Male Reproductive Pathology - Twomey Flashcards

Question

Infertility With Oligospermia (2 - 20,000,000/ml)

Answer 1

Testicular: many genetic, toxic, endocrine, vascular, infectious causes Post-testicular: usually obstruction Key feature: normal testicular biopsy Post vasectomy - most common Site of obstruction in non-vasectomy cases: 50% - epididymis, 25% - absence of vas (1% of infertile males), 10% - obstruction of vas or ejaculatory ducts, 40% of male infertility is idiopathic

Answer 2

Bacterial = Related to UTI’s – spread through vas deferens or lymphatics Under 35 yrs. old most are sexually transmitted (Neisseria gonorheae, Chlamydia, Mycoplasma, Treponema Pallidum (1T) ) Older than 35 usually associated with recurrent UTI’s or BPH - coliform bacteria Granulomatous => Tuberculosis uncommon today; typically involves epididymis Non-tuberculous – unilateral, autoimmune? Viral - several implicated (Mumps – testes rarely involved pre-pubertal, 20-30% post-pubertal, 2/3 unilateral)

Answer 3

TB or fungal (histo-, crypto-, or coccidio-)

Answer 4

Torsion and Varicocele

Answer 5

testicle rotates, twisting the spermatic cord that brings blood to the scrotum (Venous > arterial) Usually before age 30 – can see as early as 1 yr old Causes - violent motion or trauma, usually in setting of abnormal anatomy ( incomplete descent, atrophy etc.) Many cases have no history of a defining event Hemorrhagic infarction - surgical repair within 4 hours may salvage function

Answer 6

dilation of veins within pampiniform plexus ("bag of worms") Incidence: up to 25% of adults More common on left side; 10-15% bilateral A cause of infertility (relative hyperthermia, others)

Answer 7

Seminoma Embryonal carcinoma Yolk sac tumor Teratoma Choriocarcinoma

Answer 8

Sertolic cell tumor Leydig cell tumor Granulosa cell tumor Mixed

Answer 9

Seminomatous = Seminoma Non-Seminomatous = Embyronal, Yolk sac, Teratoma, Choriocarcinoma

Answer 10

Incidence - appears to be rising 1-3% of all malignancies in men 30% of all malignancies in age group 20 - 34 yr Most common solid tumor in men 15-34 Varies by location and ethnic group 6/100,000 in US, highest in Denmark and adjacent countries 5:1 white:black ratio 7,000 new cases in US/yr; 6,900 in testis, 300 deaths Most cases are non-familial and no major gene linkages are apparent

Answer 11

“Intratubular germ cell neoplasia” (CIS) - data from Denmark 0.8 % of all males 2-3 % with cryptorchidism >25% with androgen insensitivity syndrome/gonadal dysgenesis/feminization syndrome (no androgen receptors)

Answer 12

Progressive, painless testicular enlargement Bilateral in 1- 3%; up to 15% in bilateral cryptorchidism can have different phenotypic expression lymphoma is most likely cause in older males (>40's)

Answer 13

50% of all germ cell tumors ***Peak in 30’s Rare in children Ovary - dysgerminoma Phenotypic expression: Typical seminoma—95%, Spermatocytic seminoma—5%

Answer 14

clear cytoplasm (lots of white) lots of lymphocytes lot of fibrous tissue occasional non-caseating granulomas some syncytiotrophoblast cells (secrete Beta-hCG => can use as tumor marker)

Answer 15

2nd most frequent form of pure GCT ***20-30 year age group More aggressive than seminoma Rare before puberty or after 50 Grossly smaller than seminoma because they are found earlier Pain/twinge => will precede finding a lump

Answer 16

More pleomorphisms Dark nuclei, more mitotic activity Hemorrhage

Answer 17

Most common testicular tumor in infants/young children under 3 years, in pure form Clear cells recapitulating endodermal sinus Schiller-Duval bodies (ring of cells, "yolk sac" appearing) and lobules of protein (pink) Marker—aFP (alpha-feta protein)

Answer 18

Highly malignant (spread hematogenously) Rare in pure form -

Answer 19

Recapitulates tissue from >1 germ cell layer Infancy to throughout adulthood Pure form common in infancy/childhood, rare in adults Mature, immature, malignant forms ***Never benign in adult males

Answer 20

cysts (endodermal tract linings) fat (mesodermal layer) skin (multiple forms of epithelium)

Answer 21

60% of testicular tumors Prognosis worsens with inclusion of more aggressive forms Pattern of metastases: - Lymphatic spread (Retroperitoneal (aorta), Mediastinal and supraclavicular nodes) - Hematogenous spread (Lung, brain, liver, other organs common depending on tumor phenotype) Metastasis histology may differ from primary Seminomatous component of mixed tumors usually does not metastasize

Answer 22

Stage I: Local spread (rarely spreads beyond tunica albuginea - Ic) Stage II: Involvement of retroperitoneal lymphatics Stage III: Parenchymal metastases or nodes beyond retroperitoneal

Answer 23

exquisitely radiosensitive Stage I – orchiectomy alone with W.W. Stage II – orchiectomy and pelvic/paraortic LN XRT or orchiectomy and single agent chemo -cisplatin

Answer 24

Sertoli cell Tumor: Several variants - often admixed with granulosa cells, Associated with gynecomastia Leydig cell Tumor: elaborate androgens and/or estrogens 1-3% of tumors, Adults with gynecomastia

Answer 25

5% of tumors Older adults, >60 Usually large cell histology and systemic disease

Answer 26

cystic space obliterated on each end

Answer 27

cystic mass arising from efferent ducts | lumen filled with sperm