DLA8- Male GUT Pathology II (testis, penis)

Question 1

Cryptorchidism = (1):

• (2) phases of descending testis
• (3) general causes

Answer 1

1- undescended testis (one or both)

2- transabdominal phase, inguino-scrotal phase

3- anatomical abnormalities, hormonal imbalances, mechanical defects

Question 2

testicles descend from the abdomen to the pelvis in response to (1); they descend further through (2), controlled by (3)

Answer 2

1- anti-mullerian hormone (transabdominal phase)

2- inguinal canal

3- androgen-dependent

Question 3

Cryptochordism:

• most commonly on (R/L/both) side(s)
• most cases are seen in (2) babies
• (3) usual course of disease

Answer 3

1- R side (25% bilateral)

2- premature births&raquo_space; full-term births

3- spontaneous testis descent w/in 6 mos (1% persist >1yr)

Question 4

Cryptochoridism describe the complications

Answer 4

-infertility: preventable with surgical correction before 2y/o (orchipexy / orchidopexy)

Germ cell tumors: risk is reduced with surgical correction before 5y/o

Question 5

Cryptochordism histological features

Answer 5

(of undescended testicle)

• atrophy of semiferous tubules
• Leydig cell prominence
• thickened BM

Question 6

relate the testicular tumor type to age

Answer 6

infants/children- teratomas, yolk sac tumors

15-30 y/o- mixed germ cell tumors

30-50 y/o- seminomas

> 60 y/o- lymphomas

Question 7

list the risk factors for testicular cancer

Answer 7

• cryptochordism (10% of all testicular carcinomas)
• testicular dysgenesis syndrome (congenital anomalies)
• Klinefelter’s (XXY)
• i(12)p = isochromosome 12
• FHx
• environment- radiation, pesticides

Question 8

describe the local effects of testicular tumors

Answer 8

Usually-painless unilateral mass

Sometimes- heavy feeling in scrotum with dull achy pain in groin / abdomen

Even Less- hydrocele

Note- Acute Testicular pain indicates trauma, hemorrhage, infarction w/in tumor

Question 9

describe the Paraneoplastic effects and Metastatic effects of testicular tumors

Answer 9

• gynecomastia (via β-hCG secretion, dec androgens, or inc estrogen)
• weight loss (via TNF secretion)

-20% with metastatic spread via LNs

Question 10

list the classifications of testicular tumors, indicate the most common form

Answer 10

• GCT (germ cell tumor), 95%:
• seminoma: semiferous differentiation (30% GCT)
• non-seminoma: embryoidal, choriocarcinoma, yolk sac tumor
• mixed GCT
• teratoma

Sex-Cord / Stromal:

• sertoli cells
• leydig cells

Others: lymphoma, sarcoma, metastatic

Question 11

Most common GCT = (1), originating from (2).

• (3) gross appearance
• (4) histological appearance

Answer 11

1- seminoma
2- seminiferous tubules

3- unilateral, bulky mass / gray-white, lobulated cut surface, no hemorrhage (usually)

4- large uniform cells is sheets, clear cytoplasm (glycogen rich), central nucleus with prominant nucleoli (fried egg) / poorly demarcated lobules divided by fibrous septa with lymphocyte infiltration

Question 12

Embryonal testicular carcinoma:

• (1) is most affected age group
• (2) aggressiveness
• (3) gross appearance
• (4) histological appearance

Answer 12

1- 20-30 y/o men
2- very aggressive - usually invades surrounding tissue at Dx

3- variegated (different colored streaks) w/ hemorrhage and necrosis commonly

4- poorly differentiated sheet of tumor cells forming glands or tubules / papillary forms cysts in some areas

Question 13

Yolk sac tumor (testicular) = (1):

• (2) most affected group
• (3) tumor marker
• (4) gross appearance
• (5) histological appearance

Answer 13

1- endodermal sinus tumor
2- <3y/o
3- AFP (α-fetoprotein), 90% tumors

4- unencapsulated tumor, pale-yellow mutinous appearance

5- endodermal sinus like = Schiller-Duvall Bodies surrounding central BV (resembles glomerulus appearance)

Question 14

Choriocarcinoma:

