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Disease Of The Testis Flashcards

1
Q

What do you find in the lobule of testis

A

Convoluted Seminiferous tables

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2
Q

Tubules in each lobule join to form a short straight tube called…

A

Tubulus rectus

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3
Q

Network of interconnecting tube from tubuli recti from all lobules

A

Rete testis

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4
Q

C shaped structure made up of tightly coiled tube

A

Epididymis

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5
Q

Two types of cells in epithelium of testis

A

Sertoli ceLls

spermatogenesis or germ cells

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6
Q

What are Sertoli cell

A

Non proliferating elongated cells with cytoplasm extending from basement membrane to the lumen of tubule

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7
Q

Read histology

A
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8
Q

Leydig sells morphology Morphology

A

Large polygonal cell
round nuclei
abundant eosinophilic cytoplasm which may contain rectangular crystalloids reinke crystals

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9
Q

Why do we say that the other way to the testes is specialized

A

Highly coiled

intimately associated with network of anastomotic thanks forming the pampiniform plexus

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10
Q

Characteristics of veins to the testis

A

Thin walled party muscular raised no effect evolves except at inflow points into inferior vena cava or renal vein

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11
Q

Vein of the testes

A

Rights Spermatic vein (vena cava )

left spermatic vein( left renal vein )

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12
Q

What are some congenital anomalies of the testis

A 
Testicular agenesis 
 Cryptorchidism
Arrested descend
Ectopic  testis
Crossed  testicular ectopia
Vanishing testes syndrome
Leydig cell only syndrome
Supernumerary testicles
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13
Q

What is testicular agenesis

A

Complete absence of testicular tissue in individual with normal male phenotype in normal karyotype

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14
Q

Do male patient with testicular agenesis have generally small penises

A

Yes

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15
Q

What Are the characteristics of early failure in testicular agenesis

A

Absence of testes and wolffian structure on the same side

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16
Q

What are the characteristics of late failure in testicular agenesis

A

Absence of testis

presence of vas

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17
Q

Common manifestation of congenital agenesis agenesis in male

A

Presence of male external genitalia
hypoplasia of both scrotum
microphallus or ambiguous external genitalia

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18
Q

Typical hormonal characteristics of testis agenesis are

A

High basal levels of gonadotropins especially FSH
no plasma increase testosterone in an hCG administration
prolonged increase in FSH and LH levels after gonadotropin releasing hormone test

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19
Q

cryptorchidism

A

Absence of testis in scrotal sac with failure of testes to descend normally into scrotum

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20
Q

Is cryptorchidism more common in preterm infants

A

Yes

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21
Q

Is cryptorchidism more common on the right or the left side if unilateral

A

Right side

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22
Q

Percentage of bilateral cryptorchidism

A

25

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23
Q

True or false , most undescended testes migrate into lower scrotum within the first three months of life due to surge in testosterone

A

True

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24
Q

What are the factors involved in descent of testis

A

Hormones like Ganadotropins and testosterone

gubernaculum active migration which determine final position of the testes by connecting developing testes to scrotum

