Flashcards in Lecture 9: Testicular Pathology Deck (30)
What kind of environment does sperm mature in
Where are the three sites of injury for infertility?
-Hypothalamic Pituitary axis
-Germ cell elements
-Epididymis and beyond
What stimulates GnRH release?
What inhibits GnRH release?
4. Opiates, illness, stress
What injuries comprise pretesticular category?
1. Androgen excess
2. Estrogen Excess
3. thyroid/adrenal dysfunction
4. Kallman’s Syndrome
5. Hyperprolactinemia (associated with azoospermia)
What injuries comprise testicular?
3. Vascular disease
4. Torsion, trauma
6. Drugs and Toxins
What injuries comprise posttesticular?
1. Drugs and toxins
2. Systemic disease
5. Sickle cell disease
6. CRF (chronic renal failure)
What is Kallman’s Syndrome?
Secondary to congenital defect in GnRH secretion by hypothalamus
Anosmia associated with failure of GnRH secreting neurons to be present…
What are the key characteristics of Congenital Adrenal Hyperplasia (CAH)?
Loss of 21-hydroxylase enzyme
Means that progesterone does not get converted to cortisol
Androgen excess, so inhibition of GnRH
i. precocious puberty
ii. impairment of testicular maturation (paradoxically)
What is cryptorchidism?
When testes do not totally descend
Accounts for 1% of infertility
Maldescended and normal gonads
Could be asymptomatic
MoA not known
What is a congenital POST testicular infertility cause?
-absence of vas deferens
What is orchiopexy?
Pulling testes into scrotum
What are types of infection that can lead to testicular infertility?
2. e coli
What is orchitis?
Inflammation of the testes
What are causes of ejaculatory dysfunction?
Spinal cord injury, MS
What are the characteristics of Sertoli Cell only syndrome?
1. Deficiency of FSH and LH
2. Sertoli cell only syndrome with dysgenetic sertoli cells
When there is only mature sertoli cells with no germ cells
What environmental factors lead to sertoli cell only?
2. cytotoxic therapy
3. hormonal therapy for prostate cancer
4. chemical/toxin exposure
What are the two types of testicular tumors?
1. germ cell
2. non germ cell cancers (not covered in lecture)
What are the characteristics of germ cell tumors?
2. spermatocytic seminoma
3. embryonal carcinoma
4. yolk sac tumor
What does ITGCN stand for?
Intratubular germ cell neoplasia (ITGCN)
What is a seminoma?
Most common pure GERM CELL tumor composed of relatively uniform cells with abundant clear cytoplasm, well defined cell borders, and nuclei with one or more prominent nucleoli
Genetically, what are germ cell tumors associated with?
Isochromosome (2 copies of same strand)
What is a key histological characteristics of seminomas?
T lymphocytes are pericellular
98% cure rate for Stage I and Stage II seminoma
What is an embryonal carcinoma?
Germ cell tumor composed of cells with epithelial appearance and marked cytologic ATYPIA
Only seen in adults….not seen in children
Necrosis and hemorrhage
What is a yolk sac tumor?
Germ cell tumor characterized by a variety of growth patterns that recapitulate yolk sac, allantois, and extra-embryonic mesenchyme
What are the histological features of yolk sac tumor?
Growth pattern is alveolar or tubular
Sometimes papillary convolutions
Have Serum ALPHA FETOPROTEIN (AFP)
Lack well formed glands
Indistinct cell borders
What are schiller-duval bodies?
Structures resembling endodermal sinus
Key characteristic of yolk sac tumor
What is the definition of the choriocarcinoma?
Germ cell tumor composed of
i. mononucleated cytotrophoblast
ii. multinucleated syncytiotrophoblast
Has a shitload of hCG
Has syncytiotrophoblastic giants cells
What is the definition of teratoma?
Tumors with more than one somatic tissue of different germinal layers
Ectoderm, mesoderm or endoderm