Disease Of The Testis Flashcards
What do you find in the lobule of testis
Convoluted Seminiferous tables
Tubules in each lobule join to form a short straight tube called…
Tubulus rectus
Network of interconnecting tube from tubuli recti from all lobules
Rete testis
C shaped structure made up of tightly coiled tube
Epididymis
Two types of cells in epithelium of testis
Sertoli ceLls
spermatogenesis or germ cells
What are Sertoli cell
Non proliferating elongated cells with cytoplasm extending from basement membrane to the lumen of tubule
Read histology
Leydig sells morphology Morphology
Large polygonal cell
round nuclei
abundant eosinophilic cytoplasm which may contain rectangular crystalloids reinke crystals
Why do we say that the other way to the testes is specialized
Highly coiled
intimately associated with network of anastomotic thanks forming the pampiniform plexus
Characteristics of veins to the testis
Thin walled party muscular raised no effect evolves except at inflow points into inferior vena cava or renal vein
Vein of the testes
Rights Spermatic vein (vena cava )
left spermatic vein( left renal vein )
What are some congenital anomalies of the testis
Testicular agenesis Cryptorchidism Arrested descend Ectopic testis Crossed testicular ectopia Vanishing testes syndrome Leydig cell only syndrome Supernumerary testicles
What is testicular agenesis
Complete absence of testicular tissue in individual with normal male phenotype in normal karyotype
Do male patient with testicular agenesis have generally small penises
Yes
What Are the characteristics of early failure in testicular agenesis
Absence of testes and wolffian structure on the same side
What are the characteristics of late failure in testicular agenesis
Absence of testis
presence of vas
Common manifestation of congenital agenesis agenesis in male
Presence of male external genitalia
hypoplasia of both scrotum
microphallus or ambiguous external genitalia
Typical hormonal characteristics of testis agenesis are
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
cryptorchidism
Absence of testis in scrotal sac with failure of testes to descend normally into scrotum
Is cryptorchidism more common in preterm infants
Yes
Is cryptorchidism more common on the right or the left side if unilateral
Right side
Percentage of bilateral cryptorchidism
25
True or false , most undescended testes migrate into lower scrotum within the first three months of life due to surge in testosterone
True
What are the factors involved in descent of testis
Hormones like Ganadotropins and testosterone
gubernaculum active migration which determine final position of the testes by connecting developing testes to scrotum
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
Two types of cryptorchidism
Arrested descent
ectopic testis
What is arrested descent
Uncomplete descent of testis a long normal path
Main location of testes arrested decent
Inguinal Canal 80%
near pubic tubercle
rarely abdomen
Macro morphology of arrested descent
Progressive atrophy
Small size
firm in consistency
short spermatic cord
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
What is ectopic testis
One of the testicle has not descended into scrotum and taken different path and get into abdominal cavity
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
What should be done if undescennded testis is discovered in adult
Removed to prevent germ cell tumor
What event increase in incidence in ectopic testis
Trauma
Torsion
Inguinal hernia
Percentage of testicular malignancy risk in male with undescended testis
10-15%
What is crossed testicular ectopia
Transverse testicular ectopia , testicular pseudoduplication unilateral double testis and transverse aberrant testicular maldescent
Both gonads migrate toward same hemiscrotum
Main site of ectopic testis in crossed testicular ectopia
Opposite hemiscrotum
Inguinal canal
Deep inguinal ring
Do you find inguinal hernia next to ectopic testis
Yes
Remnants structures found in 38% of CTE cases
Persistent Müllerian duct, tubes, rudimentary uterus, hemiuterus
3 types of CTE
Associated with inguinal hernia alone
Associated with persistent or rudimentary Müllerian duct structure
Associated with other anomalies without mullerian remnant
Mean age of CTE presentation
4 yo
Common sequalae of CTE
Infertility
Malignancy
What is vanishing testes syndrome
