12. Testes

Question 1

Diseases of the testes

Answer 1

1. Orchitis & Epididymitis
2. Filariasis
3. Testicular neoplasms

Question 2

Definition of Orchitis & Epididymitis

Answer 2

Inflammation of the testes & epididymis

Question 3

Microorganisms that can cause orchitis & epididymitis

Answer 3

1. Tuberculosis
2. Mumps
3. Gonorrhoea
4. Syphilis

Question 4

Orchitis & epididymitis with tuberculosis

Answer 4

1. Begins in epididymis, spreads to rest of testes

2. Invokes typical caseating granulomatous inflammation

Question 5

Orchitis & epididymitis with Mumps

Answer 5

1. Mumps primarily causes inflammation & swelling of the
   parotid glands
2. Complication in post-pubertal males include orchitis &
   acute pancreatitis

Question 6

Orchitis & epididymitis with Gonorrhea

Answer 6

1. Typically causes orchitis as an extension from infection of the urethra, which first affects the epididymis
2. Produces frank abscesses

Question 7

Orchitis & epididymitis with Syphilis

Answer 7

1. Usually affects testes without affecting epididymis

2. May produce gummas

Question 8

Definition of Filariasis

Answer 8

Chronic helminthic infection of lymphatics resulting in impairment of lymphatic drainage, causing lymphedema of affecting tissues

Question 9

Clinical features of filariasis

Answer 9

1. Chronic filariasis gives rise to persistent lymphedema of the scrotum, penia, vulva & limbs
2. Results in subcutaneous fibrosis & epithelial hyperkeratosis
   - Elephantiasis (limbs)
   - Scrotal enlargement

Question 10

Definition of testicular neoplasms

Answer 10

The vast majority of testicular neoplasms are germ cell tumours (95%) which are mainly seen in young men; lymphomas seen in older men

Question 11

Etiologies & Associations with testicular neoplasms

Answer 11

1. Cryptorchidism (undescended testes)
2. Genetic factors
3. Testicular dysgenesis syndrome
   - Cryptorchidism + hypospadias (anomalous opening of the external urethral orifice) + poor sperm quality

Question 12

Classification of testicular germ cell tumours

Answer 12

1. Seminomatous germ cell tumours
2. Non-seminomatous germ cell tumours
3. Mixed tumours

Question 13

Characteristics of Seminomatous germ cell tumours

Answer 13

1. Remain localized for a long time
2. Very radiosensitive
3. Spread by lymphatics to para-aortic nodes

Question 14

Example of seminomatous germ cell tumours

Answer 14

Seminoma (commonest germ cell tumour; peak in 4th decade)

Question 15

Characteristics of non-seminomatous germ cell tumours

Answer 15

1. Metastasize relatively earlier
2. Radioresistant
3. Spreads via hematogenous route

Question 16

Examples of non-seminomatous germ cell tumours

Answer 16

1. Yolk sac tumour (most common testicular tumours in infants, good prognosis; usually occurs in mixed tumours when in adults)
2. Choriocarcinoma (highly malignant tumour)
3. Teratoma
4. Embryonic carcinoma (peak between ages 20 & 30; more aggressive than seminomas)

Question 17

Examples of mixed tumours

Answer 17

1. Seminoma + any non-seminomatous germ cell tumour (NSGCT) (one or more types)
2. Teratoma + embryonal carcinoma
3. Teratoma + choriocarcinoma

Question 18

Clinical features of testicular neoplasms

Answer 18

1. Painless enlargement of testis
2. Raised serum alpha-fetoprotein
3. Raised serum human chorionic gonadotrophin beta subunit