Lecture 25 Flashcards

(28 cards)

1
Q

What are the types of scrotal masses?

A
  1. Non-testicular.

2. Testicular.

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2
Q

Describe non-testicular scrotal masses?

A
  1. Hernia.
  2. Hydrocoele.
  3. Haematocoele.
  4. Epididymis.
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3
Q

What are the types of testicular scrotal masses?

A
  1. Non-neoplastic.

2. Neoplastic.

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4
Q

Describe epididymitis?

A

Inflammation of the epididymis (can be due to TB).

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5
Q

Describe haematocoele?

A

Collection of blood around the testis.

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6
Q

What is the clinical presentation of testicular tumours?

A
  1. Enlargement or irregularity of testis - usually painless.
  2. May be with metastatic disease - neglected primary tumour or small primary tumour.
  3. Hormonal effects - gynaecomastia.
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7
Q

What are the statistics of testicular germ cell tumours (GCT)?

A

In NZ 6/100,000. There are two types:
1. Seminoma - 40%.
2. NSGCT - 60%.
There is 2% of male malignancy, and it is the most commonest solid cancer for 20-40yo.

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8
Q

Describe germ cell neoplasms?

A

Origin - totipotent cells.

sites - i) testis and ovary. ii) midline site (mediastinum, pineal gland and sacrococcygeal).

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9
Q

What are the types of testicular GC tumours?

A
  1. Seminoma.
  2. Non-seminomatous GCT.

There is also a combined tumour (both seminoma and NSGCT).

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10
Q

What are the types of NSGCT?

A
  1. Embryonal carcinoma.
  2. Teratoma.
  3. Choriocarcinoma.
  4. Yolk sac tumour.
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11
Q

Describe the differentiation that occurs in germ cell neoplasms?

A

The totipotent cell will either undergo:

  1. Gonadal germ cell differentiation -> seminoma.
  2. Embryonic differentiation -> teratoma, choriocarcinoma, yolk sac tumour.
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12
Q

Describe the age incidence of testicular GC tumours?

A

NSGCT tend to occur slightly younger, the seminoma will occur a little bit older (wouldn’t find after the age of 60).

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13
Q

What is the aetiology of testicular GC tumours?

A
  1. Genetic factors - low incidence in african americans, undescended testes.
  2. Environmental factors - none known.
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14
Q

What is the pathogenesis of testicular GC tumours?

A
  1. Cryptorchidism - 40% increase of risk of getting a GCT, and 12% of GCT patients have undescended testes.
  2. Gonadal dysgensis - male pseudohermaphriditism.
  3. Intratubular germ cell neoplasia (CIS) - the above conditions predispose to CIS; biopsy of testis to diagnose CIS in predisposed patients.
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15
Q

Describe the genetic changes in GCT?

A
  1. 12p increased copies (usually isochromosome 12p).
  2. Many other chromosomal gains and losses.
  3. Seen in seminoma and NSGCT.
  4. Not seen in aediatric GCT or spermatocytic seminoma.
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16
Q

Describe the macroscopic appearance of GCT?

A
  1. Expands the testis and replaces the normal tissue.
  2. It is confined within T.albuginea.
  3. Cut surface:
    - Seminoma - homogenous cream with granular necrosis.
    - Teratoma - variegated: cartilage, cysts, cream/grey necrotic areas.
    - Choriocarcinoma - haemorrhagic.
    - Yolk sac tumour - grey gelatinous.
17
Q

Describe the microscopic appearance of a seminoma?

A

Generally large clear cells with large nuclei and intense lymphocytic infiltrate in the stroma.

18
Q

Describe the microscopic appearance of an embryonal carcinoma?

A

Epithelial cells, with high grad enuclei, and loose stroma.

19
Q

Describe the microscopic appearance of a teratoma?

A

Sometimes show primitive embryonic type tissues, won’t see epithelium or stroma (immature) or sometimes it can be a mature teratoma (composed of mature tissue).

20
Q

Describe the diagnosis of GCT?

A
  1. Clinical examination - important to examine the testis. Sometimes metastatic cancer can occur in the testis.
  2. Ultrasound, to confirm.
  3. Inguinal orchidectomy.
  4. Pathological examination.
21
Q

Describe the staging of the GCT?

A
  1. Chest XRAY.
  2. CT scan of chest, abdomen and pelvis.
  3. Serum tumour markers.
22
Q

Describe the local invasion spread of testicular GCT?

A

This spread is uncommon and can spread to:

  • Rete testis and epididymis.
  • Through tunica albuginea.
  • Scrotum.
23
Q

Describe the lymphatic spread of testicular GCT?

A

Common iliac and para-aortic nodes.

24
Q

Describe the haematogenous spread of testicular GCT?

A

Can spread to the lung, liver and others and later in seminomas.

25
What are the tumour markers?
1. HCG - choriocarcinomas, malignant teratomas and soem seminomas (containg syncytiotophoblastic cells). 2. AFP - yolk sac tumours and malignant teratomas.
26
Describe the management of a seminoma tumour (post-orchidectomy)?
The cure is >90%. 1. Nil or minor I.n. involement - radiotherapy: 25-30 gray to pelvic, abdo.nodes. 2. Extensive I.n. involvement - platinum-based chemotherapy.
27
Describe the management of a NSGCT (post-orchidectomy)?
The cure is >90%. Intensive surveillance: 1. Examination chest xray, Ct, markers. 2. treat any recurrence with platinum-based chemotherapy.
28
Describe the disease of the penis?
1. skin diseases and veneral disease. | 2. Carcinoma - squamous cell carcinoma (elderly men, circumcision protective, glans and coronal s