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Repro Week 2 > Icl 6.5: Penile and Testicular Cancers > Flashcards

Icl 6.5: Penile and Testicular Cancers Flashcards

1
Q

what is hypospadias?

A

most common abnormality. Urethral meatus is on the underside (ventral surface) of the penis

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2
Q

what is epispadias?

A

the urethral opening is on the upper (dorsal) surface of the penis.

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3
Q

what are the complications associated with hypo/epispadias?

A

hypo or epispadia may be associated with undescended testicles

these defects may lead to obstruction and UTI or interfere with reproduction

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4
Q

what is phimosis?

A

constriction of the orifice of the prepuce (foreskin) so you can’t pull the foreskin down

often associated with recurrent chronic inflammation

poor hygiene may predispose to carcinoma!!!!

can be prevented by circumcision

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5
Q

what is paraphimosis?

A

painful retracted prepuce so you can’t pull the foreskin back up to the glans

can be prevented by circumcision

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6
Q

what is balanoposthitis?

A

inflammation of the glans by bacteria or yeast

scarring due to inflammation can lead to phimosis

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7
Q

what are the benign tumors of the penis?

A
  1. condyloma acuminatum

2. giant condyloma

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8
Q

what is condyloma acuminatum?

A

aka anogenital warts

a benign epithelial proliferation caused by human papilloma virus (HPV types 6 and 11)

most likely mode of transmission is sexual contact

most commonly seen after puberty in either sex

grossly, a sessile or pedunculated papillary proliferation (cauliflower)

histologically, branching papillae covered by hyperplastic squamous epithelium, showing vacuolation of superficial squamous cells (koilocytosis)

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9
Q

what is a giant condyloma?

A

a large exophytic lesion that may destroy much of the penis, associated with HPV types 6 and 11

locally invasive and recurrent, metastases rare.

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10
Q

what are malignant penis tumors?

A
  1. carcinoma in situ aka bowen’s disease aka Bowenoid papulosis
  2. invasive squamous cell carcinoma
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11
Q

what is carcinoma in situ of the penis?

A

thickened skin, shiny red or white plaques +/- ulceration, genital areas of males or females

associated with HPV, especially types 16 (80%) and 18

dysplastic squamous cells that are well-confined above the basement membrane, with no evidence of invasion

Bowenoid papulosis: younger age, multiple lesions, may spontaneously regress, never invasive

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12
Q

what is invasive squamous cell carcinoma?

A

only 1% of cancers in males in the U.S., higher in non-circumcised males

etiologies: HPV types 16 and 18, carcinogens within smegma accumulating under the foreskin –> potentiated by cigarette smoking !!!

grossly, exophytic and invasive growth eroding the penis.

histologically, identical to squamous Ca involving other sites.

slow growth with metastases to regional lymph nodes (inguinal and iliac) – gonads will go to the paraaortic lymph nodes

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13
Q

what is cryptorchidism?

A

undescended testis

1% incidence, +/- hypospadia, +/- inguinal hernia

descent iis hormonally regulated by Mullerian-inhibiting substance and androgen

usually unilateral, tubular atrophy occurs by age 2, increased risk of cancer in BOTH testicles

splenogonadal fusion (left) is rare

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14
Q

what can cause testicular atrophy?

A
  1. atherosclerosis
  2. inflammation
  3. cryptorchidism
  4. hypopituitarism
  5. radiation
  6. female hormone administration
  7. genetic

leads to decreased fertility

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15
Q

which infectious diseases effect the epididymis vs. testis first?

A

gonorrhea and TB effect the epididymis first

syphilis affects testis first

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16
Q

what is autoimmune orchitis?

A

middle age, usually acute tender tissular mass

fever, granulomas diffusely though out tubules

17
Q

what is torsion?

A

twisting of spermaticord

sudden onset excruciating testicular pain

urologic emergency, should be deterred within 6 hrs

18
Q

what are the spermaticord and paratesticular benign tumors?

A
  1. cord lipoma (most common)

2. adenomatoid tumor

19
Q

what is an adenomatoid tumor of the spermatic cord?

A

benign, mesothelioma organ, near upper pole of the epididymys

looks like glands and can be misdiagnosed as adenocarcinoma but it’s benign!

20
Q

what are the most common malignant tumors of the spermaticord?

A

children: rhabdomyosarcoma
adults: liposarcoma

21
Q

what are the types of testicular tumors?

A
  1. germ cell tumors
22
Q

what are testicular germ cell tumors?

A

usually highly malignant and there are 2 types: seminomas and non-seminomatous germ cell tumors (NSGCT)

ages 15-34 most common

95% of malignant testicular neoplasms are seminomas!!!!! they are generally cytokeratine negative while NSGCTs are generally CK+***

non-seminomatous germ cell tumors: embryonal carcinoma, yolk sac tumor, teratoma, choriocarcinoma, mixed tumors

23
Q

what do you do when you find a testicular tumor?

