disease of testis and penis Flashcards
list the stages of sperm development
spermatogonia > primary spermatocytes (diploid) > secondary spermatocytes (haploid) > spermatids > spermatozoa
What is spermiogenesis
process of cytodifferentiation by which spermatids become spermatozoa
anatomy of tunica propria
surrounds the tubules. Composed of myofibroblasts and elastic fibers
anatomy of testis interstitial tissue
contains vessels, nerves, and Leydig cells (produces testosterone in response to LH)
anatomy of tunica vaginalis
outer layer of testis- derived from peritoneum during descent
histology of penile urethra
lined by transitional mucosa
histology of glans penis
covered by squamous mucosa
cryptorchidism- what is it
Congenital maldescent of one (75% of cases) or both (25%) testes. May be found anywhere along pathway of descent.
cryptorchidism histology
Atrophy begins as early as 2 years old. Germ cell development arrest, thickening of basement membrane and hyperplasia of Leydig cells, eventual hyaline replacement
cryptorchidism risks
risk of developing cancer in both the undescended testis plus the contralateral testis (less extent). Surgery may not reduce the risk
List causes of testicular atrophy
cryptorchidism, Atherosclerosis, Inflammation, Malnutrition, Hypopituitarism, Hormone therapy (prostate cancer), Klinefelter’s Syndrome
List congenital causes of male infertility
cryptorchidism, immotile cilia syndrome, anorchia, absent vas deferens
List acquired causes of male infertility
Torsion and infarction (traumatic/mechanical or vascular), varicocele, obstruction, inflammation
List hormonal abnormalities that cause male infertility
FHS, LH or GnRH deficiency
Klinefelters syndrome
Causes male infertility. 47, XXY. Tubular sclerosis with absence of elastic fibers. Leydig cell nodules (hyperplasia), elevated FSH/LH and decreased testosterone
causes of epididymitis and orchitis
Usually due to direct extension from urinary tract (vas deferens or lymphatics) and tends to effect epididymis first with subsequent orchitis.
compare causes of epididymitis and orchitis in children vs adults vs elderly
children: gram negative rods (urinary tract malformations). Sexually active adults: chlamydia trachomatis, N. gonorrhoeae. Elderly: enterobacteria.
epididymitis and orchitis histology
acute inflammation +/- abscesses
mumps orchitis histology
Mononuclear inflammatory infiltrate with interstitial edema +/- neutrophils
mumps orchitis presentation and consequences
unilateral in 70%. Occurs in pubertal or adult males with mumps (30%) usually subsequent to parotid involvement. Infertility is uncommon
define varicocele
abnormal dilatation & tortuosity of veins in pampiniform plexus due to venous valve insufficiency
Varicocele and infertility
Possibly an epiphenomenon, thermal effect, maturation arrest, hyperspermatogenesis and/or abnormal sperm morphology
varicocele location
left side alone in 90%. Bilateral in 10%
tuberculus orchitis presentation/ histology
Begins in epididymis and spreads to testes. Usually part of systemic dz. Caseating granulomas
Syphilis presentation and histology
Involves testes first then epididymis. Diffuse mononuclear interstitial inflammation rich in plasma cells. Obliterative endarteritis +/- gummas (coagulative necrosis)
Most tumors of testes are what kind of tumor? And who do they occur in?
germ cell tumors- occur in young men (15-35 years)
list types of germ cell tumors
seminoma (comes from totipotent germ cell), spermatocytic seminoma, embryonal carcinoma, yolk sca (extraembryonic), choriocarcinoma, teratoma (embryonic), mixed
Sx and predisposing factors of germ cell tumors
Sx: painless testicular enlargement. Predisposing factors: cryptorchidism (5X), genetic factors (family history-5X), dysgenesis (50X)
Most common germ cell tumor and who gets it
seminoma- occurs in fourth decade
seminoma macro and microscopic appearance
macro: homogeneous “fish flesh” appearance. Micro: uniform large, polygonal cells with distinct cell membrane, clear cytoplasm, central nucleus and prominent nucleolus. Fibrous septa with lymphocytic infiltration or granulomatous reaction. Uncommonly may be anaplastic with high mitotic counts. Can have syncytiotrophoblastic giant cells which produce hCG
Seminoma prognosis
Good! Radiosensitive and chemosensitive.
spermatocytic seminoma - population, histology, prognosis
Older men (>65yrs). Mixture of cells resembling primary and secondary spermatocytes in myxoid stroma. Good prognosis- Slow growing and rarely metastasizes
embryonal carcinoma- macro and micro features, prognosis
More aggressive than seminomas. Usually found as small tumors in testes but has high potential for extension through tunica albuginea and into spermatic cord. Large, hyperchromatic, pleomorphic nuclei and indistinct cytoplasm – mitoses frequent. Glandular, trabecular, papillary arrangements
embryonal carcinoma population and markers
Pure is rare, mixed is more common. Third decade. Markers: PLAP, placental lactogen, hCG
Yolk sac tumor- population, histology, markers
Most common testicular tumor of infants and children. Loose or maze-like network of cells on thin
fibrovascular cords or microcystic / myxomatous. Marker: alpha-fetoprotein
choriocarcinoma- histology, prognosis, markers
Placental differentiation – syncytiotrophoblast and cytotrophoblast. Aggressive, often metastasize. Chemosensitive but worse prognosis. Produce human chorionic gonadotropin – useful as marker
Teratoma- prognosis, histology
good prognosis in children, variable in adult (considered malignant). Mature: heterogeneous differentiated elements including any combination of neural tissue; muscle; cartilage; bronchial, intestinal, squamous epithelium, etc. within loose stroma. Immature: incompletely differentiated elements of the three germ cell layers
Testis cancer staging
stage I: confined to testis. Stage II: retroperitoneal nodes or below diaphragm. Stage III: outside retroperitoneal nodes or above diaphragm
What kind of tumor is a Leydig cell tumor
sex cord stromal tumor
Leydig cell tumor Sx and histology
May produce hormones (androgen, estrogen) – gynecomastia,precocious puberty. Characteristic granular eosinophilic cytoplasm & intracytoplasmic crystals. 90% are benign
What kind of tumor is a sertoli cell tumor
sex-cord-stromal tumor. Uncommon
what is condyloma acuminatum
“Genital wart” of the penis composed of papillary projections of connective tissue covered with thickened hyperplastic epithelium. Koilocytes – epithelial cells with atypical crinkled nuclei and large perinuclear halo – a characteristic of human papilloma virus infection
What is verrucous carcinoma
A “giant condyloma” of the penis with the tendency for local invasion. Rarely metastasizes
Bowns disease
squamous carcinoma in situ involving skin of genital region. Small percent progress to invasive squamous carcinoma. Associated with visceral cancers
Erythroplasia of Queyrat
squamous carcinoma in situ involving mucosal surfaces of glans penis in noncircumsized men. Can progess to invasive carcinoma
penile squamous carcinoma incidence and population
rare in US due to hygeine practices. Largely a dz of elderly. Blacks > whites. HPV type 16 and 18 implicated
staging of penile squamous cell carcinoma
stage I: confined to glans or prepuce. Stage II: penile shaft. Stage III: operable inguinal node metastases. Stage IV: distant metastases
grading of penile squamous cell carcinoma
grade I: keratinization, squamous perals, intercellular bridges. Grade II-III: nuclear atypia, mitotic activity. Grade IV: nuclear pleomorphism, necrosis, no keratin pearls
