male path Flashcards
Cryptorchidism
One or both testes fail to descend into the scrotum, an hCG dependent process, they may be found in the inguinal canal - most common, the upper scrotum, or within the abdomen
Bilateral in 18% of pts, family history of cryptochid testis in 14%
Pravalence - 5% of newborns and 1% of 1 yr old boys
Infertlity is most frequent complication
Germ cell tumors are 4-10 x more likely, even after fixing
inflammatory conditions
Epididymitis- painful inflammatory conditions, can start from a UTI (if older than 35) or an STI (<35), Gonorrhea, chlamydia, TB, E coli, pseudomonas, Prehn’s sign (elevation of scrotum decreases pain
Orchitis- painful inflammatory condition of testis, caused by TB, Mumps, HIV, syphilis, extension from epididymitis, mmps orchitis- compliicates 20% of adult mumps infections, most cases are unilateral
torsion of the tesitis
Twisting of the spermatic cord cuts off the venous/ arterial blood supply
Predisposing factors- violent movement or physical trauma, cryptochid testis, atrophy of testis, needs surgery to prevent hemorrhagic infaction of the testis
Clinical findings- sudden onset of testicular pain, negative prehns sign-elevation of the crotum doesnt decrease pain
Testicular cancer
Risk factors- cryptorchid testis is the most common risk factor, risk is highest if the testis is intra abdominal, testicular feminization, klinefelters syndrome (XXY), clinical finding- unilateral, painless enlargement of the testis
Germ cell neoplasia in situ (GCNIS)
The non invasive precursor of germ cell tumors of the testis (both seminoma and non seminoma)
Seen in cryptorchidism
Share many other features with seminoma, including karyotypic abnormalities, DNA content, ultrastructural changes, and immunohistochemical profiles
Most pts with GCNIS develop an invasive germ cell tumor within 7 years involvement is patchy, and 40% of cases are bilateral, two 3 mm testicular biopsies will identify the majority of patients with GCNIS
Spermatogenesis is absent in involved tubules. cells are atypical with nuclear enlargement and large nucleoli, DNA content is aneuploid, contains isochromosome 12 p, like seminoma does
GCNIS (non-invasive) types
Seminoma 40%, Age late 30s to 40s
Seminoma and non seminoma 30%
Non- seminomatous tumor- 30%, embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma (mature, or immature) age 15-30%
non germ cell tumors- leydig cells, sertoli cell, others (lymphomas)
i 12 p
Clear cytoplasms
seminoma
mean pt age 40s, markers- alpha fetoprotein (AFP), B- HvG can be elevated
Arranged in solid nests separated by fibrous septa, lymphoid infiltrate, treatment is dependent on location of tumor, confined to testis: surgery +/- radiation/ chemo (carboplatin)
Outside of testis- radiation +/- chem
Sheet like of cells with lymphocytes
Non seminomatous germ cell tumor
unlike seminoma they are chemo sensitive but not radiosensitive,
Embryonal carcinoma
age 15- 30s, second most common germ line tumor, present in the majority of mixed germ cell tumors but occurs in pure form in only 10 %
MEts in up to 40%, serum AFP is normal, and B- nCG elevated in 60% of cases
Fleshy graypwhite tumor with prominent necrosis, cells of embryonal carcinoma are large, with vesicular nuclei, prominent nucleoli, glandular structures nuclei vesicular
yolk sac tumor (endodermal sinus tumor)
most common germ cell tumor in infants/children, where it occurs in pure form, and 90% are cured by orchiectomy alone
In adults, occurs as a component of mixed germ cell tumor, the main tumor marker in children and adults is elevated serum alpha feto protein (AFP), white to tan masses with myxoid and cystic change
Deposition of Basement membrane material, and schiller- duval bodies (central vessel rimmed by loose CT that in turn is lined by malignant epithelium, all within a cystic space, are characteristic
Teratoma
Pure form with a mean age of diagnosis at 20 months, in kids, no mets, in adults, occurs in mixed germ cell tumor, and is identified in >50% of mixed tumors, mature form is composed of somatic type tissue that can include- intestine type gland, respiratory epithelium, cartilage, muscle squamous epithelium
May have a typia associated with IGCNU, immature teratomas contain immature neuroepithelium, blastema, carcinoid or cell stroma, worse outcome
choriocarcinoma
mets to the brain or lungs, serum b- hCG elevated, confers poorer prognosis, but the tumor is sensitive to chemo, multinucleated syncytiotrophoblastic cells and mononuclear cytotrophoblast or intermediate trophoblast, stains hCG
Speratoocytic tumoe
pts over 50, benign behavior, histologically variable size no lymphoid infiltrate
Sex cord stromal tumors- leydic cell tumor
leydic cell tumor, is 3% to 5% of testicular neoplasms, adults (80%) and kids
in adults 10-17% are malignant
Unilateral with rare exceptions, benign tumors are treate by orchiectomy, malignant ones require retroperitoneal lymph node disections
cells are not nested
sex cord-stromal tumors- sertoli cell tumor
<1% of testicular tumors, malignant in 10% of cases, estrogen production by the tumor can resul in gynecomasia and impotence
Closely packed corms
Lymphoma
Most common testis tumor over age 60, usually the result of secondary spread, involvemnt is bilateral in20% of all cases, survival is stage dependent, white to tan fleshy tumor, has an interstitial growth pattern with sparing of seminferous tubules, most are diffuse large cell types with a B cell phenotype
