Male Genital II Flashcards
What serum markers do we use to work up a testicular mass? Is there a role for biopsy?
- AFP and HCG
2. No role for biopsy
What are 4 differential diagnosis for a testicular mass?
- inflammation
- torsion
- Neoplasms
- Hydrocel etc.
True or false- epididymitis is only caused by sexually transmitted organisms?
False - E.Coli and pseudomonas are common too
What is torsion precipitated by? is it an emergency?
- violent movement or trauma
2. yes, must be surgically corrected within 4 hours
T-F– in torsion cases we may see contralateral spermatogenic abnormalities too?
True- autoimmune possibly
What type of testicular neoplasm makes up for 95% of them? What age do they peak at?
- germ cell tumors
2. 15-34
What are 4 main risk factors for germ cell tumors of the testes?
- cryptochidism
- prior testicular germ cell tumor
- Family history
- Testicular dysgenesis: ie. Klinefelter’s
T-F—most cases of cryptorchidism are bilateral? Where do they mostly get hung up?
- False- 25%
2. Inguinal canal
What does cryptorchidism look like microscopically?
atrophied, decreased spermatogenesis, peritubular fibrosis, INCREASED LEYDIG CELLS
What is the most important distinction in germ cell tumors?
seminomas and non-seminomatous tumors
What are a couple gross characteristics of seminomas?
homogenous nodules, gray-white/tan, without hemorrhage or necrosis
What does a seminoma look like microscopically?
- sheets of seminoma cells divided in lobules by fibrous septa with infiltration of lymphocytes
What is described by, large, round to polygonal, well defined, clear cytoplasm, round nucleus and prominent central nucleolus?
seminoma cell
What is a main gross difference of non-seminomatous germ cell tumors?
hemorrhagic cut surfaces, necrosis
What type of non-seminomatous germ cell tumor may show cartilaginous areas and cystic spaces?
teratoma
what is described by large, pleomorphic, amphiphilic cytoplasm, overlapping angry-looking nucleus, and hyper chromatic nuclei, prominent nucleoli?
embryonal carcinoma
What is the most common yolk sac tumor pattern?
reticular network of cuboidal/elongated cells
What does the yolk sac solid pattern look like?
sheets of polygonal cells with pale eosinophilic or clear cytoplasm
The endodermal sinus patter of the yolk sac tumor is characterized by what?
schiller-duval body (micro cyst that looks like glomeruli)
What stain is frequently positive in yolk sac tumor?
AFP- alpha fetoprotein
What is the overall microscopic structure of a choriocarcinoma?
syncytiotrophoblasts are intimately associated with cytotophoblasts within areas of extensive hemorrhage
What is described as large, multinucleate, abundant eosinophilic cytoplasm, vacuolated?
syncytiotrophoblasts
What are characterized by small polygonal cells, distinct borders, uniform round nuclei and sparse cytoplasm?
cytotrophoblasts
What does choriocarcinoma stain positive for?
HCG
Does a mature or immature teratoma more commonly have neuroepithelial tubules?
immature
How many testicular tumors are a mixture of two or more patterns?
32-54%
T-F– any solid intratesticular mass is considered neoplastic?
True- until proven otherwise
Are testicular neoplasms painful?
Usually not
Why is LDH an important tumor marker?
correlates with tumor burden and has a prognostic value in patients with metastatic disease
Can testicular cancers spread to lungs and liver?
Yes-hematogenously
Review staging of testicular cancer
I confined in testes
II confined to retroperitoneal nodes below diaphragm
III outside of retroperitoneal nodes or above diaphragm
What is treatment and prognosis of seminoma?
Radiation and prognosis is very good
What are problems with the non-seminomatous carcinomas?
- present advanced
- metastasize earlier and hematogenously
- some may not cause enlargement at all (choriocarcinoma)
Is adenocarcinoma of the prostate more commonly periurethral or posterior?
Posterior/peripheral zone
BPH is periurethral/transitional zone
A benign prostatic gland has how many cell layers?
- cuboidal secretory cells
2. flattened basal cells
What are the 3 differentials of prostate nodules?
- prostatitis
- nodular hyperplasia
- adenocarcinoma
Prostatitis is commonly caused by which organism? what about in chronic cases
- E. Coli
2. Can be same, but usually bacterial- chlamydia, mycoplasma, ureaplasma.
What is the incidence of BPH at 40? 60? 70?
20%, 70%, 90%
Is BPH a precursor of adenocarcinoma?
NO!!!!
What does BPH look like grossly?
multiple variable sized nodules encroaching on the urethra, making it slit like
What does nodular hyperplasia look like microscopically?
papillary structures with preserved 2 cell layers
In an enlarged prostate from hyperplasia, what are some common upstream effects?
hypertrophied bladder, hydrouretor and hydronephrosis
Also, increased UTIs
What is the #2 cause of male cancer deaths?
Prostate- although it is the number 1 type of cancer
T-F- PSA is cancer specific?
False- organ specific
IT IS INCREASED IN BPH AND CANCER
What is the cut off for PSA?
4
What does a gross prostatic adenocarcinoma look like?
gritty, yellow nodule, at the peripheral zone
What does a microscopic adenocarcinoma look like?
- crowded hyperchromatic nodules
- architectural disarray
- single layer of cuboidal cells
- enlarged nucleus/prominent nucleoli
Does prostatic cancer have basal cells microscopically??
No
What is the gleason grading system based on?
glandular patterns and degree of differentiation
What are the main characteristics of gleason pattern 5?
single cells and cords, necrosis the glands are largely missing (pattern 3 had small glands, pattern 4 had long glands)
What stage matches the following description- confined within prostate? extraprostatic extension into fat or vesicle? invasion of adjacent structures?
T2
T3
T4
What is a very common metastases of prostatic cancer?
osteoblastic bone metastases- vertebrae, ribs, pelvic bones
What is the tx for prostatic cancer?
surgery and radiation
What is the treatment for metastatic prostate cancer/
orchiectomy (remove testes) or anti-androgen therapy
Review the criteria for active surveillance of prostate cancer-
Gleason score <50% involvement of any positive core of 12
