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1st Repro > Penis and Scrotum Pathology > Flashcards

Penis and Scrotum Pathology Flashcards

1
Q

The normal testis is surrounded by the ______ made of up dense connective tissue. The testis is divided into lobules surrounded by dense connective tissue called septa.

A

tunica albuginea

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2
Q

Where does spermatogenesis occur?

A

The lobules contain seminiferous tubules where spermatogenesis occurs.

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3
Q

Mature sperm drain into the lumen of the seminiferous tubules and are transported to the

A

rete testis.

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4
Q

From the Rete Testis sperm are transported to the______, where glycoproteins are added to the sperm membrane. The sperm then travel through the ______before thye enter the prostatic urethra through the ejaculatory ducts.

A

epididymis

ductus (vas) deferens

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5
Q

The normal testis consists of seminiferous tubules where the Germinal (spermatogenic) cells and Sertoli cells are present. The germinal cells develop into mature sperm under the influence of _______

Surrounding the capsule is the interstitium where the ______ are present that secrete testosterone.

A

Sertoli cells.

Leydig cells

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6
Q

This is a condition in which one or both testes fail to descend into the scrotum. They may be found in the inguinal canal (most common), the upper scrotum, or within the abdomen.

A

Cryptorchidism

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7
Q

Epidemiology of Cryptorchidism

A

Bilateral in 18% of patients; family history of cryptorchid testis in 14%

– Prevalence: 5% of newborns and 1% of 1 year-old boys.

– Infertility is most frequent complication
– Germ cell tumors are 4 to 10 times more likely.

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8
Q

Epididymitis: Painful inflammatory condition, what are it’s causes?

A
  • Can start from a UTI (>35 yo) or an STI (< 35 yo)
  • Gonorrhea, Chlamydia, TB, E coli, Pseudomonas
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9
Q

What is the Prehn Sign? When is it positive?

A

Prehn’s sign (elevation of scrotum decreases pain)

+ in Inflammatory Epididymitis

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10
Q
  • Orchitis: painful inflammatory condition of testis; what causes it?
A
  • Caused by TB, Mumps, HIV, syphilis, extension from epididymitis
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11
Q

Complication of mumps

A

Mumps orchitis: painful inflammatory condition of testis
- complicates 20% of adult mumps infections - Most cases are unilateral

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12
Q

Twisting of the spermatic cord cuts off the venous/arterial blood supply

A

Torsion of the Testis

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13
Q

Predisposing factors causing torsion on testis

A

Violent movement or physical trauma: most common cause
Cryptorchid testis
Atrophy of testis

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14
Q

What is a concern in torsion of testes?

A

Needs surgery to prevent hemorrhagic infarction of the testis

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15
Q

Clincal findings of torsion on testes

A

Sudden onset of testicular pain
Negative Prehn’s sign
Elevation of the scrotum DOESN’T decrease pain (negative)

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16
Q

Risk factors for testicular cancer

A

Cryptorchid testicle = most common
Overall most common risk factor
Greatest risk is an intra-abdominal cryptorchid testis.
Testicular feminization
Klinefelter’s syndrome (XXY)

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17
Q

Clincal finding of testicular cancer

A

unilateral painless enlargemet of the testis

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18
Q

Three types of Intratublar germ cell neoplasiaTesticular Tumors

A

Seminoma (40%)

Mixed (30%)

Non-seminomatous (30%)

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19
Q

The non-invasive precursor of germ cell tumors of the testis (both seminoma and non-seminoma): Seen in cryptorchidism.

A

Intratubular germ cell neoplasia, (ITGCN)

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20
Q

Share many other features with seminoma, including karyotypic abnormalities, DNA content, ultrastructural changes, and immunohistochemical profiles

A

Intratubular germ cell neoplasia, (ITGCN)

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21
Q

What happens to most patients with ITGCN?

A

(>70%) with ITGCN develop an invasive germ cell tumor within 7 years.

• Involvement is patchy, and 40% of cases are bilateral. Two 3 mm testicular biopsies will identify the majority of patients with ITGCN.

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22
Q

– Spermatogenesis is absent in involved tubules. Cells are atypical with nuclear enlargement and large nucleoli.

– DNA content is aneuploid; contains isochromosome 12p, like seminoma does

A

ITGCN

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23
Q

Describe the pathology of germ cell tumor ITGCN

A

– Spermatogenesis is absent in involved tubules. Cells are atypical with nuclear enlargement and large nucleoli.

– DNA content is aneuploid; contains isochromosome 12p, like seminoma does

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24
Q

– Spermatogenesis is absent in involved tubules. Cells are atypical with nuclear enlargement and large nucleoli.

– DNA content is aneuploid; contains isochromosome 12p, like seminoma does

A

Intratubular germ cell neoplasia, (ITGCN)

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25
Q

Key markers in Seminoma

A

α-fetoprotein (AFP): usually normal
• β-human chorionic gonadotropin (hCG): can be elevated

26
Q

Arranged in solid nests separated by fibrous septa; Lymphoid infiltrate

A

Seminoma

27
Q

95% of testicular neoplasms arise from _____and are malignant. Testicular tumors can arise from the germ cells= _______or from the other cells within the testis including Sertoli and Leydig cells =

A

germ cells

(germ cell tumors)

(non-germ cell tumors).

