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Pathology > Testicular Path > Flashcards

Testicular Path Flashcards

1
Q

What is “Cryptoorchidism”?

A

Failure of the testicles to descend into the scrotal sac. Most common congenital male abnormality.

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2
Q

How is Cryptoorchidism treated?

A

Generally treated on its own spontanously however if the testes fails to descend after the age of two it can be surgically repaired. If testicles do not descend there is increased risk of testicular atrophy, with infertility and increased risk for Seminomas. (The temperature of the body is higher than temperature in scrotal sac).

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3
Q

What is “Orchitis” and what causes it?

A

Inflammation of the testicles, classically seen in Chlamydia infections (serotypes D-K). Also Gonorrhea, E. Coli, Pseudomonas, (seen in older males with UTIs) mumps, and “Autoimmune orchitis.”

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4
Q

What are the 4 areas of infection of the Mumps virus?

A

Inflames the parotid glands classically, but can also infect the meninges (aseptic meningitis), pancreatitis, and orchitis (increased risk of infertility).

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5
Q

What is the hallmark of autoimmune orchitis?

A

Granulomas that involve the tubules of the testicles. This can be TB as well, but that can be accounted for by an AFB stain, and TB generally produces necrotizing granulomas.

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6
Q

What is “Testicular Torsion?”

A

Twisting of the spermatic cord, leading to hemorrhagic infarction.

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7
Q

Why does testicular torsion occur?

A

It is due to the failure of the testis to attach to the inner lining of the scrotum, happens congenitally. Artery is thick walled so blood will flow in but the vein is thin so blood wont go out, hence the hemorrhagic infarction.

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8
Q

What are the 2 requirements needed to have a hemorrhagic infarction?

A

Blood enters a dead tissue, and a loosely organized tissue.

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9
Q

How does testicular torsion persent?

A

Presents in adolescents with sudden testicular pain and an absent cremasteric reflex.

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10
Q

What is a Varicocele?

A

Dilation of spermatic vein due to improper drainage.

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11
Q

How do varicoceles present?

A

Presents as scrotal swelling with “bag of worms” appearance. Seen in a large percentage of infertile males.

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12
Q

What side does varicoceles tend to present in and what is it associated with?

A

Usually presents left sided, and is associated with left sided renal cell carcinoma.

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13
Q

What is the anatomic difference between the sparmatic vein on left and right side?

A

On left side the spermatic vein drains into the renal vein which drains into the IVC, whereas in the right side the spermatic vein drains directly into the IVC. Thus there is an increased risk of varicoceles on the left spermatic vein when the left renal vein gets occluded or invaded by renal cell carcinoma.

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14
Q

What is a “Hydrocele?”

A

Fluid collection in the tunica vaginalis, which is the serosa of the testis, somewhat like a pouch that connects the testis to the scrotum. If incorrectly closed off from the peritoneum fluid can collect.

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15
Q

What are the reasons for hydroceles in adults and infants?

A

In infants the tunica vaginalis did not close off properly and as a result the fluid is collecting from the peritoneum into the tunica vaginalis. In adults, this is associated with blockage of lymphatic drainage, classically.

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16
Q

How does hydroceles present?

A

Presents as scrotal swelling that can be transluminated (light can be shown through the scrotum and it will come out the other side because there is no mass.

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17
Q

What are the 2 broad origins of testicular tumors?

A

Germ cell tumor and sex cord stromal tumor.

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18
Q

How do patients with testicular tumor present?

A

Presents as a firm, painless testicular mass that cannot be transilluminated.

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19
Q

Can testicular tumors be biopsied?

A

It should not be biopsied because first of all in 95% of the cases it is a germ cell tumor, ergo malignant. Secondly by removing the mass we run the risk of seeding the scrotum as well.

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20
Q

What are the risk factors for testicular germ cell tumors?

A

Cryptorchidism and Klienfelter’s syndrome.

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21
Q

Who gets germ cell tumors?

A

Males between the age of 15-40, this is the most common type of testicular tumor.

22
Q

What are the two types of germ cell tumors of the testicles?

A

Seminomas and non seminomas.

23
Q

Why is the distinction between seminomas and nonseminomas vital?

A

Seminomas are very responsive to tx, metastisizes late and has an excellent prognosis. Nonseminomas have variable response, metastisizes earlier and not as good a prognosis as seminomas.

24
Q

Describe a “Seminoma?” Describe the mass?

A

Malignant tumor of the large cells with clear cytoplasm and central nuclei. Homogenous mass with no hemorrhage or necrosis.