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25
What are some reasons for failure of testes decent
Anatomical abnormalities of gubernaculum hormonal dysfunction mechanical impairment like shorts spermatic cord , underdeveloped vaginal process DysGenesis of testicule hereditary like Klinefelter and Prader Willi syndrome
26
Two types of cryptorchidism
Arrested descent | ectopic testis
27
What is arrested descent
Uncomplete descent of testis a long normal path
28
Main location of testes arrested decent
Inguinal Canal 80% near pubic tubercle rarely abdomen
29
Macro morphology of arrested descent
Progressive atrophy Small size firm in consistency short spermatic cord
30
Micro morphology arrested descent
Loss germ cells or complete absence Hyalinization ,thickening of seminiferous tubular basement membrane and stromal fibrosis ,mmicroliths Leydig cells form prominent nodules in interstitium and eventually nodular mass Leydig
31
What is ectopic testis
One of the testicle has not descended into scrotum and taken different path and get into abdominal cavity
32
2 important sequalae of ectopic testis
Failure of spermatogenesis in Cryptorchidism testis due to high temp of non scrotal tissue Reduction of germ cells in scrotal testis so infertility increased risk for development of testitucal germ cell tumors
33
What should be done if undescennded testis is discovered in adult
Removed to prevent germ cell tumor
34
What event increase in incidence in ectopic testis
Trauma Torsion Inguinal hernia
35
Percentage of testicular malignancy risk in male with undescended testis
10-15%
36
What is crossed testicular ectopia
Transverse testicular ectopia , testicular pseudoduplication unilateral double testis and transverse aberrant testicular maldescent Both gonads migrate toward same hemiscrotum
37
Main site of ectopic testis in crossed testicular ectopia
Opposite hemiscrotum Inguinal canal Deep inguinal ring
38
Do you find inguinal hernia next to ectopic testis
Yes
39
Remnants structures found in 38% of CTE cases
Persistent Müllerian duct, tubes, rudimentary uterus, hemiuterus
40
3 types of CTE
Associated with inguinal hernia alone Associated with persistent or rudimentary Müllerian duct structure Associated with other anomalies without mullerian remnant
41
Mean age of CTE presentation
4 yo
42
Common sequalae of CTE
Infertility | Malignancy
43
What is vanishing testes syndrome
Disappearance of one or both testes between last month of intrauterine life and beginning of puberty
44
Consequences of vanishing testes syndrome of both testes
Hypergonadotropic hypogonadism after puberty Gynecomastia Hypoplastic scrotum Impalpable prostate
45
Main cause of vanishing testes syndrome
Secondary to perinatal scrotal torsion
46
What is Leydig cell only syndrome
Agonadism without eunuchoidism and normal male phenotype | Spermatic cord with clusters Leydig cells
47
Level of testosterone in Leydig cell only syndrome
Enough to have male phenotype | Not enough to support complete development of secondary sex characteristics
48
What is supernumerary testicles
Poly orchid, triochisdism , supernemerary testicles | Presence of more than 2 testes
49
Most common variety of polyorchidism
Triorchidism
50
Main side with supernumerary testis
Left side
51
Associated anomalies with supernumerary testicles
``` Maldescent of testis or cryptorchidism m indirect hernia (80%) Torsion Infertility Malignancy Hydrocele Epididymis Varicocele ```
52
Type of vascular disturbances of testes
Torsion Varicocele
53
What is testis torsion
Twisted testis on spermatic cord
54
What happens when there is testis torsion
Venous occlusion with maintained arterial blood flow | Intense vascular engorgement and hemorrhagic infarction
55
Classic presentation of torsion
Excruciating testicular pain after often violent physical activity
56
Amount of Time at which testitucal viability has decreased significantly
6h
57
Testicular torsion seen mostly in which population
Adolescent | Neonate
58
Congenital abnormalities associated with torsion
Tunica vaginal is on spermatic cord No scrotal ligaments Atrophy of testis
59
Group of age with mostly extra vaginal torsion
Neonates because tunica vaginalis not yet secured to gubernaculum
60
What is bell clapper deformity
Attachment of Tunica vaginalis to testicle is high | Spermatic cord can rotate in it causing intravaginal torsion
61
Degree of rotation in torsion
90 to 180 degrees
62
Degrees of complete torsion
360 degrees
63
Consequence of twisting testes
Venous occlusion Engorgement Arterial ischemia Infarction of testicle
64
Morphology of testes torsion
Diffuse congestion Widespread interstitial hemorrhage Hemorrhagic infarction of entire organ
65
Varicocele definition
Abnormal enlargement of venous plexus within spermatic cord
66
Is Varicocele common in infertility
Yes
67
Side with more Varicocele case
Left side
68
Palpation of testes Varicocele feels like
Bag of worms
69
What examination should you always do in left sided Varicocele
Left kidney examination because of left e renal vein that can be blocked by renal cell carcinoma
70
Consequence of Varicocele on spermatogenesis
``` Increased testicular temperature Increased intratesticular pressure Hypoxia due to attenuation of blood flow Toxic metabolites reflux form adrenal glands Hormonal profile abnormalities ```
71
Most common tumor in adolescent and young men
Testicular tumor
72
Main site of occurrence of testicular cancer
Germ cells
73
2 types of testicular tumor
Germ cell tumor | Sex cord / gonadal stromal tumor
74
Main population affected by germ cell tumors
White | 20-34 yo
75
Is latency period long or short when going from carcinoma in situ to invasive carcinoma for GCT
Long
76
2 main kind of tumors by germ cell tumors
Seminomas | Non seminomatous tumors
77
Risk factor of GCT
Cryptorchidism | GCT in one testis increase risk in other one
78
Malignant pure germ cell tumor of seminoma types
Classic seminoma | Spermatocytic tumor
79
Malignant pure germ cell tumor of non seminomas types
``` embryonal carcinoma Teratoma Choriocarcinoma Yolk sac tumor Polyembryoma ```
80
Malignant mixed germ cell type
Embryonal carcinoma and teratoma with or without seminoma Embryonal carcinoma and yolk sac tumor with or without seminoma Embryonal carcinoma and seminoma
81
Percentage of seminoma in testicular neoplasm
35-70%
82
Percentage of classic seminoma in seminoma type
95%
83
Morphology of classic seminoma
Mass anywhere in testis Moderate smooth or bosselâtes enlargement of organ Yellow or tan
84
Micro classic seminoma
Sheets of uniform undifferentiated germ cells Clear or fine granular cytoplasm Well defined cell border Round nuclei Prominent nucleoli Slender fibrous septa separating sheets of tumors 1/3 of cases with non caseating granulomatosis areas with small giant cells Diffuse or focal lymphoid infiltrate Glycogen in cytoplasm
85
Population at risk of spermatocytic seminoma
old men
86
Macro morphology spermatocytic seminoma
Soft gelatinous or mucoid appearance Cystic areas No hemorrhage or necrosis Poor demarcation
87
Micro spermatocytic seminoma
Solid sheets of without nesting pattern of classical seminoma Small cells looking like lymphocyte Intermediate sized cells with round nuclei and fine granular chromatic pattern Giant cells Abundant mitotic figures
88
Main population of nonseminomatous germ cell tumor
20s 30s
89
Most primitive form of nonseminomatous germ cell tumor
Embryonal carcinoma
90
Gross morphology embryonal carcinoma
Large Hemorrhagic Necrotic Variegated cut surface
91
Histo embryonal carcinoma
``` Pleomorphic Variable pattern Glands Tubules Primitive embryo like structures Many mitotic figures Sheets of cells with large hyper chromatic nuclei Poorly defined cell borders ```
92
What do you find in yolk sac tumor
Embryonic remnants Fetal yolk sac Alla trois Extra embryonal mesenchyme
93
2 types of yolk sac tumor
Postpubertal type - mixed | Prepubertal type- pure
94
Go read about post and pre
95
Second most common GCT in children after yolk sac tumor
Teratoma
96
Which is more common , postpubertal or prepubertal teratoma
Postpubertal

Reproductive (14 decks)

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