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Reproductive > Disease Of The Testis > Flashcards

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
Q

What are some reasons for failure of testes decent

A

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

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26
Q

Two types of cryptorchidism

A

Arrested descent

ectopic testis

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27
Q

What is arrested descent

A

Uncomplete descent of testis a long normal path

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28
Q

Main location of testes arrested decent

A

Inguinal Canal 80%
near pubic tubercle
rarely abdomen

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29
Q

Macro morphology of arrested descent

A

Progressive atrophy
Small size
firm in consistency
short spermatic cord

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30
Q

Micro morphology arrested descent

A

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

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31
Q

What is ectopic testis

A

One of the testicle has not descended into scrotum and taken different path and get into abdominal cavity

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32
Q

2 important sequalae of ectopic testis

A

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

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33
Q

What should be done if undescennded testis is discovered in adult

A

Removed to prevent germ cell tumor

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34
Q

What event increase in incidence in ectopic testis

A

Trauma
Torsion
Inguinal hernia

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35
Q

Percentage of testicular malignancy risk in male with undescended testis

A

10-15%

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36
Q

What is crossed testicular ectopia

A

Transverse testicular ectopia , testicular pseudoduplication unilateral double testis and transverse aberrant testicular maldescent

Both gonads migrate toward same hemiscrotum

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37
Q

Main site of ectopic testis in crossed testicular ectopia

A

Opposite hemiscrotum
Inguinal canal
Deep inguinal ring

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38
Q

Do you find inguinal hernia next to ectopic testis

A

Yes

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39
Q

Remnants structures found in 38% of CTE cases

A

Persistent Müllerian duct, tubes, rudimentary uterus, hemiuterus

40
Q

3 types of CTE

A

Associated with inguinal hernia alone
Associated with persistent or rudimentary Müllerian duct structure
Associated with other anomalies without mullerian remnant

41
Q

Mean age of CTE presentation

A

4 yo

42
Q

Common sequalae of CTE

A

Infertility

Malignancy

43
Q

What is vanishing testes syndrome

A

Disappearance of one or both testes between last month of intrauterine life and beginning of puberty

44
Q

Consequences of vanishing testes syndrome of both testes

A

Hypergonadotropic hypogonadism after puberty

Gynecomastia

Hypoplastic scrotum

Impalpable prostate

45
Q

Main cause of vanishing testes syndrome

A

Secondary to perinatal scrotal torsion

46
Q

What is Leydig cell only syndrome

A

Agonadism without eunuchoidism and normal male phenotype

Spermatic cord with clusters Leydig cells

47
Q

Level of testosterone in Leydig cell only syndrome

A

Enough to have male phenotype

Not enough to support complete development of secondary sex characteristics

48
Q

What is supernumerary testicles

A

Poly orchid, triochisdism , supernemerary testicles

Presence of more than 2 testes

49
Q

Most common variety of polyorchidism

A

Triorchidism

50
Q

Main side with supernumerary testis

A

Left side

51
Q

Associated anomalies with supernumerary testicles

A 
Maldescent of testis or cryptorchidism m indirect hernia (80%)
Torsion
Infertility
Malignancy 
Hydrocele 
Epididymis 
Varicocele
52
Q

