Repro 3 - Testicular Pathology Flashcards
What is epididymitis and what is a test that can be done to see if it is this disease?
It is inflammation of the epididymis. Diagnosis can be done by elevating the testes, which will bring slight relief to the patient.
What is the treatment for epididymitis?
For patients younger than 35 (GC/Chlamydia): Ceftriaxone IM then doxycyline for 10 days. For patients older than 35 or history of anal intercourse (Enterobacteriaceae), fluoroquinolone for 10-14 days.
Why do we perform an ultrasound in testicular torsion?
Because we need to see blood flow; if we don’t see it, it is very grave.
What test can we do to differentiate b/w Testicular torsion vs epididymitis?
Elevation of the testes on someone suffering from testicular torsion will not relieve the pain slightly as it does in epididymitis.
What is testicular torsion?
Twisting of the spermatic cord causing ischemia. It is a high-riding testis w/ long axis oriented transversely. There is absence of cremasteric reflex.
What is the treatment for Testicular Torsion?
Manual untwist. Surgical detorsion w/ bilateral orchiopexy w/i 6hrs.
What is cryptorchidism?
Failure of testis to descend into scrotum. Usually unilateral and descent usually complete in 1st year of life.
What happens when the testes do not descend?
35x risk of malignant tumor in the undescended testicle (usually a germ cell tumor).
What is the most common testicular tumor?
Seminoma.
What is the age range when a seminoma would most likely appear?
From ages 15 to 35 y.o.
What is a seminoma?
Most common testicular tumor, appears at ages 15-35, is malignant and presents as painless homogenous testicular enlargement.
Why does Seminoma have a good prognosis?
It is radiosensitive and has a late metastasis (when found, they have most likely not metastasized).
What would be the female equivalent of a seminoma?
Ovarian dysgerminoma.
What do we see in histology of Seminoma?
Large cells and lobules w/ watery cytoplasm, giving it a “fried egg” appearance. This “fried-egg” appearance is also used in koilocytes in HPV and oligodendrogliomas.
What is a testicular Embyronal carcinoma?
A malignant, painful palpable mass in scrotum. They tend to be painful. AFP usually normal unless it is a mixed germ cell tumor. hCG may be elevated.
What do we see in the histology of embyronal carcinoma?
Appear more glandular and have a papillary morphology.
What is another name for Yolk sac tumor?
Endodermal sinus tumor.
What is the most common testicular cancer in children up to the age of three?
Yolk sac tumor AKA endodermal sinus.
What is a Yolk sac (endodermal sinus) tumor?
The most common testicular cancer in children up to the age 3, they are yellow and mucinous. Causes Schiller-Duval bodies, which resembles a primitive glomerular structure. Will have elevated AFP.
What is a choriocarcinoma?
A malignant cancer of disordered syncitotrophoblasts and cytotrophoblasts, hence elevating hCG. They metastasize thru the blood.
What is a teratoma?
A tumor of multiple tissue types. Mature teratomas in males may be malignant. Elevates nGC. AFP elevated in half the cases.
What is the most common of the non-germ cell tumors?
Leydig cell tumor.
What are Leydig cell tumors?
A most common of the non-germ cell tumors, they contain Reinke crystals which are lipofusion pigmented, rod-shaped crystal structures. It is androgen producing; can cause gynecomastia and precocious puberty. These tumors have a golden-brown color.
What are Sertoli cell tumor?
A non-germ cell tumor, they secrete estrogen, causing gynecomastia. Most are benign. May be associated w/ Peutz-Jeghers syndrome And Carney syndrome.
Which testicular tumor may be associated with Peutz-Jeghers syndrome and Carney syndrome?
Sertoli cel tumor.
Which testicular cancer is the most common in older men?
Testicular lymphoma.
What is testicular lymphoma?
Most common testicular cancer in older men, it is a secondary cancer (metastasis to testes).
In what testicular cancer do we see Schiller-Duval bodies?
Yolk sac tumor.
In what testicular cancer do we see increase in AFP?
Yolk sac tumor. Teratoma (50%).
In what testicular cancer do we see increase in hCG?
Choriocarcinoma.
In what testicular cancer do we see fried-egg appearance?
Seminoma.
In what testicular cancer do we see normal AFP but increase in hCG?
Embryonal carcinoma.
In what testicular cancer is the most common overall?
Seminoma.
In what testicular cancer do we see syncytiotrophoblasts?
Choriocarcinoma.
In what testicular cancer do we see as a painful tumor?
Embryonal carcinoma.
Which testicular cancer has a very poor prognosis?
Embryonal carcinoma.
In what testicular cancer do we see teeth and hair?
Teratoma.
In what testicular cancer is the most common up to age 3?
Yolk sac tumor.
In what testicular cancer is testosterone secreting?
Leydig cells.
In what testicular cancer is estrogen secreting?
Sertoli cells.
What is the Tunica vaginalis?
A serous covering of the testes.
What would be tunica vaginalis lesions?
Hydrocele. Spermatocele. Varicocele.
What is the cause of hydrocele?
A tunica vaginalis lesion, It is due to incomplete fusion of processus vaginalis. Can remain up to a year in newborns; it is benign.
What is the cause of Spermatocele?
A tunica vaginalis lesion, due to dilated epididymal duct.
What is the cause of varicocele?
A tunica vaginalis lesion, due to dilated veins in pampiniform plexus. Can cause infertility due to increased temperature. Causes a “bag of worms” feeling in PE.
A 23 y.o patient presents with one testicle. For what is this patient at risk?
Testicular cancer (germ cell tumor).
What testicular tumor Is composed of cytotrophoblasts and syncytiotrophoblasts?
Choriocarcinoma.
What testicular tumor may present initially w/ gynecomastia?
Sertoli cell tumor. Leydig cell tumor.
In what testicular cancer has elevated beta-hCG?
Choriocarcinoma. Embryonal carcinoma. Teratoma.
In what testicular cancer has histologic appearance similar to koilocytes (cytoplasmic clearing)?
Seminoma.
In what testicular cancer may have histologically alveolar or tubular appearance sometimes w/ papillary convolutions?
Embryonal carcinoma.
In what testicular cancer is composed of multiple tissue types?
Teratoma.
In what testicular cancer has histologic endodermal sinus structures (Schiller-Duval bodies)?
Yolk sac tumor.
In what testicular cancer has cytoplasmic rod-shaped crystalloids of Reinke in 25% of cases?
Leydig cell tumor.
In what testicular cancer has androgen-producing and associated w/ precocious puberty?
Leydig cell tumor.