• (common/rare)
• (2) aggressiveness
• (3) secretion
• (4) gross appearance
• (5) histological appearance

Answer 14

1- rare
2- highly aggressive, poor prognosis
3- β-hCG

4- no enlargement, small papable nodule

5- syncytiotophoblasts (large, multi-nucleated, abundant cytoplasm with hCG) + cytotrophoblasts (polygonal, distinct borders, clear cytoplasm)

Question 15

Teratomas:

• (1) usual age of onset
• (benign/malignant)
• (3) gross appearance

Answer 15

1- childhood
2- benign (good prognosis, worse in adults)

3- large, heterogenous, solid (cartilaginous and cystic areas possibly)- maybe hair, skin, teeth, mucosa

Question 16

Teratoma histological apperance

Answer 16

(based on age)
Child / benign: well-differentiated heterogenous mature tissues of all 3 germ layers

Adults / poor prognosis: poorly-differentiated tissues, more malignant to invade borders

Question 17

Testicular Cancer:

• (1) Dx
• (2) Tx

Answer 17

Dx:
-palpable mass + maybe biomarker screening (AFP, β-hCG)
-surgical excision and histology for confirmation
(Stages: I- local, II- to LNs below diaphragm, III- LNs above diaphragm)

Tx: depends on stage / histology type

• seminomas respond best to rafiotherapy
• non-seminomas respond best to chemotherapy

Question 18

define hypospadias

Answer 18

urethral opening on ventral penis (bottom) anywhere along shaft

Question 19

define epispadia

Answer 19

urethral opening on dorsal penis (top)

-associated with cryptochordism, inguinal hernia, urinary tract obstruction, recurrent infections, infertility

Question 20

define phimosis

Answer 20

oriface of prepuce (foreskin) is too small to permit normal retraction
-developmental anomaly or infection with scarring are the causes

Question 21

define paraphimosis

Answer 21

phimotic prepuce (foreskin) is forcibly retracted over glans penis –> constriction / swelling

• painful, urethral constrictions and recurrent UTIs
• cure with circumcision

Question 22

Pair the congenital abnormality with the following definitions:

• (1) too small prepuce oriface
• (2) forcibly retracted prepue of glans penis
• (3) urethral opening on ventral penis
• (4) urethral opening on dorsal penis

Answer 22

1- phimosis
2- paraphimosis
3- hypospadias
4- epispadias

Question 23

(1) is the main benign tumor of the penis, usually caused by (2). (3) is the main gross appearance in men with (4) histologic changes)

Answer 23

1- Condyloma Acuminatum / genital warts
2 HPV-6/11

3- warty growths on penile meatus / glans

4- papillary infoldings of squamous cell epithelium with koliocytic (vacuolization) changes

NO CANCER RISK

Question 24

Penile Carcinoma in-situ:

• (1) types
• (2) cause

Answer 24

1- Bowen’s disease, Erythroplasia of Queyrat, Bowenoid Papulosis

2- HPV 16/18 (high malignancy risk)

Question 25

Bowen’s Lesion:

• (single/multiple)
• (2) penile location
• (3) lesion type
• (4) prognosis

Answer 25

(penile carcinoma in-situ)
1- solitary
2- shaft
3- plaque / scaly
4- 10% to SCC, associated with visceral malignancies

Question 26

Erythroplasia of Queyrat:

• (single/multiple)
• (2) penile location
• (3) lesion type
• (4) prognosis

Answer 26

(penile carcinoma in-situ)
1- both
2- glans, prepuce
3- red patch, shiny plaque
4- usually progresses to SCC

Question 27

Bowenoid Papulosis:

• (single/multiple)
• (2) penile location
• (3) lesion type
• (4) prognosis

Answer 27

(penile carcinoma in-situ)
1- multiple
2- shaft (+ glans, prepuce)
3- papular
4- no SCC progression

Question 28

Invasive SCC of penis:

• (1) risk factors
• (2) gross appearance
• (3) histological apperance
• (4) prognosis

Answer 28

1- smegma carcinogens, HPV 16/18, smoking, Bowen’s disease (CIS)

2- papillary (cauliflower on shaft) or flat

3- keratin pearls, intercellular bridges, maybe necrosis + hemorrhage

4- slow growing, fairly good w/o metastasis