Module 4: Male Genital: Testicular Cancer

Question 1

Now moving on to the final topic of male genital pathologies is testicular cancers. What are risk factors associated with all testicular cancer?

Answer 1

Cryptorchidism 
White Male 
Radiation 
Klinefelter syndrome (dysgenesis) 
Isochromosome 12p

Question 2

In male children what kind of testicular tumors do you see?

Answer 2

Benign teratoma + yolk sac tumors of testes

–adult testicular teratomas are malignant; opposite of ovarian teratomas

Question 3

What are common testicular cancer based on age group?

Answer 3

15-30 y.o = mixed germ cell tumors
30-50 y.o = pure seminomas
over 60 = testicular lymphomas

Question 4

First we are going to discuss seminoma testis for testicular cancers, which again is seen in 30-50 y.o. What are some features?

Answer 4

Malignant, solid and unilateral tumors

• -well circumscribed with no hemorrhage and necrosis (hence painless)
• -spreads via lymphatics – para aortic and iliac lymph nodes

Question 5

What is the histology for seminoma testis?

Answer 5

Fried Egg Appearance (Sheets of uniform monomorphic cells with delicate septa and lymphocytic infiltrate) with prominent nucleolus and pale cytoplasm

• -infiltration of non-neoplastic, reactive lymphocytes in the stroma
• -same histology seen in dysgerminoma and medullary carcinoma of the breast and oligodendroglioma of the brain and hairy cell leukemia

Question 6

What is the presentation for seminoma testis?

Answer 6

Tumor maker: LDH

No increase in serum HCG or AFP

Question 7

What is treatment for seminoma testis?

Answer 7

Excisional biopsy: allows for dx and treatment

radiosensitive: so do radiotherapy
- -excellent prognosis
- –does not cause infertility

Question 8

Moving on to mixed germ cell tumor, describe the gross image?

Answer 8

Hemorrhagic and Necrotic Tumor of the testicle

Question 9

What is the etiology for mixed germ cell?

Answer 9

Again same as all other testicular cancers

• cryptorchidism: 3-5fold increase
• -intersex syndrome: androgen insensitivity syndrome and gonadal dysgenesis
• -family history
• -isochromosome of short arm of chromosome 12

Question 10

What is the pathogenesis for mixed germ cell tumor?

Answer 10

Germ cell origin: makes up 95% of testicular tumors usually seen in 15-30 y.o males – more aggressive than a seminoma
Mixed: seminiferous (Seminona) and non-seminiferous (Choriocarcinoma, embryonal, teratoma, and yolk sac) cells of origin: all 3 germ layers on histology

Question 11

Explain what is seen for mixed germ cell with each of the respective non seminiferous parts?

Answer 11

Seminoma (fried egg): LDH
Choriocarcinoma: beta HCG (male pregnancy)
Teratoma : greater than one germ layer
Yolk Sac (schiller-duval bodies): AFP and alpha 1 antitrypsin
Embryonal (Small round blue cells in bizarre arrangement)
–90% of patients have elevated hCG and AFP

Question 12

What are the complications of mixed germ cell tumors?

Answer 12

Mets: via lymph (para aortic and iliac nodes) and blood (liver, lung, brain, bone and kidney)
Tx: orchiectomy and chemo + radiotherapy
–good prognosis due to surgery and chemo response

Question 13

What are the congenital anomalies hypospadias and epispadias ?

Answer 13

Malformations of the urethral groove and urethral canal may create openings:

• -ventral surface of the penis: hypospadias
• -dorsal surface of the penis: epispadias

Question 14

What is the congenital anomaly phimosis?

Answer 14

Orifice of the prepuce is too small to permit normal retraction
–due to development anomalies or infection and scarring of the preputial ring

Question 15

What is the congenital anomaly paraphimosis?

Answer 15

When a phimotic prepuce is forcibly retracted over the glans penis – marked constriction and swelling
–painful, urethral constrictions, UTI

Question 16

Moving onto carcinoma of the penis, what is the etiology?

Answer 16

HPV 16 and 18 — integrate into host chromosome — E6 and E7 inactivate p53 and Rb

Question 17

What are the risk factors for carcinoma of the penis?

Answer 17

Multiple sexual partners
Cigarettes
Smegma (dirty lubricating fluid in uncircumscribed males)
—rare in muslims and jews because circumcised

Question 18

There are three pre-malignant conditions that are pretty important when it comes to Carcinoma of the penis. Each card will go through one. First is Bowden’s, what are some features?

Answer 18

Bowen’s:

• -40-60 y.o
• -single (solitary) white lesion in the shaft
• -squamous dysplasia on histology
• -Leukoplakia (scaly)
• -10% chance of progression into invasive squamous cell carcinoma

Question 19

2nd premalignant condition is Erythroplasia of Queyrat, what are some features?

Answer 19

Erythroplasia Queyrat:

• -Solitary red shiny patch plaques on the glans and prepuce
• -progression to invasive squamous carcinoma
• -most common one

Question 20

3rd premalignant condition of carcinoma of the penis is Bowenoid Papulosis, what are some features?

Answer 20

Bowenoid Papulosis:

• -30-40s
• -multiple red (papular) lesions on the shaft and glans
• -does not progress to invasive squamous cell cancer, tends to regress

Question 21

What is the presentation for carcinoma of the penis?

Answer 21

Painless ulcer

• -only becomes painful if secondarily infected with S. aureus — epididymo-orchitis
• more common on the glans

Question 22

What investigation is used to make a dx?

Answer 22

Penile biopsy most accurate

-malignant squamous cells with keratin pearls

Question 23

What is the spread of penile carcinoma?

Answer 23

Inguinal first and then femoral lymph nodes

–inguinal its either deep or superficial depending on the site

Question 24

What is the treatment for penile carcinoma?

Answer 24

Resection if not too bad

–penectomy if needed