Disappearance of one or both testes between last month of intrauterine life and beginning of puberty
Consequences of vanishing testes syndrome of both testes
Hypergonadotropic hypogonadism after puberty
Gynecomastia
Hypoplastic scrotum
Impalpable prostate
Main cause of vanishing testes syndrome
Secondary to perinatal scrotal torsion
What is Leydig cell only syndrome
Agonadism without eunuchoidism and normal male phenotype
Spermatic cord with clusters Leydig cells
Level of testosterone in Leydig cell only syndrome
Enough to have male phenotype
Not enough to support complete development of secondary sex characteristics
What is supernumerary testicles
Poly orchid, triochisdism , supernemerary testicles
Presence of more than 2 testes
Most common variety of polyorchidism
Triorchidism
Main side with supernumerary testis
Left side
Associated anomalies with supernumerary testicles
Maldescent of testis or cryptorchidism m indirect hernia (80%) Torsion Infertility Malignancy Hydrocele Epididymis Varicocele
Type of vascular disturbances of testes
Torsion
Varicocele
What is testis torsion
Twisted testis on spermatic cord
What happens when there is testis torsion
Venous occlusion with maintained arterial blood flow
Intense vascular engorgement and hemorrhagic infarction
Classic presentation of torsion
Excruciating testicular pain after often violent physical activity
Amount of Time at which testitucal viability has decreased significantly
6h
Testicular torsion seen mostly in which population
Adolescent
Neonate
Congenital abnormalities associated with torsion
Tunica vaginal is on spermatic cord
No scrotal ligaments
Atrophy of testis
Group of age with mostly extra vaginal torsion
Neonates because tunica vaginalis not yet secured to gubernaculum
What is bell clapper deformity
Attachment of Tunica vaginalis to testicle is high
Spermatic cord can rotate in it causing intravaginal torsion
Degree of rotation in torsion
90 to 180 degrees
Degrees of complete torsion
360 degrees
Consequence of twisting testes
Venous occlusion
Engorgement
Arterial ischemia
Infarction of testicle
Morphology of testes torsion
Diffuse congestion
Widespread interstitial hemorrhage
Hemorrhagic infarction of entire organ
Varicocele definition
Abnormal enlargement of venous plexus within spermatic cord
Is Varicocele common in infertility
Yes
Side with more Varicocele case
Left side
Palpation of testes Varicocele feels like
Bag of worms
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
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
Most common tumor in adolescent and young men
Testicular tumor
Main site of occurrence of testicular cancer
Germ cells
2 types of testicular tumor
Germ cell tumor
Sex cord / gonadal stromal tumor
Main population affected by germ cell tumors
White
20-34 yo
Is latency period long or short when going from carcinoma in situ to invasive carcinoma for GCT
Long
2 main kind of tumors by germ cell tumors
Seminomas
Non seminomatous tumors
Risk factor of GCT
Cryptorchidism
GCT in one testis increase risk in other one
Malignant pure germ cell tumor of seminoma types
Classic seminoma
Spermatocytic tumor
Malignant pure germ cell tumor of non seminomas types
embryonal carcinoma Teratoma Choriocarcinoma Yolk sac tumor Polyembryoma
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
Percentage of seminoma in testicular neoplasm
35-70%
Percentage of classic seminoma in seminoma type
95%
Morphology of classic seminoma
Mass anywhere in testis
Moderate smooth or bosselâtes enlargement of organ
Yellow or tan
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
Population at risk of spermatocytic seminoma
old men
Macro morphology spermatocytic seminoma
Soft gelatinous or mucoid appearance
Cystic areas
No hemorrhage or necrosis
Poor demarcation
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
Main population of nonseminomatous germ cell tumor
20s 30s
Most primitive form of nonseminomatous germ cell tumor
Embryonal carcinoma
Gross morphology embryonal carcinoma
Large
Hemorrhagic
Necrotic
Variegated cut surface
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
What do you find in yolk sac tumor
Embryonic remnants
Fetal yolk sac
Alla trois
Extra embryonal mesenchyme
2 types of yolk sac tumor
Postpubertal type - mixed
Prepubertal type- pure
Go read about post and pre
Second most common GCT in children after yolk sac tumor
Teratoma
Which is more common , postpubertal or prepubertal teratoma
Postpubertal
