Penis and Scrotum Pathology Flashcards
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.
tunica albuginea
Where does spermatogenesis occur?
The lobules contain seminiferous tubules where spermatogenesis occurs.
Mature sperm drain into the lumen of the seminiferous tubules and are transported to the
rete testis.
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.
epididymis
ductus (vas) deferens
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.
Sertoli cells.
Leydig cells
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.
Cryptorchidism
Epidemiology of Cryptorchidism
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.
Epididymitis: Painful inflammatory condition, what are it’s causes?
- Can start from a UTI (>35 yo) or an STI (< 35 yo)
- Gonorrhea, Chlamydia, TB, E coli, Pseudomonas
What is the Prehn Sign? When is it positive?
Prehn’s sign (elevation of scrotum decreases pain)
+ in Inflammatory Epididymitis
- Orchitis: painful inflammatory condition of testis; what causes it?
- Caused by TB, Mumps, HIV, syphilis, extension from epididymitis
Complication of mumps
Mumps orchitis: painful inflammatory condition of testis
- complicates 20% of adult mumps infections - Most cases are unilateral
Twisting of the spermatic cord cuts off the venous/arterial blood supply
Torsion of the Testis
Predisposing factors causing torsion on testis
Violent movement or physical trauma: most common cause
Cryptorchid testis
Atrophy of testis
What is a concern in torsion of testes?
Needs surgery to prevent hemorrhagic infarction of the testis
Clincal findings of torsion on testes
Sudden onset of testicular pain
Negative Prehn’s sign
Elevation of the scrotum DOESN’T decrease pain (negative)
Risk factors for testicular cancer
Cryptorchid testicle = most common
Overall most common risk factor
Greatest risk is an intra-abdominal cryptorchid testis.
Testicular feminization
Klinefelter’s syndrome (XXY)
Clincal finding of testicular cancer
unilateral painless enlargemet of the testis
Three types of Intratublar germ cell neoplasiaTesticular Tumors
Seminoma (40%)
Mixed (30%)
Non-seminomatous (30%)
The non-invasive precursor of germ cell tumors of the testis (both seminoma and non-seminoma): Seen in cryptorchidism.
Intratubular germ cell neoplasia, (ITGCN)
Share many other features with seminoma, including karyotypic abnormalities, DNA content, ultrastructural changes, and immunohistochemical profiles
Intratubular germ cell neoplasia, (ITGCN)
What happens to most patients with ITGCN?
(>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.
– 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
ITGCN
Describe the pathology of germ cell tumor ITGCN
– 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
– 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
Intratubular germ cell neoplasia, (ITGCN)