Heme/Onc- Male reproductive

Question 1

Diagnosis: 65yo male, hematuria, no pain, 30-pack year. UA + only RBCs

Answer 1

Bladder cancer.

Advanced age, history of tobacco, painless hematuria, absence of infection or casts raise suspicion for bladder cancer

Question 2

Bladder cancer

Answer 2

malignant transformation of the bladder surface epithelium (urothelium) due to chronic exposure. to chemical carcinogens (tobacco smoke and industrial chemicals).

Question 3

Differential diagnosis anterior mediastinal masses

Answer 3

4 Ts:

Thymoma
Teratoma
“Terrible” Lymphoma
Thyroid neoplasm

Question 4

Types of malignant germ cell tumors (teratoma)

Answer 4

Seminoma (↑ B-HCG, normal AFP)

(↑AFP and/or B-HCG):
Nonseminomatous GCT
Mixed GCT

Question 5

Differentiated a benign mediastinal teratoma

Answer 5

Normal AFP and B-HCG

Imaging: Fat bone or fluid

Question 6

Next steps possible malignant mediastinum teratoma

Answer 6

1. Biopsy (confirm diagnosis)

2. Testicular ultrasound (determine is primary of mets)

Question 7

S&S bladder cancer

Answer 7

painless hematuria (gross or microscopic)
voiding symptoms (frequency, urgency, dysuria )
suprapubic pain
Smoking history/ chemical exposure
age >40
RBC on UA and nothing else

Question 8

Tx bladder cancer

Answer 8

No muscle invasion: Transurethral reaction & intravesical immunotherapy

muscle invasion: radical cystectomy & sys. chemo

mets: sys. chemo & immunotherapy

Question 9

gynecomastia and ↑hCG

Answer 9

Testicular or gonadal germ-cell tumor

Question 10

gynecomastia and ↓/normal LH ↓Testosterone

Answer 10

Central hypogonadism

Question 11

gynecomastia and ↑LH ↓ Testosterone

Answer 11

Primary hypogonadism

Question 12

gynecomastia and ↑LH ↑Testosterone

Answer 12

Possible thyrotoxicosis

Question 13

gynecomastia and ↑ estradoil

Answer 13

testicular or adrenal tumor

Question 14

Mechanism of gynecomastia with germ cell tumors

Answer 14

Xs hCG suppresses testoerone productiona nd increases armature activity and conversion of androgens to estrogens

Question 15

Management of gynecomastia with ↑hCG

Answer 15

Testicular ultrasound to exclude occult mass

Question 16

Varicocele

Answer 16

dilation of the pampiniform plexus surrounding the spermatic cord and testis

Question 17

S&S primary varicocele

Answer 17

Bag of worms/ coiled
Pubertal onset
Left-sided
Decompresses when supine

Question 18

Management of primary varicocele

Answer 18

Reassurance and observation

Question 19

S&S secondary varicocele

Answer 19

Bag of worms/ coiled
Prepubertal onset
Right sided
Persists when supine

Question 20

Management of secondary varicocele

Answer 20

abdominal ultrasound (rule out a tumor compressing IVC)

any varicocele that persists when laying down is treated was is a secondary cause