Pathology Of The Testis Flashcards
In older men fluid can accumulate where?
In tunica vaginalis, hydrocele cyst
Most cases of acute epididymo-orchitis in what age?
20-39
To differentiate from torsion and epididymo-orchiditis?
Ultrasound
Collection of polymorphs is called?
Abscess
What is torsion?
Twisting of spermatic cord which cuts off the venous drainage of the testis,if untreated can lead to infarction
In how many hours will untwisting will the testis remain viable?
6 hours
What is orchidopexy?
Other testis attached to skin to avoid torsion of this
Testicular cancer is higher in who?
Caucasian men
Prostate cancer mor common in?
Black men
Testicular accounts for less than?
1%
Cryptochordism and undescended testis increases risk of cancer?
4-8 times
Which genetic abnormalities are associated with testicular cancer?
Downs and klienfelters
What can lead to cryptorchidism?
Exposure to oestrogens in uterus ( women were given it to maintain pregnancy)
Atrophic undescended testis appearance?
Scarred, fibrotic
Longer less round
Classical seminoma affects?
Younger men
Spermatocytic seminoma affects?
Older men
What percentage of testicular cancers are due to germ cells?
90
Classical seminomas accounts to what percent of seminomas?
95
And affect men 25-45
Tumour markers may be normal or raised
Most common form of testicular cancer in children?
Yolk sac carcinoma, rare in adults hence better prognosis in children too
What is wierd about choriocarcinoma?
Rare, fast growing in adults, spreads to lungs bones and brain
Usually present in mixed germ cell tumours it’s associated haemorrhage
Can happen in women, she becomes pregnanct, embryo dies and she develops choriocarcinoma, raised bhcg
Difference between teratomas of ovary and testicular?
Ovaries are benign and testicular are always malignant
A complex cyst is most likely?
Malignant
Simple cysts are most likley?
Benign
Yolk sac tumour and embryonal carcinoma give off which marker?
Alpha fetoprotein
Choriocarcinoma and embryonal carcinoma give off which marker?
Beta hcg
Which marker is given off by seminoma?
Lactate dehydrogenase
Seminoma cells look?
Large with prominent lymphocytic infiltrate, vascular invasion
Early seminoma looks?
Central white tumour surrounded by brown seminiferous tubules
Advanced seminoma looks like?
Potato, no haemorrhage or necrosis, only if choriocarcinoma present too
Which has best prognosis?
Seminoma because people present quite early on
If chemotherapy before orchidectomy this is called?
Neoadjuvant
In male teratoma there are no?
Hairs or sebaceous glands, and immature cartilage present (very blue)
What is acute epididymis-orchid is associated with?
Neisseria gonorrhoea
Chlamydia trachomatis,
In older men over 40 it is ecoli
How to treat acute epididymis-orchid is?
Antibiotics, pain relief and scrotal elevation
Hydrocele?
Collection of fluid around the testis surrounded by the tunica vaginalis
Haemorrhaging infarction and polymorph infiltrate is seen when?
Testicular torsion
Causes of testicular cancer?
Cryptorchidism and undescended testis Previous testicular cancer Kelinfelters and downs FH Men with infertility problems Exposure to oestrogens
Germ cell tumours?
Seminomatous:
Classical seminoma
Spermatocytic seminoma
Non-seminamotus: Yolk sac Teratomas Choriocarcinoma Embryonal carcinoma
Sex cord/ stromal tumours?
Leydig
Sertoli
Less than 5% of testicular tumours
Rate of growth of seminoma?
Slow and spread slowly too
Spermatocytic seminoma?
Rare tumour, affects older men age 65
Grow more slowly than classical seminoma and less likely to spread
What type accounts for 40% of testicular tumours?
Embryonal carcinoma, tends to grow rapidly and spread quickly
Pure form 3/4% of cases
Difference in mature and immature teratomas?
Mature formed by cells similar to adult tissue, rarely spread, cured with surgery but may come back
Immature resemble those of early embryo, invade tissues
What is different about teratomas in males and females?
Females- mature cystic teratomas of ovary is benign
Testicular teratomas are always malignant
Signs of metastasis of testicular cancer?
Back pain due to enlarged para optic l nodes
Supraclavicular lymphadenopathy
Cough chest pain heamoptysis and sib due to metastasis t lungs
Gynaecomastia- due to beta hcg secretion
When would you use PET scan?
To scan for recurrent disease after treatment lesion appear hot when there is a viable cancer
