Path of Male Repro Tract Flashcards
This lecture has a lot of overlap with the male gonad physiology lecture, esp the infertility stuff. Trying to focus on new material.
Review-ish: What affect does FSH have on Sertoli cells’ handling of androgens?
Causes increase in adrogen binding protein
Causes increase in aromatase -> conversion of T -> estradiol for release in periphery
For party trivia: How many sperm does each testis make per day?
about 100 x 10^6
What’s one really important thing that seminal vesicles add to the ejaculate?
Fructose
3 main regions for infertility?
Pre-testicular (HPT axis), testicular, post-testicular
What is hyperprolactinemia? What might cause it? What might it cause related to infertility?
May be caused by pituitary microadenoma.
May cause azoospermia (found in 13% of azoospermic men).
(may also cause gynecomastia)
Review: What’s azoospermia?
No sperm in the semen.
A defect in what enzyme can cause Congenital Adrenal Hyperplasia (CAH)? What happens to affected males?
Defect in 21-hydroxylase (which shunts an androgen precursor toward cortisol) -> increased T.
Males with CAH develop secondary sex characteristics early, but excess T impairs gonadotropin release necessary for testis maturation.
What blood test can you do for CAH?
Can test for increased 17-hydroxyprogesterone, which is 21 hydroxylase’s substrate.
What tumors are males with CAH predisposed to?
Testicular adrenal rest tumors….. whatever those are.
Review: Genetic causes of male infertility?
Mostly chromosome abnormalities: XXY (Klinefelter's) <- probs most important XYY Yq loss Autosomal chromosome abnormalities too.
Bad things about cryptorchidism..?
Infertility due to impaired spermatogenesis.
If unilateral, descended testis can still have problems.
Increased risk for neoplasia.
(interestingly, Leydig cells still seem to work)
2 physical testicular causes of infertility? (other than cryptorchidism)
Varicocele - impaired veins drainage of testes, esp. left.
Torsion
(and trauma)
2 broad categories of infectious causes of infertility?
Granulomatous (esp. TB)
Non-granulomatous (esp. Mumps… but that’s not very common nowdays)
3 causes of post-testicular infertility?
Congenital (esp. CF)
Diethylstilbestrol (DES) exposure
Epididymitis
What the heck is diethylstilbestrol (DES)?
Similar to thalidomide, it’s a synthetic hormone that was given do lots of pregnant women that turned out later to have terrible effects. (probably not that important these days)
3 causes of epididymitis?
STDs (gonorrhea and chlamydia)
E. coli (in older men with prostatism -> reduced integrity of all sorts of tubes -> E. coli get into places they shouldn’t)
TB and others.
3 causes of ejaculatory dysfunction?
Neurogenic (spinal cord injury, MS)
Diabetes
Surgery (esp. prostatectomy)
5 histologic patterns seen in infertility?
Hypospermatogenesis Maturation arrest (no spermatids) Germ cell sloughing Atrophy and fibrosis Sertoli cell only
3 ways to have Sertoli cell only syndrome?
Deficiency of FSH / LH
Dysgenetic Sertoli cells
Failure of migration / loss of PGCs
What are 5 male germ cell tumors we looked at?
Seminoma Embryonal Carcinoma Yolk Sac Tumors Choriocarcinoma Teratoma (we didn't talk about Spermatocytic Seminoma)
Why is important to destinguish seminoma vs. non-seminoma GC tumor?
Seminomas are very radiosensitive
Are more GC tumors of one type (pure) or mixed?
60% are mixed. Keep that in mind when agonizing over what type of tumor you’re looking at.
4 risk factors for GC tumor?
Cryptorchidism
Prior testicular GC tumor
Family Hx
Infertility
What’s the most consistent chromosome change in GC tumors?
isochromosome 12p (this seems to be an important point)
Which GC tumor is most like a germ cell?
Seminoma.
What type of process stains positive for Placental Alkaline Phosphatase (PLAP)?
Intratubular Germ Cell Neoplasia (ITGCN)
What’s the significance of Intratubular Germ Cell Neoplasia (ITGCN)?
It’s a precursor lesion that very often progresses to GC tumor.
What do seminoma cell look like histologically?
Uniform cells with abudant clear cytoplasm (like a fried egg). Prominent nucleoli.
Lymphocytic infiltration.
How do seminomas usually present?
Painless testicular mass (70% of time)
What do seminomas look like grossly?
Homogenous, gray-white.
No necrosis or hemorrhage.
Relatively well-demarcated.
What are hCG and AFP staining and serum levels like in seminoma?
Seminoma does not stain for hCG and AFP.
Serum hCG may be slightly elevated.
Prognosis for seminoma?
Excellent, for stage I and II. (98% cure rate)
Appearance of embryonal carcinoma, grossly?
Variegated, poorly demarcated.
Foci of necrosis and hemorrhage.
Exta-testicular involvement common.
What does embryonal carcinoma look like histologically?
Large, anaplastic cells in sheets.
No well-formed glands.
Nuclei large, hypochromatic, with prominent nucleolus.
Lots mitosis. Giant cells common.
(the slide says hyperchromatic… but that’s wrong)
Yolk sac tumor gross appearance / presentation?
Rapid testicular enlargement.
Non-encapsulated.
Yellow-white, hemorrhagic, gelatinous.
Histological buzz-words for yolk sac tumors?
Lace-like, Schiller-Duval Bodies
A mess of cells - lots of white, open spaces,
Intercellular eosinophillic globules
What do yolk sac tumors stain positive for? Is it in serum?
AFP, strongly
Yes, elevated AFP in serum too.
Choriocarcioma presentation?
Unfortuately, often doesn’t get big enough in testis to notice before metastasizing.
Gross appearance of choriocarcinoma?
Hemorrhagic and necrotic, may be scarred.
Immunostain and serum signs of choriocarcinoma?
Very very high hCG, often > 100,000 mlU/ml
Which GC tumor has the worst prognosis?
Choriocarcinoma.
Histological features of choriocarcinoma?
Large anaplastic cells (pretty similar to embryonal carcinoma).
Main feature is prominent syncytiotrophoblastic giant cells.
Teratoma definition?
Tumor with cells from more than one germ cell layer.
Gross appearance of teratoma?
Well-circumscribed.
Nodular, firm, cystic.
Mature tissue often present (hair, bone)
Mature vs. immature teratoma histological appearance?
Mature has more organized tissue - glands, epithelium vs. sheets of spindle-shaped cells in immature.
What can make a teratoma get worse?
When epithelial structures differentiate more and become carcinomas /adenomas/ sarcomas.
Difference in aggressiveness in children vs. adults with teratomas?
In children, almost always benign.
In adults, malignant with high recurrence / metastases.