25
Q

Can seminomas produce beta HCG? Whats special about beta HCG?

A

Some rare cases can. We associate beta HCG with choriocarcinoma usually.

26
Q

What female malignancy is very similar to the seminoma?

A

Very similar to the dysgerminoma of the ovary, i.e. large cell with clear cytoplasm and central nuclei.

27
Q

Tx of seminomas?

A

Good prognosis and reacts well to radiotherapy.

28
Q

What is “Embryonal carcinoma”?

A

It is a form of nonseminomal cancer, it is the malignant tumor of immature, primitive cells that might form glands.

29
Q

How does the mass of embryonal carcinomas present?

A

It is hemorrhagic with necrosis, which is the exact opposite of seminomas which is not hemorrhagic and does not necrose.

30
Q

What is interesting about radiation and embryonal carcinomas?

A

It can cause the embryonal carcinoma to differentiate and turn into a teratoma instead.

31
Q

What is the nature of spread of embryonal carcinomas?

A

Very aggressive with early hematogenous spread because it is embryo like cells, and they are genetically designed to move and spread quickly.

32
Q

What are the two proteins that can be secreted by embryonal carcinomas?

A

Alpha Fetoprotein (AFP), which is associated with yolk sac tumors, or Beta HCG.

33
Q

What should we be thinking if there is a testicular tumor in a child?

A

Probably of a yolk sac tumor.

34
Q

What is a yolk sac tumor?

A

Malignant tumor that resembles yolk sac elements. Most common testicular tumor in children.

35
Q

What protein is secreted in a yolk sac tumor?

A

AFP, which can also be secreted by an embryonal tumor.

36
Q

What is the classic characteristic histology of a yolk sac tumor?

A

Schiller-Duval body. Also described as a “glomeruloid like structure.”

37
Q

What is “Choriocarcinoma?” What kind of cells are infected?

A

Malignant tumor of the “synctiotrophoblasts” and “cytotrophoblasts.”

38
Q

What protein is elevated in choriocarcinoma? How does this cancer spread?

A

Spreads hemotagenously early via blood. Beta HCG is generally elevated and early signs of hyperthyroidism or gynacomastia may be present.

39
Q

What exactly produces the beta HCG?

A

The synctiotrophoblasts.

40
Q

Why does elevated levels of beta HCG possibly result in gynacomastia or hyperthyroidism?

A

The alpha subunit of beta HCG is similar to that of TSH and LH/FSH, as a result, hyperthyroidism and gynacomastia is noted.

41
Q

Histologically how would the choriocarcinoma present?

A

There should’ve been a villi with a blood vessel running down the middle, and synctiotrophoblasts and cytotrophoblasts running around the perimeter. In choriocarcinoma there is NO BLOOD VESSEL within the villi.

42
Q

What is the malignancy of teratomas in males and females?

A

Benign in females but malignant in males.

43
Q

What is a teratoma?

A

Tumor of mature fetal tissue (it is a germ cell tumor) derived of two or three embryonic layers.

44
Q

What proteins can be elevated with teratomas?

A

Beta HCG and AFP.

45
Q

How is the prognosis in testicular malignancy determined?

A

Most germ cell tumors are of the mixed variety, so the prognosis is based on the worst cancer involved, i.e. in a seminoma and choriocarcinoma, the prognosis will be based on the choriocarcinoma.

46
Q

Describe “Sex cord-stromal tumors?”

A

Tumors that resemble sex cord stromal tissues of testicles, and are usually benign.

47
Q

What are the two cells of the sex cord?

A

Sertoli cells (lines the tubules of the testicles) and the Lydig cells (pink cells found in between the tubules).

48
Q

How do Lydig cell tumors present and why?

A

It can present in precocious puberty in children and gynacomastia in adults, because the Lydig cells produce androgens.

49
Q

What kind of crystals can be seen in a Lydig cell tumor?

A

Reinke crystals will be seen in histology.

50
Q

Whats notable of Sertoli cell tumors?

A

They are composed of tubules and are usually clinically silent.

51
Q

If it is a young male with a testicular mass, what kind of tumor would we suspect vs a tumor in the testicles in a 60+ year old?

A

In a young male suspect a germ cell tumor (95% of the time), but in an older male suspect a lymphoma. Usually the large B cell type of lymphoma.

52
Q

If a lymphoma appears in the testicles, how would it present?

A

Presents in older males, often bilaterally, and is composed of diffuse large B cell type.

Pathology (50 decks)

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