Lymph node metastasis in testicular tumor. First lymph node involved is:

Ans. (b) Para aorticRef Harrison 19th ed. / 589Points to Remember about testicular tumor* In metastatic disease-retroperitoneal LN is Most commonly involved* Metastasis- Lymphatic >> Blood (m/c lung)* Exception is Choriocarcinoma where blood metastasis (m/c lung)>> lymphatic metastasis.* Most common testicular tumor- in general - seminoma# Prepubertal adults- teratoma# Infant and children- yolk sac tumor* Most common presentation- nodule or painless swelling of one gonad* Most common bilateral testicular tumor- Malignant lymphoma* Most common bilateral primary testicular tumor- Seminoma* FNAC contraindicated* Intial IOC- USG(hypo echoic area within tunica albuginea is suspicious)* HPE diagnosis by-radical orchiectomy (inguinal approach)* Scrotal orchiectomy- contraindicated* Chavesseac maneuver- soft clamp applied to cord- biopsy from suspicious area- sent for frozen section- if+ ligate cord, do orchiectomy- final HPE