A

if you have a tumor of the testicle you automatically assume they’re malignant and you immediately remove the testicle!

almost always germ cell tumors whereas ovarian ones are usually epithelial

24
Q

what are some of the causes of germ cell tumors?

A
  1. environment
  2. cryptorchidims
  3. testicular dysgenesis
  4. genetic factors: isochrome 12p is found in almost all germ cell tumors
25
Q

what is intratubular germ cell neoplasia?

A

a proliferation of abnormal germ cells within seminiferous tubules, may progress to invasive germ cell tumor

premalignant lesion of the testicle!

26
Q

how do you treat germ cell tumors?

A
  1. almost every painless testis mass is presumed to be a malignant tumor
  2. check LDH, HCG, and AFP levels before surgery – no biopsy. Rx is radical orchiectomy
  3. lymphatic mets first to retroperitoneal para-aortic nodes unlike the penis which goes to the iliac*
  4. hematogenous mets to lungs, liver, brain, bones
  5. most tumors are curable
    seminoma (95% complete cure) even with mets!
NSGCT: 90% complete remission, most cured but not as good as seminomas
Higher stage II or III at Dx
Hematogenous mets
Radioresistant
Worse prognosis
27
Q

what are the characteristics of seminomas vs. NSGCT?

A

SEMINOMA
1. localized for longer so usually stage I at diagnosis

  1. nodal mets
  2. radiation sensitive
  3. better prognosis; 95% completely cured

NSGCT
1. higher stage II or III at diagnosis

  1. hematogenous mets
  2. radio resistant
  3. worse prognosis; 90% complete remission, most cured
28
Q

what is a seminoma?

A

most common testicular tumor, most likely tumor to occur in an undescended testis, accounts for 50% of all germ cell tumors

occurs predominantly during the third through fifth decade, painless enlargement of the testis

variants: classic seminoma (99%) and spermatocytic seminoma (1% - older population over 65, more slowly growing, rarely mets, excellent prognosis).

29
Q

what is the histology of a seminoma?

A

lobules of uniform cells separated by thin fibrous septa which contain lymphocytes.

the individual cells have sharp cell membranes, clear cytoplasm (glycogen) and large nuclei with prominent nucleoli

30
Q

what immunostain is important for seminomas?

A

negative cytokeratin (CK)

31
Q

what is a testicular embryonal carcinoma?

A

peak incidence in 20 to 30 age group; more aggressive than seminoma.

alveolar or tubular growth pattern with primitive gland formation

stains CK+ and c-KIT- (to differentiate from seminoma)

syncytial cells in the tumor may produce HCG

+/- AFP –> some pathologists classify any tumor with AFP production as focal yolk sac tumor in a mixed tumor

32
Q

what is a testicular yolk sac tumor?

A

most common “pure” testicular neoplasm in infants and young children (endodermal sinus tumor)

in adults, yolk sac elements usually found in a mixed tumor, commonly in embryonal carcinoma

microscopically, malignant cells form primitive glomeruli-like structures (Schiller-Duval bodies**)

express AFP and α1-antitrypsin**

33
Q

what is a testicular choriocarcinoma?

A

a rare, highly malignant neoplasm composed of cytotrophoblastic and syncytiotrophoblastic elements

more common as part of a mixed tumor

HCG positive

similar neoplasms may occur in the ovary and placenta

34
Q

what is a testicular teratoma?

A

neoplasms exhibiting evidence of simultaneous differentiation along endodermal, mesodermal, and ectodermal lines

uncommon in testis but common in the ovary

occur at any age
In children, regarded as benign with good prognosis

in post-puberty, regarded as malignant and capable of mets

three variants include: mature teratomas, immature teratomas, and malignant teratomas

35
Q

what is a mixed tumor?

A

60^of all germ cell tumors with variable mixed histological patterns

36
Q

what are the stages of testicular tumors?

A

Stage I: Tumor confined to the testis

Stage II: Metastases limited to retroperitoneal nodes

Stage III: Metastases outside the retroperitoneal nodes

37
Q

what are biomarkers used for with testicular cancer?

A
  1. valuable presurgery to predict a malignant tumor
  2. valuable post surgery to help stage and monitor for recurrence

LDH non-specific marker of tumor burden

38
Q

what are testicular sex cord-gonadal stroma tumors?

A

not common

may secrete androgen and/or other steroids like estrogens and corticosteroids

testicular mass with changes referable to hormonal abnormalities: gynecomastia, precocious puberty

Reinke crystalloids*

39
Q

what are testicular lymphomas?

A

5% of testicular neoplasms

most common neoplasm in patients over 60

most are diffuse, large b-cell lymphomas or Burkitt lymphomas

they disseminate widely and the prognosis is poor…

Repro Week 2 (21 decks)

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