Module 4: Male Genital: Testicular Cancer Flashcards
Now moving on to the final topic of male genital pathologies is testicular cancers. What are risk factors associated with all testicular cancer?
Cryptorchidism White Male Radiation Klinefelter syndrome (dysgenesis) Isochromosome 12p
In male children what kind of testicular tumors do you see?
Benign teratoma + yolk sac tumors of testes
–adult testicular teratomas are malignant; opposite of ovarian teratomas
What are common testicular cancer based on age group?
15-30 y.o = mixed germ cell tumors
30-50 y.o = pure seminomas
over 60 = testicular lymphomas
First we are going to discuss seminoma testis for testicular cancers, which again is seen in 30-50 y.o. What are some features?
Malignant, solid and unilateral tumors
- -well circumscribed with no hemorrhage and necrosis (hence painless)
- -spreads via lymphatics – para aortic and iliac lymph nodes
What is the histology for seminoma testis?
Fried Egg Appearance (Sheets of uniform monomorphic cells with delicate septa and lymphocytic infiltrate) with prominent nucleolus and pale cytoplasm
- -infiltration of non-neoplastic, reactive lymphocytes in the stroma
- -same histology seen in dysgerminoma and medullary carcinoma of the breast and oligodendroglioma of the brain and hairy cell leukemia
What is the presentation for seminoma testis?
Tumor maker: LDH
No increase in serum HCG or AFP
What is treatment for seminoma testis?
Excisional biopsy: allows for dx and treatment
radiosensitive: so do radiotherapy
- -excellent prognosis
- –does not cause infertility
Moving on to mixed germ cell tumor, describe the gross image?
Hemorrhagic and Necrotic Tumor of the testicle
What is the etiology for mixed germ cell?
Again same as all other testicular cancers
- cryptorchidism: 3-5fold increase
- -intersex syndrome: androgen insensitivity syndrome and gonadal dysgenesis
- -family history
- -isochromosome of short arm of chromosome 12
What is the pathogenesis for mixed germ cell tumor?
Germ cell origin: makes up 95% of testicular tumors usually seen in 15-30 y.o males – more aggressive than a seminoma
Mixed: seminiferous (Seminona) and non-seminiferous (Choriocarcinoma, embryonal, teratoma, and yolk sac) cells of origin: all 3 germ layers on histology
Explain what is seen for mixed germ cell with each of the respective non seminiferous parts?
Seminoma (fried egg): LDH
Choriocarcinoma: beta HCG (male pregnancy)
Teratoma : greater than one germ layer
Yolk Sac (schiller-duval bodies): AFP and alpha 1 antitrypsin
Embryonal (Small round blue cells in bizarre arrangement)
–90% of patients have elevated hCG and AFP
What are the complications of mixed germ cell tumors?
Mets: via lymph (para aortic and iliac nodes) and blood (liver, lung, brain, bone and kidney)
Tx: orchiectomy and chemo + radiotherapy
–good prognosis due to surgery and chemo response
What are the congenital anomalies hypospadias and epispadias ?
Malformations of the urethral groove and urethral canal may create openings:
- -ventral surface of the penis: hypospadias
- -dorsal surface of the penis: epispadias
What is the congenital anomaly phimosis?
Orifice of the prepuce is too small to permit normal retraction
–due to development anomalies or infection and scarring of the preputial ring
What is the congenital anomaly paraphimosis?
When a phimotic prepuce is forcibly retracted over the glans penis – marked constriction and swelling
–painful, urethral constrictions, UTI
Moving onto carcinoma of the penis, what is the etiology?
HPV 16 and 18 — integrate into host chromosome — E6 and E7 inactivate p53 and Rb
What are the risk factors for carcinoma of the penis?
Multiple sexual partners
Cigarettes
Smegma (dirty lubricating fluid in uncircumscribed males)
—rare in muslims and jews because circumcised
There are three pre-malignant conditions that are pretty important when it comes to Carcinoma of the penis. Each card will go through one. First is Bowden’s, what are some features?
Bowen’s:
- -40-60 y.o
- -single (solitary) white lesion in the shaft
- -squamous dysplasia on histology
- -Leukoplakia (scaly)
- -10% chance of progression into invasive squamous cell carcinoma
2nd premalignant condition is Erythroplasia of Queyrat, what are some features?
Erythroplasia Queyrat:
- -Solitary red shiny patch plaques on the glans and prepuce
- -progression to invasive squamous carcinoma
- -most common one
3rd premalignant condition of carcinoma of the penis is Bowenoid Papulosis, what are some features?
Bowenoid Papulosis:
- -30-40s
- -multiple red (papular) lesions on the shaft and glans
- -does not progress to invasive squamous cell cancer, tends to regress
What is the presentation for carcinoma of the penis?
Painless ulcer
- -only becomes painful if secondarily infected with S. aureus — epididymo-orchitis
- more common on the glans
What investigation is used to make a dx?
Penile biopsy most accurate
-malignant squamous cells with keratin pearls
What is the spread of penile carcinoma?
Inguinal first and then femoral lymph nodes
–inguinal its either deep or superficial depending on the site
What is the treatment for penile carcinoma?
Resection if not too bad
–penectomy if needed
