Male Pathology Part 1 Flashcards
- In the testes, spermatogenesis occurs in the _______ ______
- Mature sperm is then transported to to the epididymis where _________ are added to the sperm membrane
- The sperm then travel to the ____ ______ before entering the prostatic urethra through the ejaculatory ducts
- In the testes, spermatogenesis occurs in the seminiferous tubules
- Mature sperm is then transported to to the epididymis where glycoproteins are added to the sperm membrane
- The sperm then travel to the vas deferens before entering the prostatic urethra through the ejaculatory ducts
Name the cell types in the normal testis
Sertoli cells
Germ cells
Leydig cells
What is Cryptorchidism?
What types of tumors arise from Cryptorchidism?
When one or both testes fail to descend into the scrotum (hCG dependent process)
Germ cell tumors are most likely (germ cells need cool temperatures to mature into spermatozoa)
What are common locations of the testes in cryptorchidism?
What is the most frequent complication?
Found in the inguinal canal (most common), upper scrotum, or within the abdomen
Infertility is the most frequent complication
What is Orchitis? What can cause it?
A painful inflammatory condition of the testis caused by TB, mumps, HIV, syphilis, epididymitis
Most cases are unilateral
What is Epididymitis? What can cause it?
Painful inflammatory condition caused by UTI or STI
- STIs (<35 YO): N. gonorrhea, C. trachomatis
- UTIs (>35 YO): E. coli, P. aeruginosa
- Tuberculosis
What is Prehn’s sign?
Elevation of the scrotum decreases pain (indicates epididymitis)
What is testicular torsion?
What are some predisposing factors?
What are the clinical findings?
- What is testicular torsion?
- Twisting of the spermatic cord that cuts off the venous/arterial blood supply
- What are some predisposing factors?
- Violent movement or physical trauma; cryptorchid testis; atrophy of testis
- What are the clinical findings?
- Sudden onset of testicular pain
- Negative Prehn’s sign
Testicular Cancer
What are the risk factors?
What are some clinical findings?
- What are the risk factors?
- Cryptorchid testicle (most common); testicular feminization; XXY (Klinefelter’s syndrome)
- What are some clinical findings?
- Unilateral, painless enlargement of the testis
What are the three types of non-invasive Intratubular germ cell neoplasias (ITGCN)?
Seminoma (40%)
Mixed (30%)
Non-seminomatous (30%)
Most patients with ITGCN develop an ________ ______ _____ tumor within 7 years
What is absent in involved tubules?
Most patients with ITGCN develop an invasive germ cell tumor within 7 years
Spermatogenesis is absent in involved tubules
What is the appearance of an ITGCN?
Atypical cells with nuclear enlargement and large nucleoli (DNA content is aneuploidy)
40% of cases are bilateral
Seminoma
- Mean patient age:
- Markers:
- Treatment: (what does it depend on?)
- Mean patient age: 40s
- Markers: α-fetoprotein and β-hCG (can be elevated)
- Treatment: Dependent on location of tumor
- Confined to testis (surgery +/- radiation/chemo)
- Outside of testis (Radiation +/- chem)
How do Seminomas appear?
Arranged in solid nests separated by fibrous septa; lymphoid infiltrate
What are differences in treatment between seminomas and non-seminomatous germ cell tumors?
Unlike seminoma, they are chemosensitive but not radiosensitive
What are the four types of non-seminomatous germ cell tumors?
Which is most common in infants/children?
Embryonal carcinoma
Yolk Sac tumor (most common gem cell tumor in infants/children)
Teratoma
Choriocarcinoma
Embryonal Carcinoma
Age range:
Markers:
Present in pure form or mixed germ cell tumors?:
Metastasis?