28
Q

Recommended treatment for Seminoma when confined to the testis

A

surgery +/- radiation/chemo (carboplatin)

29
Q

Treatement for seminoma when it spreads outside the testis

A

Radiation +/- chem

30
Q

Embryonal CA, yolk sac tumor, choriocarcinoma and teratoma are all examples of:

A

Non seminomatous tumors

get at YOUNG age: 20-30

31
Q

Unlike seminoma, they are chemosensitive but not radiosensitive There are 4 types, each with its distinctive morphologic features and immunohistochemical markers

A

Non-seminomatous Germ Cell Tumors

32
Q

These have square nulcear contours due to molding

A

Seminoma

33
Q

Second most common germ cell tumor

Present in the majority of mixed germ cell tumors but in pure form in only 10%

Metastases in up to 40%.

A

Embryonal Carcinoma

34
Q

Age men get embryonal carcinoma

A

Age 20s to 30s

35
Q

Embryonal Carcinoma Metastases in up to _____.

A

40%

36
Q

Embryonal Carcinoma has what levles of Serum aFP and hCG?

A

AFP is normal, hCG is elevated in 60% of the cases

37
Q

Fleshy gray-white tumor with prominent necrosis

A

Embryonal carcinoma

38
Q

Cells of embryonal carcinoma are large, with vesicular nuclei, prominent nucleoli, glandular structures

• There is a solid pattern of embryonal carcinoma, which can simulate seminoma

A

Embryonal carcinoma

39
Q

Most common germ cell tumor in infants/children, where it occurs in pure form, and 90% are cured by orchiectomy alone

A

Yolk Sac Tumor (Endodermal Sinus Tumor)

40
Q

White to tan masses, with myxoid and cystic change

A

Yolk Sac Tumor

41
Q

What marker is elevated in Yolk Sac Tumors?

A

The main tumor marker in children and adults is elevated serum alpha-fetoprotein (AFP)

42
Q

Deposition of basement membrane material, and Schiller-Duval bodies (central vessel rimmed by loose connective tissue that in turn is lined by malignant epithelium, all within a cystic space), are characteristic

A

Yolk Sac Tumor

43
Q

is composed of somatic-type tissues that can include intestine-type glands, respiratory epithelium, cartilage, muscle, squamous epithelium

A

MATURE teratoma

44
Q

Epidemiology of Teratomas

A

Teratoma

  • Pure form with a mean age of diagnosis at 20 months; in children, no metastases
  • In adults, occurs in mixed germ cell tumor and is identified in >50% of mixed tumors
45
Q

contain immature neuroepithelium, blastema, carcinoid, or cellular stroma. Worse outcome.

A

IMMATURE teratomas

46
Q

where do choriocarcinomas of the testes met to ?

A

Brain or lung

47
Q

What levels are elevated in choriocarcinoma?

A

Serum B hCG

48
Q

Multinucleated syncytiotrophoblastic cells and mononuclear cytotrophoblast or intermediate trophoblast located in the testes

A
49
Q

treating choriocarcinoma

A

Confers a poorer prognosis, but the tumor is sensitive to chemotherapy

50
Q
  • malignant in 10% of cases
  • estrogen production by the tumor can result in gynecomastia and impotence
A

Sertoli cell tumor

(Sex Cord-Stromal Tumor)

**note the cords of tumor cells

51
Q

epidemiology on Leydig cell tumors

A

Is 3% to 5% of testicular neoplasms

  • Adults (majority: 80%) and children
  • In adults, 10-17% are malignant
52
Q

Tumor with Clear cells that are NOT nested

A

Leydig cell tumor

53
Q

How do you treat Leydig cell tumors?

A
  • Unilateral with rare exceptions
  • Benign tumors are treated by orchiectomy

•Malignant ones require retroperitoneal lymph node dissection

54
Q

Lymphoma:

White to tan fleshy tumor

Has an interstitial growth pattern with sparing of _______

Most are diffuse large cell types with a _______

A

seminiferous tubules

B-cell phenotype

55
Q

______is the most common testis tumor over age 60.

Is usually the result of secondary spread. Involvement is bilateral in 20% of all cases. Survival is _____

A

Lymphoma

stage-dependent

56
Q

•Typically involves epididymis; may also be identified in tunica albuginea and spermatic cord. Circumscribed nodule, may extend into rete testis and testis. Always benign.

A

Adenomatoid Tumor

57
Q

origin of adenomatoid tumor

A

Probable mesothelial origin; rare cases described in adrenal and other organs

58
Q

is most common cause of scrotal swelling

A

Hydrocele

59
Q

has papillary excrescences present within tunica vaginalis which forms hydrocele sac papillae lined by **bland cells with large nuclei and nucleoli. **

A

Papillary mesothelioma

60
Q

Usually observed after vasectomy, blind end of transected vas deferens

Sperm-containing ductules, which communicate with the central lumen of the vas deferens, extend into stroma

A

Spermatic cord: Vasitis Nodosa

61
Q

Resembles invasive adenocarcinoma, but the presence of sperm, chronic inflammation, and lack of atypia

A
62
Q

1 met to testis

A

prostate cancer

1st Repro (16 decks)

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