Pathology of the Testis, Epididymis and Penis Flashcards
What is cryptorchidism?
“hidden testis” caused by either absent, ectopic or undescended testis
How are ectopic and undescended testicles different?
Undescended stop short on their way to scrotum
Ectopic diverted to an aberrant position
What percentage of full term babies have cryptorchidism?
5% have undescended testicles
1% at one year old
10% are bilateral
What happens to testis if they are undescended?
They do not form spermatozoa and look irregular on histology
What are potential complications of cryptorchidism?
Inguinal hernia
Testicular torsion
Subfertility
Malignant transformation
What is epididymo-orchitis and what causes it?
Inflammation of testis or epididymis
Trauma
Autoimmune diseases
Most commonly caused by:
It is caused by infections mostly (neisseria gonorrhoeae and chlamydia trachomatis <35yo, Ecoli, other coliforms, and pseudomonas in >35)
What are the symptoms of epididymo-orchitis?
Localised testicular pain
Tenderness and swelling
Scrotal wall erythema
Hydrocoele
If untreated can form abscess and testicular infarction
How does tuberculosis manifest in the genital tract?
Forms a caseous mass
What happens if testicular torsion is left untreated?
Haemorrhagic infarction can result
What happens if testicular torsion is left untreated?
Haemorrhagic infarction can result
Can result in irreversible damage after 12 hours of ischaemia
Can also be damage the other testis as anti-sperm antibodies can form -> infertility
What are the symptoms of testicular torsion?
Acute onset moderate to severe pain
Profound diffuse tenderness and swelling
Absent cremasteric reflex
Nausea and vomiting
Asymmetrically high rising testis
Long axis is transverse rather than horizontal
Testicular swelling with hydrocoele
How is testicular torsion confirmed?
Ultrasound and referred to surgeon urgently
What is the 5 year survival rate of testicular cancer?
In 2017 it was 95% which is an improvement from the 1970s where it was 64%
What ages is testicular cancer most common?
15 to 35
What are the most common types of tumours that arise in the testis?
Germ cell tumours (95% of all testicular tumours)
What are the types of germ cell tumours?
Seminoma and non-seminoma (embryonal carcinoma, yolk sac tumour, choriocarcinoma, and teratoma)
Where are germ cell tumours most common?
Increasing incidence seen in Western countries like Scandinavia and Switzerland
What are the risk factors for germ cell tumours of the testis?
Caucasian men
Undescended testis
Previous germ cell tumour
Inguinal hernia
Family history
How do germ cell tumours present?
Painless testicular swelling
Feels heavy
Hormonal manifestations like gynaecomastia
Symptoms of metastasis (abdominal pain, retroperitoneal metastases, haemoptysis, etc)
What causes seminomas?
Strongly associated with cryptorchidism
What ages are men more prone to seminomas?
30 to 50
What is the most common type of germ cell tumour?
Seminoma
How is a seminoma treated? What is its prognosis?
Orchidectomy
Sensitive to chemo and radiotherapy
Spreads to lymph nodes particularly para-aortic nodes.
What does a seminoma look like on histology?
Background lymphocytes
Clear cells
Nuclear atypia
Nucleoli
What percentage of testicular cancers are non-seminomatous germ cell tumours?
~33% of testicular cancers
They may also be combined with seminoma
What aged people get non-seminomatous germ cell tumours?
20s to 30s
What are the types of non seminomatous germ cell tumours? What hormones are they associated with?
Embryonal carcinoma
Teratoma
Yolk sac tumour: Associated with elevated serum AFP
Choriocarcinoma: Associated with elevated serum bHCG
What do teratomas look like on histology?
Random cells of all types can appear here
What work is done for suspected testicular tumour?
Scrotal ultrasound
Measurement of serum tumour markers (AFP, bHCG, LDH)
Abdominal CT scan and CXR looking for metastases to the retroperitoneal lymph nodes and lungs.
Orchidectomy
How is a tumour staged?
TNM system.
T1 limited to testes
T2 limited to testes with LVSI or tumour spread into hiilar soft tissue/epididymis/tunica albuginea
T3 invades spermatic cord
T4 invades scrotum
N0 N1 or N2 presence or absence of regional lymph node metastasis and size of metastasis
M0 or M1 presence or absence of distant metastasis
How are germ cell tumours treated?
Surgery
If early stage seminoma orchidectomy may be adequate
If early stage NSGCT treatment depends on presence of poor prognostic factors like LVSI, predominance of embryonal carcinoma, T3 or T4 disease
In advanced disease options are chemo, radiotherapy, surgery to metastatic deposits.
Summary of testicular tumours:
Most are germ cell tumours
Most common malignancy in men 15 to 35
Very high cure rate
Present with painless testicular mass
What is hypospadias/epispadias?
Malformation of the urethral groove and urethral canal (an abnormal urethral opening on the ventral surface of the penis (Hypospadias) or on the dorsal surface (epispadias)
Formed in 1:300 live births
What is condyloma acuminata?
Caused by HPV infection. Usually low risk HPV subtypes. It is common and increased risk with immunosuppression.
What is prognosis like in condyloma acuminata?
It tends to recur but only rarely can progress to malignancy
What are the histological features of condyloma acuminata?
Papillomatosis
Acanthosis
Hyperkeratosis
Koilocytosis
What is carcinoma of the penis? Which cancer type is most common?
A rare condition that presents as a painless lump or ulcer. SCC is most common
Where is SCC of the penis most common? What age group?
Africa, Asia, and South America (can be up to 20% of cancers in men)
Older men, 60+
What are the risk factors for SCC of the penis?
High risk HPV (16 and 18)
Phimosis
Men not circumcised in childhood (smegma)
HIV infection
Smoking
What does carcinoma of the penis look like?
Red patches
Painless lumps
Ulcers
What is the prognosis of carcinoma of the penis?
Often slow growing
They often metastasize to inguinal lymph nodes
Prognosis related to stage
