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CASE 34


A 28-year-old man noticed a small mass on his right testicle during self examination. Concerned, he visited an oncologic specialist. The specialist also detected a small mass on the right testicle upon palpation. Laboratory tests showed that α-fetoprotein and human chorionic gonadotrophin levels were elevated in the patient’s blood. A computed tomography scan revealed involvement of lymph nodes. A radical inguinal orchiectomy was performed. Pathologic evaluation of the excised testicle led to the diagnosis of choriocarcinoma.



WHAT IS THE ARTERIAL SUPPLY AND VENOUS DRAINAGE OF THE TESTICLE?


The right and left testicular arteries spring from the abdominal aorta at the level of the second lumbar vertebra inferior to the renal arteries. They descend retroperitoneally and cross anterior to the respective psoas major muscle and external iliac artery. The artery then enters the inguinal canal to travel within the spermatic cord to reach the testis.


In addition to the testis, the artery also supplies perirenal fat, ureter, and the cremaster muscle. The testis is also partially supplied by the cremasteric branch of the inferior epigastric artery.


Veins from each testis converge to form the pampiniform plexus within the spermatic cord. The numerous small veins that comprise the pampiniform plexus ascend within the spermatic cord and prior to entering the superficial inguinal ring, the veins unite to form three to four testicular veins. The testicular veins travel through the inguinal canal to enter the abdomen through the deep inguinal ring. After passing through the deep inguinal ring, the three or four testicular veins join to form two testicular veins that accompany the testicular artery on each side. The testicular veins travel retroperitoneally anterior to the psoas major and ureter. As the paired testicular veins ascend on each side of the body, they ultimately unite to form a single testicular vein. The right testicular vein travels posterior to the distal ileum and third (horizontal) part of the duodenum before emptying into the inferior vena cava. Infrequently, the right testicular vein drains into the right renal vein. The left testicular vein passes posterior to the inferior segment of the descending colon before joining the left renal vein. The testicular veins possess valves.


Functionally, the pampiniform plexus helps to lower testicular temperature. It accomplishes its cooling effect by serving as a heat sink. Because the temperature of venous blood in the plexus is lower than that of testicular arterial blood, heat is drawn away from arterial blood being delivered to the testis. This effectively lowers the temperature of arterial blood and that of the testis.

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Jun 16, 2016 | Posted by in ANATOMY | Comments Off on 34

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