- Age range: 20s - 30s
- Markers: Serum AFP is normal, β-hCG is elevated (in 60% of cases)
- Present in pure form or mixed germ cell tumors?:
- Present in the majority of mixed germ cell tumors (10% pure form)
- Metastasis: 40%
Describe the appearance of an embryonal carcinoma
Fleshy-gray white tumor with prominent necrosis; cells are large with vascular nuclei, prominent nucleoli and glandular structures
Yolk Sac Tumors
- Treatment:
- Markers:
- Present in pure form or mixed germ cell tumors?:
- Treatment: Orchiectomy alone cures 90%
- Markers: AFP
- Present in pure form or mixed germ cell tumors?: Occurs as component of mixed germ cell tumor in adults; pure form in children
Describe the appearance of a Yolk Sac Tumor
What is the characteristic finding?
White to tan masses with myxoid and cystic change
Deposition of basement membrane material, and characteristic Schiller Duval bodies (central vessel rimmed by loose connective tissue that is in turn lined by malignant epithelium)
Teratoma
- Mean age of diagnosis:
- Present in pure form or mixed germ cell tumors?:
- Metastasis?
Mean age of diagnosis: 20 months
Present in pure form or mixed germ cell tumors?: Pure form in children; in adults, occurs in mixed germ cell tumor (>50% of mixed tumors)
Metastasis?: no metastases
What are the differences between Mature and Immature teratomas in terms of what they contain?
Which has the worse outcome?
- Mature form is composed of somatic-type tissues that can include intestine-type glands, respiratory epithelium, cartilage, muscle, squamous epithelium
- Immature teratomas contain immature neuroepithelium, blastemal, carcinoid, or cellular stroma (worse outcome)
- What makes choriocarcinoma so aggressive?
- What are markers?
- Treatment?
- What types of cells are present?
- What makes choriocarcinoma so aggressive?
- Metastases to the brain or lungs
- What are markers?: Serum β-hCG is elevated (stain
- Treatment?: Confers a poorer prognosis – but sensitive to chemotherapy
- What types of cells are present?
- Multinucleated syncytiotrophoblastic cells and mononuclear cytotrophoblasts or intermediate trophoblast
What are the two sex cord-stromal tumors?
Sertolic cell tumors
Leydig cell tumors
Sertoli tumors produce _______ which can result in _______ and ________
What is a defining feature on histology?
Sertoli tumors produce estrogen which can result in gynecomastia and impotence
Closely packed cords
Leydig cell tumor
- Majority in (adults/children)?
- Unilateral or Bilateral?
- Difference in treatment between benign and malignant forms?
- Histology?
- Majority in (adults/children)?: Adults (80%)
- Unilateral or Bilateral?: Unilateral (with rare exceptions)
- Difference in treatment between benign and malignant forms?
- Benign tumors treated by orchiectomy
- Malignant ones require retroperitoneal lymph node dissection
- Histology: clear cytoplasm; cells not nested
Lymphomas
- Usually the result of _________ spread
- How often is it bilateral?
- Survival is dependent on _______
- Usually the result of secondary spread
- How often is it bilateral?: Bilateral in 20% of cases
- Survival is dependent on stage
Describe the appearance of a testicular lymphoma
- White to tan fleshy tumor
- Interstitial growth pattern with sparing of seminiferous tubules
- Most are diffuse large cell types with B phenotype
Adenomatoid tumors typically involve what structure in the testes?
Are they benign or metastatic?
Tissue of origin?
- Adenomatoid tumors typically involve what structure in the testes?
- Epididymis (may also be identified in tunica albuginea)
- Are they benign or metastatic?: Always benign
- Tissue of origin?: Probable mesothelial origin
What is the most common cause of scrotal swelling?
Hydrocele
What is a papillary mesothelioma?
A mesothelioma that has papillary excrescences present within the tunica vaginalis – forms hydrocele sac papillae lined by bland cells with large nuclei and nucleoli
Vasitis nodosa
Usually observed after what procedure?
What distinguishes its appearance from an invasive adenocarcinoma?
- Usually observed after what procedure?
- Vasecotmy (blind end of transected vas deferens)
- What distinguishes its appearance from an invasive adenocarcinoma?
- Presence of sperm containing ductules, chronic inflammation, and the lack of atypia
What type of cancer is the number one cause of metastases to the testes?
Prostate cancer
