Pathology of the Testes- Iczkowski Flashcards
What path do the testicles take to the scrotum during development?
What is cryptorchidism?
Testicles descend from the abdomen, through the inguinal ring, into the superior scrotum and finally settle into the scrotum.
A failure of the testicles to fully descend into the scrotum
What controls testicle descent?
What are some complications of cryptorchidism?
hCG controls descent
Mostly infertility, but increases the risk of germ cell tumors as well.
What commonly causes epididymitis?
What sign is positive in epididymitis?
UTI if >35yo
STI if <35yo
Usually gonorrhea, chylamydia, TB, E coli, or Pseudomonas
Prehn’s sign (relief when testes are elevated)
What is orchitis?
What causes it?
Inflammation of the testis
TB, mumps, HIV, syphilis, spread from epididymitis
*20% of adult mumps infection result in orchitis
What is testicular torsion?
What symptoms will the patient have?
Twisting of the spermatic cord to cut off the venous/arterial supply that can cause infarction
Sudden onset of pain, Negative Prehn’s sign
What are the clinical findings in testicular cancer?
What are risk factors for testicular cancer?
Unilateral PAINLESS mass in the testicle
Cryptorchidism
Testicular Feminization (androgen insensitvity)
Klinefelter’s syndrome- XXY
What are the three classes of testicular tumors?
(This is the most general classification)
Germ Cell Tumors
Stromal Cell Tumors
Lymphoma
What are the two classes of testicular germ cell tumors?
What defines a tumor as one or the other?
Seminomas, Non-seminomas
A tumor is considered a seminoma if it’s PURELY seminoma cells; mixed tumors may have elements of both types, but are treated like non-seminomas
What is ITGCN?
What abnormalities are seen?
Intratubular germ cell neoplasia; a precursor to germ-cell tumors
aneuploidy, Isochromosome 12p, atypical enlargemet in cells, absent spermatogenesis
What blood markers are seen in seminomas?
What is seen on histology in seminomas?
hCG might be elevated
Fibrous septa with lympocyte infiltrate, square nuclei
What are the four classes of non-seminoma testicular cancers?
How are these cells identified?
Choriocarcinoma
Embryonal carcinoma
Yolk Sac tumors
Teratomas
usually immunohistochemistry; remember, it is VERY COMMON for one tumor to contain multiple types of non-seminoma cells and even seminoma cells
What is the difference in treatment between seminomas and non-seminomas?
Tumors constrained in the testicle are treated by orchiectomy for both
If tumor has spread, both can be treated chemotherapy, but ONLY seminomas are radiosensitive
What blood markers are seen in embryonal carcinoma?
What is seen on histology?
hCG may be elevated
Gland-like structure formation, vesicular nuclei
What blood markers are seen in yolk sac tumors?
What is seen on histology?
Alpha-feto protein is elevated
Schiller-Duval bodies, microcyst formation
What blood markers are seen in teratomas?
What is seen on histology?
None
Multiple somatic tissues, including lung, muscle, cartilage, etc.
