Male Pathology (Testes Penis Scrotum)

Question 1

what types of cells are located in the seminiferous tubules? what cells surround the capsule in the interstitium?

Answer 1

spermatogonia (germ cells) and Sertoli cells; Leydig cells

Question 2

cryptorchidism: pathogenesis, increased risk for what

Answer 2

undescended testis (one or both) –> impaired spermatogenesis (since sperm develop best at temperatures <37 C); germ cell tumors

Question 3

orchitis: pathogenesis

Answer 3

inflammation or infection of the testis, complicates 20% of adult mumps infections

Question 4

major risk factors for testicular cancer

Answer 4

cryptorchidism, Klinefelter syndrome (47,XXY)

Question 5

seminoma: presentation, characteristics, histology, prognosis

Answer 5

malignant, painless, homogenous testicular enlargement; most common testicular tumor, most common in 3rd decade, never in infancy

histology: large cells in lobules with watery cytoplasm and “fried egg” appearance
prognosis: radiosensitive, excellent prognosis

Question 6

list the 4 nonseminomatous germ cell tumors of the testes

Answer 6

yolk sac tumor, choriocarcinoma, teratoma, embryonal carcinoma

Question 7

embryonal carcinoma: presentation, characteristics, histology, lab findings, prognosis

Answer 7

malignant, hemorrhagic mass with necrosis (painful), most commonly mixed with other tumor types
histology: glandular/papillary
lab findings: increased hCG and normal AFP (if pure, AFP is elevated when mixed)
prognosis: worse than seminoma

Question 8

yolk sac tumor: characteristics, histology, lab findings

Answer 8

yellow, mucinous, aggressive malignancy of the testes, most common testicular tumors in boys <3 years old
histology: Schiller-Duval bodies resemble primitive glomeruli
lab findings: increased AFP is highly characteristic

Question 9

testicular teratoma: pathogenesis, characteristics, lab findings

Answer 9

tumor composed of mature fetal tissue derived from two or three embryonic layers; malignant in males (as opposed to females), benign in children
lab findings: AFP or hCG may be increased

Question 10

choriocarcinoma: characteristics, clinical presentation, lab findings

Answer 10

malignant, disordered syncytiotrophoblastic and cytotrophoblastic elements; hematogenous metastases to lungs and brain (may present with “hemorrhagic stroke” due to bleeding into metastasis
may produce gynecomastia, symptoms of hyperthyroidism (hCG is structurally similar to LH, FSH, TSH)
lab finding: increased hCG

Question 11

what type of testicular tumors are mostly benign?

Answer 11

non-germ cell tumors

Question 12

Sertoli cell tumor: important finding

Answer 12

etrogen productio by the tumor can result in gynecomastia and impotence

Question 13

Leydig cell tumor: clinical presentation, histology, important finding

Answer 13

golden brown color
histology: Reinke crystals (eosinophilic cytoplasmic inclusions)
usually produce androgens –> gynecomastia in men, precocious puberty in boys

Question 14

testicular lymphoma: characteristics, histology, prognosis

Answer 14

most common testicular cancer in older men; not a primary cancer, arises from metastatic lymphoma to testes

histology: usually of diffuse large B cell type
prognosis: aggressive

Question 15

most common cause of scrotal enlargement in adult males

Answer 15

varicocele (dilated veins in paminiform plexus (vein that is in the scrotum draining the testicles) due to increased venous pressure)

Question 16

compare and contrast epispadius and hypospadias

Answer 16

epispadias: abnormal opening of penile urethra on dorsal surface of penis due to faulty positioning of genital tubercle
hypospadius: abnormal opening of penile urethra on ventral surface of penis due to failure of urethral folds to fuse

Question 17

Peyronie disease: pathogenesis, association, clinical presentation, treatment

Answer 17

abnormal curvature of penis due to fibrous plaques within tunica albuginea; associated with erectile dysfunction; painful
treatment: consider surgical repair once curvature stabilizes

Question 18

risk factors for squamous cell carcinoma of the penis

Answer 18

HPV, lack of circumcision

Question 19

Bowen disease: what is it

Answer 19

precursor for squamous cell carcinoma of the penis; in penile shaft, presents as leukoplakia

Question 20

erythroplasia of Queyrat: what is it

Answer 20

precursor for squamous cell carcinoma of the penis; cancer of glans, presents as erythroplakia

Question 21

Bowenoid papulosis: what is it

Answer 21

precursor for squamous cell carcinoma of the penis; carcinoma in situ with no predisposition for invasion, presents as reddish papules

Question 22

varicocele: pathogenesis

Answer 22

dilated veins in pampiniform plexus (vein that is in the scrotum draining the testicles) due to increased venous pressure; most often on left side because of increased resistance to glow from left gonadal vein drainage into left renal vein; can cause infertility due to increase temeprature; “bag of worms” on palpation

Question 23

diagnosis of varicocele

Answer 23

ultrasound with Doppler

Question 24

if scrotal enlargement does not transilluminate, what are the differential diagnoses?

Answer 24

varicocele or testicular cancer

Question 25

most common cause of scrotal enlargement

Answer 25

hydrocele

Question 26

congenital hydrocele: pathogenesis

Answer 26

incomplete obliteration of processus vaginalis