Testicular Neoplasia - Fremont-Smith Flashcards
germ cell tumors
seminomatous
non-seminomatous
sex cord stromal tumors
leydig cell tumor
sertoli cell tumor
lymphoma
older men
non-hodgkin diffuse B cell lymphoma
seminomatous
seminoma - young men
spermatocytic seminoma - older men
non-seminomatous
embryonal carcinoma - common
yolk sac tumor
choriocarcinoma
teratoma
often mixed
torsion of testicle
breakdown of blood/testicle barrier
- immune system recognize germ cells/sperm as foreign
- 10% develop infertility
get immune response against unaffected testicle
-poor sperm quality
cryptorchidism
hypospadius
poor sperm quality
testicular dysgenesis syndrome
associated with seminomatous and non-seminomatous germ cell tumors
tunica albuginea
surrounding seminiferous tubules
contains the germ cells and sperm
sertoli cell surround germ cell
leydig cells - surrounding fibrosis
sertoli cell
surround maturing sperm
-important interaction
germ cell CIS
exist before boy is born
- CIS child born with
- idiopathic
90% tumors in male
germ cell
- seminoma - majority
- embryonal - NSGCT
- mixed - both
malignant
malignant
germ cell tumors
yolk sac tumor
teratoma
spermatocytic seminoma
benign
sertoli cell tumor
leydig cell tumor
sex cord stromal tumor
i12p
genetic marker in germ cell tumors
germ cell tumors
good response to chemotherapy
most common neoplasm young adult men
germ cell tumors of testis
GCT
risk factors for GCT
abnormal testis
fam hx - KT and BAK
white
brothers 8-10x risk
path of GCT
precursor malignant cell develops in fetus and is activated at puberty
abnormal chromosome i12p
spermatogonia GCT
seminoma
primitive germ cell GCT
embryonal carcinoma
mets of GCT
periaortic abdominal lymph nodes
painless testicular mass with HCG, LDH, aFP
GCT
most common GCT
seminoma
slow growing with late spread
LDH and HCG
AFP
non-seminomatous GCT
staging seminoma
good - no mets
intermediate - mets
tx of seminoma
sperm preserved
- radical orchiectomy
- node dissection
low risk - no mets - very radiosensitive
intermediate risk - mets - platinum chemo
large cell with distinct borders, prominent nucleoli, watery cytoplasm, lymphoid infiltrate, in a nested pattern
seminoma histo**
spermatocytic seminoma
rare tumor men >65yo
slow-growing, non-met
looks like seminoma
non-senimonatous GCT
mixed germ cell tumor usually
more aggresive and worse prognosis
hematogenous and lymph spread
respond well to chem
mixed GCT
50-60% of all testicular tumors
yolk sac tumor
produce AFP
most common GCT in children <3 years old
schiller duval bodies
yolk sac tumors
hemorrhagic, aggressive, HCG
choriocarcinoma
hematogenous spread**
prognosis - depend on mets and serum marker levels
tx - radical orchiectomy
use of serum markers in NSGCT
evaluate masses
staging
assessing tumor burden
response to therapy
zones of prostate
transition - BPH and obstruction
peripheral - cancers - most posterior** feel with rectal exam
central zone
acute prostatitis
E. coli gram neg rods, enterococci
reflux of urine
fever, chills, cysuria
tx antibiotics
chronic prostatitis
recurrent UTIs, dysuria, localized pain
PMNs in urine** diagnosis
granulomatous prostatitis
most secondary to ruptured acini
BPH
enlarged prostate transition zone
60-100 g (normal DHT > grwoth factor
treatment of BPH
alpha blockers - decreased smooth m tone
5 alpha reducatese inhibitor - decreases DHT
tissue destruction
5-hydroxy-reductase
T > DHT
compress urethra into slit-like lumen
BPH
glands and stroma proliferate
malignant vs. benign prostate gland
look for the basal layer (bark) and if cells have invaded from gland
imaging of prostate
U/S
IVP
phenazopyridine
drug given if urinary procedure
makes pee dark orange
urinary bladder muscle
hypertrophies with BPH
to push urine past prostate
complications of BPH
obstruction - cystitis, pyelonephritis, nephropathy
infection - prostatitis, epididymitis
urosepsis
serum Cr level doubles
regardless of initial value
indicates serious renal issue
adenocarcinoma of prostate
posterior wall tissue
2nd leading cause cancer death in men
risk >50yo, AA, fam hx
androgen dependent**
precursor - prostatic intraepithelial neoplasm (PIN)
screening - DRE and PSA
predictive value
likelihood a positive test respresents disease
pararectal US with needle
can biopsy prostate mass
prominent nucleoli
necessary for dx of adenocarcinoma of prostate
PSA velocity
change of PSA over time
PSA
organ specific
not cancer specific
more free PSA - more likely benign
prostate mets
osteoblastic - bone
gleason scoring
for prostate cancer
staging of prostate
T3 - through capsule
N1 - node mets present
M1 - distant mets present
