MALE-TESTIS and EPIDIDYMIS INFLAMMTION and CONGENITAL PROBLEM Flashcards
Testis and Epididymis
Distinct pathological conditions affect the testis and epididymis.
In the epididymis, the most
important and frequent conditions are ____________,
- inflammatory diseases
whereas in the testis the major
lesions are__________
tumors.
T for T!!!!!
CONGENITAL ANOMALIES
Cryptorchidism
With the exception of undescended testes (cryptorchidism), congenital anomalies are extremely
rareandinclude absence of one or both testes and fusion of the testes (so-called synorchism).
synorchism
- *___________is found in approximately 1% of 1-year-old boys.** [67] This anomaly represents a
- *complete or incomplete failure** of the intra-abdominal testes to descend into the scrotal sac
. It
usually occurs as an isolated anomaly but may be accompanied by other malformations of the
genitourinary tract, such as hypospadias.
Cryptorchidism
Creepy d bumaba un testis
1 %
1 year old
Testicular descent occurs in two morphologically and hormonally distinct phases. [68]
During
- the first, the transabdominal, phase, the testis comes to lie within the lower abdomen or brim of the pelvis.
- In the second, or the inguinoscrotal, phase, the testes descend through the inguinal canal into the scrotal sac.
During
the_______________, the testis comes to lie within the lower abdomen or brim of
the pelvis.
This phase is believed to be controlled by a hormone called müllerian-inhibiting
substance.
first, the transabdominal, phase
In the _____________, the testes descend through the inguinal canal into the scrotal sac.
This phase is androgen dependent and is possibly mediated by
androgen-induced release of calcitonin gene–related peptide,from thegenitofemoral nerve.
second, or the inguinoscrotal, phase
Although testes may be arrested anywhere along their pathway of descent, defects in
transabdominal descent are uncommon, accounting for approximately 5% to 10% of cases
. In
most patients the undescended testis is palpable in the inguinal canal.
Even though testicular
descent is controlled by hormonal factors, cryptorchidism is only rarely associated with a welldefined
hormonal disorder.
The condition is completely asymptomatic, and it is found by the
patient or the examining physician only when the scrotal sac is discovered not to contain the
testis.
Cryptorchidism is unilateral in most cases, but it may be bilateral in 25% of
patients
Histologic changes in the malpositioned testis begin as early as 2 years of age.
They are characterized by an_________________( Fig. 21-20
).
- ** arrest in the development of germ cells**
- associated with marked hyalinization and thickening of the basement membrane of the **spermatic tubules **
- Eventually the tubules appear as dense cords of hyaline connective tissue outlined by prominent basement membranes.
- There is concomitant increase in interstitial stroma.
Because Leydig cells are spared, they appear to be prominent.
As might be expected with
progressive tubular atrophy, the cryptorchid testis is small in size and is firm in consistency as
a result of____________
Histologic deterioration, associated with a paucity of germ cells,
has also been noted in the contralateral (descended) testis in males with unilateral
cryptorchidism, supporting an intrinsic defect in testicular development.
fibrotic changes.
In addition to sterility, cryptorchidism can be associated with other morbidity.
When the testis lies in the inguinal canal, it is particularly exposed to trauma and crushing against the ligaments and
bones.
A concomitant ____________ accompanies the undescended testis in about 10% to 20% of cases
inguinal hernia
. In addition, the undescended testis is at a greater risk of developing____________ than is the descended testis. [69] During the first year of life the majority of inguinal
cryptorchid testes descend spontaneously into the scrotum. Those that remain undescended
require surgical correction, preferably before histologic deterioration sets in at around 2 years
of age. [70]
testicular cancer
_____________does not guarantee fertility; deficient
spermatogenesis has been reported in 10% to 60% of patients in whom surgical repositioning
was performed. [67,] [70]
To what extent the risk of cancer is reduced after orchiopexy is also
unclear.
According to some studies, orchiopexy of unilateral cryptorchidism before 10 years of age protects against cancer development. [71] This is not universally accepted, however. [72]
Orchiopexy (placement in the scrotal sac)
Malignant change may occur in the_____________.
These
observations suggest that cryptorchidism is associated with a defect in testicular development
and cellular differentiation that is unrelated to anatomic position.
contralateral, normally descended testis
REGRESSIVE CHANGES
- Atrophy
- and Decreased Fertility
Atrophy is a regressive change that affects the scrotal testis and can have any of several
causes, including
(1) progressive atherosclerotic narrowing of the blood supply in old age,
(2) the end stage of an inflammatory orchitis
(3) cryptorchidism,
(4) hypopituitarism,
(5) generalized malnutrition or cachexia,
(6) irradiation,
(7) prolonged administration of
antiandrogens (treatment for advanced carcinoma of the prostate), and
(8) exhaustion atrophy, which may follow the persistent stimulation produced by high levels of follicle-stimulating pituitary hormone.
The gross and microscopic alterations follow the pattern already described
for cryptorchidism.
Atrophy occasionally occurs as a primary failure of genetic origin, such as in
______________ (discussed in Chapter 5 ).
Klinefelter syndrome
____________ is an end-stage pattern of testicular injury.
Atrophy
Before this terminal histologic appearance is
reached, several other patterns are associated with decreased fertility. [73]
These include
_____________. In some instances a specific cause for the testicular injury can be found, and if it
can be removed before the development of atrophy, testicular function can be restored.
- hypospermatogenesis,
- maturation arrest,
- and findings associated with vas deferens obstruction
INFLAMMATION
Inflammations are distinctly more common in the epididymis than in the testis.