Type of vascular disturbances of testes

A

Torsion

Varicocele

53
Q

What is testis torsion

A

Twisted testis on spermatic cord

54
Q

What happens when there is testis torsion

A

Venous occlusion with maintained arterial blood flow

Intense vascular engorgement and hemorrhagic infarction

55
Q

Classic presentation of torsion

A

Excruciating testicular pain after often violent physical activity

56
Q

Amount of Time at which testitucal viability has decreased significantly

A

6h

57
Q

Testicular torsion seen mostly in which population

A

Adolescent

Neonate

58
Q

Congenital abnormalities associated with torsion

A

Tunica vaginal is on spermatic cord
No scrotal ligaments
Atrophy of testis

59
Q

Group of age with mostly extra vaginal torsion

A

Neonates because tunica vaginalis not yet secured to gubernaculum

60
Q

What is bell clapper deformity

A

Attachment of Tunica vaginalis to testicle is high

Spermatic cord can rotate in it causing intravaginal torsion

61
Q

Degree of rotation in torsion

A

90 to 180 degrees

62
Q

Degrees of complete torsion

A

360 degrees

63
Q

Consequence of twisting testes

A

Venous occlusion
Engorgement
Arterial ischemia
Infarction of testicle

64
Q

Morphology of testes torsion

A

Diffuse congestion
Widespread interstitial hemorrhage
Hemorrhagic infarction of entire organ

65
Q

Varicocele definition

A

Abnormal enlargement of venous plexus within spermatic cord

66
Q

Is Varicocele common in infertility

A

Yes

67
Q

Side with more Varicocele case

A

Left side

68
Q

Palpation of testes Varicocele feels like

A

Bag of worms

69
Q

What examination should you always do in left sided Varicocele

A

Left kidney examination because of left e renal vein that can be blocked by renal cell carcinoma

70
Q

Consequence of Varicocele on spermatogenesis

A 
Increased testicular temperature 
Increased intratesticular pressure
Hypoxia due to attenuation of blood flow
Toxic metabolites reflux form adrenal glands 
Hormonal profile abnormalities
71
Q

Most common tumor in adolescent and young men

A

Testicular tumor

72
Q

Main site of occurrence of testicular cancer

A

Germ cells

73
Q

2 types of testicular tumor

A

Germ cell tumor

Sex cord / gonadal stromal tumor

74
Q

Main population affected by germ cell tumors

A

White

20-34 yo

75
Q

Is latency period long or short when going from carcinoma in situ to invasive carcinoma for GCT

A

Long

76
Q

2 main kind of tumors by germ cell tumors

A

Seminomas

Non seminomatous tumors

77
Q

Risk factor of GCT

A

Cryptorchidism

GCT in one testis increase risk in other one

78
Q

Malignant pure germ cell tumor of seminoma types

A

Classic seminoma

Spermatocytic tumor

79
Q

Malignant pure germ cell tumor of non seminomas types

A 
embryonal carcinoma 
Teratoma
Choriocarcinoma 
Yolk sac tumor 
Polyembryoma
80
Q

Malignant mixed germ cell type

A

Embryonal carcinoma and teratoma with or without seminoma

Embryonal carcinoma and yolk sac tumor with or without seminoma

Embryonal carcinoma and seminoma

81
Q

Percentage of seminoma in testicular neoplasm

A

35-70%

82
Q

Percentage of classic seminoma in seminoma type

A

95%

83
Q

Morphology of classic seminoma

A

Mass anywhere in testis
Moderate smooth or bosselâtes enlargement of organ

Yellow or tan

84
Q

Micro classic seminoma

A

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
Q

Population at risk of spermatocytic seminoma

A

old men

86
Q

Macro morphology spermatocytic seminoma

A

Soft gelatinous or mucoid appearance
Cystic areas
No hemorrhage or necrosis
Poor demarcation

87
Q

Micro spermatocytic seminoma

A

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
Q

Main population of nonseminomatous germ cell tumor

A

20s 30s

89
Q

Most primitive form of nonseminomatous germ cell tumor

A

Embryonal carcinoma

90
Q

Gross morphology embryonal carcinoma

A

Large
Hemorrhagic
Necrotic
Variegated cut surface

91
Q

Histo embryonal carcinoma

A 
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
Q

What do you find in yolk sac tumor

A

Embryonic remnants
Fetal yolk sac
Alla trois
Extra embryonal mesenchyme

93
Q

2 types of yolk sac tumor

A

Postpubertal type - mixed

Prepubertal type- pure

94
Q

Go read about post and pre

A
95
Q

Second most common GCT in children after yolk sac tumor

A

Teratoma

96
Q

Which is more common , postpubertal or prepubertal teratoma

A

Postpubertal

Reproductive (14 decks)

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