Penis and Scrotum Pathology

Question 1

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.

Answer 1

tunica albuginea

Question 2

Where does spermatogenesis occur?

Answer 2

The lobules contain seminiferous tubules where spermatogenesis occurs.

Question 3

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

Answer 3

rete testis.

Question 4

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.

Answer 4

epididymis

ductus (vas) deferens

Question 5

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.

Answer 5

Sertoli cells.

Leydig cells

Question 6

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.

Answer 6

Cryptorchidism

Question 7

Epidemiology of Cryptorchidism

Answer 7

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.

Question 8

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

Answer 8

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

Question 9

What is the Prehn Sign? When is it positive?

Answer 9

Prehn’s sign (elevation of scrotum decreases pain)

+ in Inflammatory Epididymitis

Question 10

• Orchitis: painful inflammatory condition of testis; what causes it?

Answer 10

• Caused by TB, Mumps, HIV, syphilis, extension from epididymitis

Question 11

Complication of mumps

Answer 11

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

Question 12

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

Answer 12

Torsion of the Testis

Question 13

Predisposing factors causing torsion on testis

Answer 13

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

Question 14

What is a concern in torsion of testes?

Answer 14

Needs surgery to prevent hemorrhagic infarction of the testis

Question 15

Clincal findings of torsion on testes

Answer 15

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

Question 16

Risk factors for testicular cancer

Answer 16

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

Question 17

Clincal finding of testicular cancer

Answer 17

unilateral painless enlargemet of the testis

Question 18

Three types of Intratublar germ cell neoplasiaTesticular Tumors

Answer 18

Seminoma (40%)

Mixed (30%)

Non-seminomatous (30%)

Question 19

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

Answer 19

Intratubular germ cell neoplasia, (ITGCN)

Question 20

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

Answer 20

Intratubular germ cell neoplasia, (ITGCN)

Question 21

What happens to most patients with ITGCN?

Answer 21

(>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.

Question 22

– 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

Answer 22

ITGCN

Question 23

Describe the pathology of germ cell tumor ITGCN

Answer 23

– 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

Question 24

– 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

Answer 24

Intratubular germ cell neoplasia, (ITGCN)

Question 25

Key markers in Seminoma

Answer 25

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

Question 26

Arranged in solid nests separated by fibrous septa; Lymphoid infiltrate

Answer 26

Seminoma

Question 27

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 =

Answer 27

germ cells (germ cell tumors) (non-germ cell tumors).

Question 28

Recommended treatment for Seminoma when confined to the testis

Answer 28

surgery +/- radiation/chemo (carboplatin)

Question 29

Treatement for seminoma when it spreads outside the testis

Answer 29

Radiation +/- chem

Question 30

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

Answer 30

Non seminomatous tumors get at YOUNG age: 20-30

Question 31

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

Answer 31

Non-seminomatous Germ Cell Tumors

Question 32

These have square nulcear contours due to molding

Answer 32

Seminoma

Question 33

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%.

Answer 33

Embryonal Carcinoma

Question 34

Age men get embryonal carcinoma

Answer 34

Age 20s to 30s

Question 35

Embryonal Carcinoma Metastases in up to \_\_\_\_\_.

Answer 35

40%

Question 36

Embryonal Carcinoma has what levles of Serum aFP and hCG?

Answer 36

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

Question 37

Fleshy gray-white tumor with prominent necrosis

Answer 37

Embryonal carcinoma

Question 38

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

Answer 38

Embryonal carcinoma

Question 39

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

Answer 39

Yolk Sac Tumor (Endodermal Sinus Tumor)

Question 40

White to tan masses, with myxoid and cystic change

Answer 40

Yolk Sac Tumor

Question 41

What marker is elevated in Yolk Sac Tumors?

Answer 41

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

Question 42

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

Answer 42

Yolk Sac Tumor

Question 43

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

Answer 43

MATURE teratoma

Question 44

Epidemiology of Teratomas

Answer 44

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

Question 45

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

Answer 45

IMMATURE teratomas

Question 46

where do choriocarcinomas of the testes met to ?

Answer 46

Brain or lung

Question 47

What levels are elevated in choriocarcinoma?

Answer 47

Serum B hCG

Question 48

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

Question 49

treating choriocarcinoma

Answer 49

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

Question 50

* malignant in 10% of cases * estrogen production by the tumor can result in **gynecomastia** and **impotence**

Answer 50

Sertoli cell tumor (Sex Cord-Stromal Tumor) \*\*note the cords of tumor cells

Question 51

epidemiology on Leydig cell tumors

Answer 51

Is 3% to 5% of testicular neoplasms * Adults (majority: 80%) and children * In adults, 10-17% are malignant

Question 52

Tumor with Clear cells that are NOT nested

Answer 52

Leydig cell tumor

Question 53

How do you treat Leydig cell tumors?

Answer 53

* Unilateral with rare exceptions * Benign tumors are treated by orchiectomy •Malignant ones require retroperitoneal lymph node dissection

Question 54

Lymphoma: White to tan fleshy tumor Has an interstitial growth pattern with sparing of \_\_\_\_\_\_\_ Most are diffuse large cell types with a \_\_\_\_\_\_\_

Answer 54

seminiferous tubules B-cell phenotype

Question 55

\_\_\_\_\_\_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 \_\_\_\_\_

Answer 55

Lymphoma stage-dependent

Question 56

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

Answer 56

Adenomatoid Tumor

Question 57

origin of adenomatoid tumor

Answer 57

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

Question 58

is most common cause of scrotal swelling

Answer 58

Hydrocele

Question 59

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

Answer 59

Papillary mesothelioma

Question 60

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

Answer 60

Spermatic cord: Vasitis Nodosa

Question 61

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

Question 62

1 met to testis

Answer 62

prostate cancer