Of the three major
specific inflammatory states that affect the testis and epididymis, ______________
almost invariably arise in the epididymis, whereas syphilis affects first the testis.
Epididymis: gonorrhea and tuberculosis
“EGT”
Testis: Syphillis affects first
Nonspecific Epididymitis and Orchitis
Epididymitis and possible subsequent orchitis are commonly related to infections in the _urinary
tract (cystitis, urethritis, prostatitis),_whichreach the epididymis and the testis through either the
__________________________________
vas deferens or the lymphatics of the spermatic cord.
(Orchitis is inflammation of the testes)
The cause of epididymitis varies with the age of the patient.
Though uncommon in children,
epididymitis in childhood is usually associated with a ______________ and __________________.
congenital genitourinary abnormality and
infection with gram-negative rods
In sexually active men younger than age 35 years, the
sexually transmitted pathogens ____________are the most
frequent culprits.
C. trachomatis and Neisseria gonorrhoeae
In men older than age 35 the common urinary tract pathogens, such as ______________ are responsible for most infections.
E. coli
and Pseudomonas,
The bacterial invasion in epididymis induces nonspecific acute inflammation characterized by
___________________
congestion, edema, and infiltration by neutrophils, macrophages, and lymphocytes.
Although
the infection, in the early stage, is more or less limited to the interstitial connective tissue, it
rapidly extends to involve the tubules and may progress to frank abscess formation or
complete suppurative necrosis of the entire epididymis ( Fig. 21-21 ). Usually, having involved
the epididymis, the infection extends into the testis to evoke a similar inflammatory reaction.
Such inflammatory involvement of the epididymis and testis is often followed by _________________which in many cases leads to sterility.
fibrous
scarring,
Usually the interstitial cells of Leydig are not
totally destroyed, so sexual activity is not disturbed.
Granulomatous (Autoimmune) Orchitis
Idiopathic granulomatous orchitis presents in middle age as a moderately tender testicular mass
of sudden onset sometimes associated with fever.
It may appear insidiously, however, as a
painless testicular mass mimicking a testicular tumor, hence its importance.
Granulomatous (Autoimmune) Orchitis
Histologically the
orchitis is distinguished by___________________________
The lesions closely
resemble tubercles butdiffer in that the granulomatous reaction is present diffusely throughout
the testis and is confined to the seminiferous tubules.
Although an autoimmune basis is
suspected, the cause of these lesions remains unknown.
granulomas restricted to spermatic tubules.
What are your nonspecific cause of inflammation in the testis?
Epididymitis
Granulomatous (Autoimmune) Orchitis
Specific Inflammations
- Gonorrhea
- Mumps
- Tuberculosis
- Syphilis
Extension of infection from the posterior urethra to the prostate, seminal vesicles, and then to
the epididymisis theusual course of a ______________.
neglected gonococcal infection
Inflammatory changes in Gonorrhea
similar to those described for nonspecific infections occur, with the development of frank
abscesses in the epididymis, which maylead to extensive destruction of this organ.
In neglected
cases, the infection may spread to the testis and produce _____________
suppurative orchitis.
_____________ is a systemic viral disease that most commonly affects school-aged children.
Testicular
involvement is extremely uncommon in this age group.
In postpubertal males, however, orchitis
may develop and has been reported in 20% to 30%of male patients.
Most often, acute
interstitial orchitisdevelopsabout 1 weekafter theonset of swelling of the parotid glands.
Mumps
________________ almost invariably begins in the epididymis and may spread to the testis. The
infection invokes the classic morphologic reactions of caseating granulomatous inflammation
characteristic of tuberculosis elsewhere.
Tuberculosis
The testis and epididymis are affected in both acquired and congenital syphilis, but almost
invariably the _____________is involved first by the infection_. _
TESTIS
TestiSyphillis!!!!
In many cases of Syphillis, the orchitis is not
accompanied by epididymitis.
The morphologic pattern of the reaction takes two forms:
- the production of gummas or a diffuse interstitial inflammation characterized by edema
- and** lymphocytic and plasma cell infiltration** with the characteristic hallmark of all syphilitic infections
(i. e., obliterative endarteritis with perivascular cuffing of lymphocytes and plasma cells).
Vascular DO
Torsion
Torsion
Twisting of the spermatic cord typically cuts off the venous drainage of the testis.
The thickwalled arteries remain patent, so that the intense vascular engorgement may be followed by hemorrhagic infarction.
Torsion
There are two types of testicular torsion.
- Neonatal torsion
- Adult torsion
______________ occurs either
in utero or shortly after birth.
It lacks any associated anatomic defect to account for its
occurrence.
Neonatal torsion
_____________________ is typically seen in adolescence presenting as sudden onset of
testicular pain.
It often occurs without any inciting injury; sudden pain heralding the torsion may
even occur during sleep.
Torsion is one of the few urologic emergencies
Adult torsion
If the testis is explored surgically and manually untwisted within approximately ___________________, there is a good chance that the testis will remain viable.
6 hours after the onset of
torsion
In contrast to neonatal torsion,
- *adult torsion results from a bilateral anatomic defect** where the testis has increased mobility,
- *giving rise to what is termed the** ________________.
To prevent the catastrophic
occurrence of subsequent torsion in the contralateral testis, the testis unaffected by torsion is
surgically fixed to the scrotum (orchiopexy).
bell-clapper abnormality
Depending on the duration of the process, the morphologic changes range
from intense congestion to widespread extravasation of blood into the interstitial tissue to
hemorrhagic testicular infarction ( Fig. 21-22 ). In these late stages the testis is markedly
enlarged and is converted virtually into a sac of soft, necrotic, hemorrhagic tissue.
