploration is doneTrans scrotal biopsy is neededHigh inguinal exploration is doneScrotal us is done  <response>: Trans-scrotal biopsy is contraindicated. A painless testicular mass is pathognomic for a testicular malignancy. US of the testis is indicated whenever a testicular malignancy is considered and for persistent or painful testicular swelling. If a testicular mass is detected, a radical inguinal orchiectomy should be performed. Because the testis develops from the gonadal ridge, its blood supply and lymphatic drainage originate in the abdomen and descend with the testis into the scrotum. An inguinal approach is taken to avoid breaching anatomic barriers and permitting additional pathways of spread. Thus - US scrotum is done for any suspected testicular tumor If a testicular mass found on US then high inguinal orchiectomy done to remove the primary as well as know about the histology of the tumor. After orchiectomy fuher inv. done for staging are CT abdomen pelvis - for retroperitoneal l.n. Chest x-ray - for mediastinal and pulmonary metastasis. Chest CT - if mediastinal or pulmonary metastasis is suspected. Tumour markers - AFP, HCG, LDH AFP Alpha-fetoprotein - seen only in Non-seminoma HCG and LDH - seen in both seminomas non-seminomas More about testicular malignancy Most common testicular tumor above 50 yrs of age is - Lymphoma Non-seminomas are more malignant than seminomas Treatment of testicular cancer is directed by the tumor histology as described in the previous question but when the tumor contains both seminoma and non-seminoma components pts. Management is directed by the more aggressive non-seminoma component. Chromosomal marker for GCT - isochromosome of the sho arm of chromosome 12. 