Male Genital Flashcards
Which of the following is LEAST accepted as a para-epididymal tumor?
- Adenomatoid tumor
- Haemangioendothelioma
- Lipoma
- Liposarcoma
- Rhabdomyosarcoma
- *Haemangioendothelioma
Concerning germ cell tumors of the testis which of the following is LEAST correct?
- This group includes seminomas
- There is a 8 -10 fold increase in brothers of patients with germ cell tumors
- There is a 50-fold increase in Mediastinal germ cell tumors in patients with Kleinfleter Syndrome but no increase in testicular germ cell neoplasms
- Spermatocytic seminomas are slow growing neoplasms seen in most common in males greater than 65 years of age
- Yolk Sac tumor (also called endodermal sinus tumor) is an aggressive neoplasm with poor (<5%) 2-year survival in children
- *Yolk Sac tumor (also called endodermal sinus tumor) is an aggressive neoplasm with poor (<5%) 2-year survival in children
Concerning testicular tumors which of the following statements is most correct?
- Mixed forms of tumors are uncommon and account for <5% of tumors
- While cell lines within a teratoma may resemble other forms of neoplasm they all behave similarly with similar sensitivities to therapy
- Seminomas commonly disseminate lymphatically early in their disease (10-15% Stage I)
- Testicular teratomas in the adult are typically bland homogenous solid masses
- Pure choriocarcinomas may not cause any testicular enlargement, but is aggressive with early haematogenous spread and usually poor prognosis
- *Pure choriocarcinomas may not cause any testicular enlargement, but is aggressive with early haematogenous spread and usually poor prognosis
A patient has a prostate cancer for bone scan which the RMO says is Gleason grade I. Which of the following is most correct?
- The RMO is in error. There is no Gleason Grade 1.
- The RMO is in error. They must mean Gleason Stage 1
- It means the tumor is histologically very well differentiated
- It means the tumor is histologically very poorly differentiated
- It means that the tumor had been graded by TURP alone and final grading is pending on resection.
- *The RMO is in error. There is no Gleason Grade 1.
Which is true of undescended testes? (September 2013)
a. 90% are intraperitoneal
b. Most will spontaneously descend by one year
c. Normal size
d. No increased risk of malignancy
e. Increased risk of torsion
Cryptorchidism: Absence of a testis from the scrotal sac
Causes/associations: - Premature birth (birth occurs before descent is complete) - IUGR - Smoking & increased ETOH intake in pregnancy - Androgen insensitivity syndrome - Gestational diabetes - Congenital syndromes: • Prader-Willi Syndrome • Noonan Syndrome • Cloacal extrophy • Prune Belly Syndrome
Prognosis:
- Most undescended testes descend w/in the first three months after birth
- Orchidopexy for viable testes high in the scrotum or inguinal canal (Performed after 1 year as the testes may descend w/o intervention)
- 32 times increased risk of germ cell tumour (Further increased risk if bilateral cryptorchism & abdominal cryptorchidism)
- Increased risk of malignancy in the contralateral testis
- Rate of infertility in the undescended testis (even w orchidopexy) is approximately 10%
- Defect of spermatogenesis
ANSWER: Most testes will descend by one year without intervention.
Which is true regarding cyptorchidism? (March 2017)
a. Bilateral in 25%
b. Orchidopexy reduces cancer risk
c. Remains present in the majority at one year old
d. The contralateral testis is normal
e. Fertility is unaffected
ANSWER: Cryptorchidism is bilateral in 10-30%
Which is false regarding cryptorchidsism? (March 2014)
a. Infertility resolves with orchidopexy
b. Complete descent by 1 year most common
c. Risk of malignancy is increased in the contralateral testis
d. Majority of undescended testes are located in the inguinal canal
ANSWER: Infertility does not resolve with orchidopexy
Which of these involves the testes more than the epididymis? (March 2015, March 2016)
a. Tuberculosis
b. Gonococcus
c. Chlamydia
d. E. Coli
e. Syphilis (Treponema pallidum)
Orchitis is an infection of the testicle which is rarely isolated
o Usually occurs as part of epididymo-orchitis (which can be bacterial or viral)
o Most commonly occurs due to retrograde seeding from the bladder or the prostate
o Isolated orchitis can occur with mumps or syphilis
ANSWER: Syphilis
Which organism does not typically involve the testes? (March 2017)
a. HPV
b. Gonorrhoea
c. TB
d. Syphilis
e. Mumps
ANSWER: HPV does not typically involve the testes. Gonorrhoea and TB are recognized causes of epipdidymo-orchitis. Syphilis and mumps are causes of isolated orchitis.
Which of the following is not a testicular germ cell tumour? (March 2017)
a. Seminoma
b. Embryonal carcinoma
c. Choriocarcinoma
d. Teratoma
e. Yolk sac tumour
ANSWER: All are testicular germ cell tumours
S - seminoma E - embryonal Ca C - chorioCa T- teratoma Y - yolk sac tumour
Which testicular tumour is most common over the age of 65? (August 2016)
a. Spermatocytic seminoma
Most common testicular tumours as per age groups:
o 1st decade – yolk sac tumour and testicular teratoma
o 2nd decade – choriocarcinoma
o 3rd decade – embryonal cell carcinoma
o 4th decade – seminoma
o 7th decade and above – lymphoma and spermatocytic seminoma
ANSWER: Spermatocytic seminoma
Which is associated with increased risk of seminoma? (March 2016)
a. Cryptorchidism
Risk factors for seminoma:
o Undescended testis
- 10-40x increased risk
- Accounts for 10% of tumours
- Increased risk in the contralateral testis also
o Previous tumour in the contralateral testis
o FHx of germ cell tumour
o Testicular microlithiasis: Controversial, Some sources claim an 8x increased risk
o Other: HIV, mumps, orchitis, history of trauma, immunosuppression
ANSWER: Cryptorchidism is assoc w an increased risk of germ cell tumours of the testes, including seminomas
What is the wrong age range for the testicular tumour? (August 2016)
a. Yolk sac 5-15 years
Yolk sac tumours (endodermal sinus tumour of the testis)
Epidemiology
- Most common testicular tumour of childhood (80%)
- Most cases occur before the age of 2
- A pure yolk sac tumour is very uncommon in adults, however may be a component of mixed germ cell tumours
Pathology
- Form from totipotent cells - Schiller-Duval bodies are seen in 50% - pathognomonic - Testis replaced by a gelatinous mass
Clinical
- Raised AFP in >90% - Treated w orchidectomy alone if localised to the testis - ChemoTx for recurrence or metastases - Metastases most commonly to the lungs
ANSWER: Yolk sac tumours do not usually occur in the 5-15 year age bracket; they are the most common tumour under the age of 2
A 2 year old has a tumour of the testis. What is the most likely diagnosis? (March 2014, March 2016)
a. Yolk sac tumour
b. Choriocarcinoma
c. Teratoma
d. Seminoma
e. Spermatocytic seminoma
ANSWER: Yolk sac tumour is most likely – most common tumour under the age of 2
Which testicular tumour has the best prognosis if left untreated? (March 2016)
a. Spermatocytic seminoma
ANSWER: Spermatocytic seminoma has an excellent prognosis, even if untreated
