Testicular Pathology Flashcards
what structures does the spermatic cord contain?
vas deferens, lymphatic vessels, testicular artery, cremasteric artery, pampiniform plexus, nerve to cremaster, testicular nerve
what is the pathophysiology of testicular torsion?
- Twisting causes arterial and venous obstruction
- increase in venous pressure subsequently causes decreased arterial blood flow, leading to decreased oxygen supply to the testicle, and if untreated, testicular infarction.
what are the risk factors to testicular torsion?
bell clapper deformity, large size, sudden change in temperature, undescended testis, previous testicular pain
what are the types of testicular torsion?
intermittent, extravaginal, intravaginal, torsion of testicular appendix
what are the features of intermittent testicular torsion?
o less serious but chronic variant
o intermittent scrotal or testicular pain, followed by eventual spontaneous detorsion and resolution of pain
o risk of complete torsion
what are the features of extravaginal testicular torsion?
o outside of the tunica vaginalis, when the testis and gubernaculum can rotate freely
o NEWBORNS
o painless scrotal swelling, discoloration, and a firm, painless mass in the scrotum
what are the features of intravaginal testicular torsion?
o testicle rotates on the spermatic cord within the tunica vaginalis
o older children and adults
o high attachment of the tunica vaginalis over the spermatic cord and failure of the normal posterior attachment of the testicle to the inner scrotum
what are the features of torsion of the testicular appendix?
o embryonic remnant that has no known function, but is at risk for torsion
o boys aged 7-14
o onset of pain gradual, blue dot sign, cremasteric reflex still active
what are the clinical features of spermatic cord torsion?
Sudden onset of pain Nausea/vomiting Referral to lower abdomen Absence of cremasteric reflex Acute hydrocele + oedema may obliterate landmarks Transverse lie Testis high in scrotum
what are the clinical features of torsion of the appendage?
Similar to spermatic cord More gradual onset Localised tenderness at upper pole Blue dot sign – palpable nodule Testies should be mobile Cremasteric reflex present
how is torsion of the spermatic cord diagnosed?
Doppler USS
how is torsion of the appendage diagnosed?
Prehns sign
Doppler
what is the management of torsion of the spermatic cord?
Prompt exploration
2-3 point fixation with fine non-absorbable sutures
If necrotic remove
Fix contralateral side
what is the management of torsion of the appendage?
Resolve spontaneously without surgery
what are the causes of Epididymitis-orchitis?
o chlamydia, E. coli, mumps, N. Gonorrhoea, TB
o Also: UTI, urethritis, catherization, urine reflux, surgery, amiodarone
what is the pathophysiology of Epididymitis-orchitis?
inflammation of epididymis
what are the clinical features of Epididymitis-orchitis?
sudden onset swelling, dysuria, sweats/fever, cremasteric reflex present
how is Epididymitis-orchitis diagnosed?
1st catch urine sample, STI screen, culture + chlamydia PCR
what is the management of Epididymitis-orchitis?
o Antibiotics – <35 doxycycline, >35 ceftriaxone
o Analgesia + scrotal support, bed rest
what is the cause of idiopathic scrotal oedema?
unknown, hypersensitivity
what is the pathophysiology of idiopathic scrotal oedema?
marked oedema of the skin and dartos fascia
what are the clinical features of idiopathic scrotal oedema?
no fever, tenderness minimal, may be pruritis, unilateral or bilateral
How is idiopathic scrotal oedema managed?
self-limiting, resolves 3-5 days, NSAIDs, antibiotics?
what are the causes of testicular tumours?
- migration of germ cells
- undescended testis
- low physical activity, cannabis use
- inguinal hernias, Klinefelter’s syndrome, mumps orchitis
what are the clinical features of testicular tumours?
- painless insensitive testicular swelling
- mets – neck nodes, dyspnoea
- also pain in abdomen, scrotum, back – advanced?
- +/- haemospermia, secondary hydrocele, pain, dyspnoea, effects of hormones
how are testicular tumours diagnosed?
US
Serum tumour markers
CT/MRI/CT excision for mets and staging – TNM
what are the serum tumour markers of testicular cancer?
o α-fetoprotein (AFP)
o β-human chorionic gonadotrophin(HCG)
o Lactate dehydrogenase (LDH)
what is the general management of testicular cancer?
• Radical orchidectomy
what is the management of seminomas testicular tumour?
radiosensitive
o Stage I, IIA = radiotherapy to paraaortic nodes
o Stage IIB – radiotherapy or chemo
o Further stages – chemo
what is the management of teratoma testicular cancer?
o Stage 1 surveillance
o Further stages – 3 cycles of bleomycin + etoposide + cisplatin
what are the leydig cell tumours?
Rare testicular sex cord stromal tumours (Sertoli cells)
what are the features of leydig cell tumours?
- Associated with hormonal activity
- May present with gynaecomastia before testicular enlargement
- Majority are benign
- Histology – eosinophils in columns
what is the cell type in seminoma testicular tumours?
Germinal epithelium of seminiferous tubules
what is the cell type in non-seminoma (teratoma) testicular tumours?
Made of different types of tissue – embryonal, yolk sac, choriocarcinoma
what age do seminoma testicular tumour commonly present?
40
what age do non seminoma testicular tumour commonly present?
20-30
what are the tumour marker levels of seminoma testicular tumours?
AFP normal
HCG elevated
Lactate dihydrogen
what are the tumour marker levels of non-seminoma testicular tumours?
↑AFP
↑HCG
what is the pathophysiology of seminoma testicular tumours?
Sheet like lobular cells with substantial fibrous component
Fibrous septa contain lymphocyte inclusions and granulomas
what is the pathophysiology of non-seminoma testicular tumours?
Heterogenous texture with occasional ectopic tissue e.g. hair
