What is the path sperm travel from production to expulsion?
seminiferous (spermatogenesis) –> lumen of seminiferous tubules –> rete testis –> epididymus –> vas deferens –> prostatic urethra –> ejactulatory ducts
What is the most common presentation of male cancer?
Usually painless testicular mass of germ cell origin
What is the most common anatomical defect of male anatomy?
Cryptorchidism – failure of decent of testicle into the scrotum getting stuck in the inguinal canal
If a young 25 y/o is playing football and has a collision causing blunt force trauma to his groin and develops severe pain for the next several hours. What is the evaluation and first step?
Immediate ultrasound to rule out testicular torsion and if yes, then emergent surgery.
What is a common symptom of mumps in a male?
– unilateral orchitis, very painful inflammation of testicle
A 22 year old male presents to the office with testicular pain over the last week that has been getting worse without any masses. He admits to having several sexual partners unprotected in the last several months. What is the most likely organism?
– N. Gonorrhea
– C. Trachomatis
(sexually transmitted, most common cause of epididymitits)
What risk is associated with cryptorchidism?
Intratubular Germ Neoplasia
If a 45 year old male presents to the urologist with a testicular mass and it is biopsied finding neoplastic germ cells in “nests” surrounded by a fibrous septa with a normal alpha-feto protein and lymphocytic infilitrate. What might be the best treatment?
- Most likely Seminoma, which is susceptible to radiotherapy.
- non-necrotic
If a 6 month old presents to the office after parents noticed a small testicular mass that does not seem to bother the child. What might be a characteristic finding if this was a neoplasia?
Yolk Sac Tumor
- Elevated alpha-fetoprotein
- Schiller-Duvel Bodies
If a male patient presents with metastatic disease in the lungs with a testicular mass for the past 4 months and it’s found he has elevated beta-hCG, what might be the source of metastasis?
Choriiocarcinoma
- Elevated beta-hCG
- sensitive to chemotherapy
- multinucleated syncytiotrophoblastic cells
- These kinds of neoplasia metastasize very rapidly hemogenously (in blood), usually found after spread**
If a biopsy of mass if found to have various kinds of tissue including respiratory and even follicles, what kind might it be?
Teratoma - random differentiated cell types
- if found in young child, poor outcome
- if found in adult, better prognosis
What are the types of non-seminomatous tumors?
- Embryonal Carcinoma
- Yolk Sac Tumor
- Teratoma
- Choriocarcinoma
If a testicular mass is determined to be an embryonal carcinoma, what might you find if it were to be biopsied?
Fleshy grey-white
- Prominent Necrosis
- Elevated beta-hCG
Upon exam you notice an abnormal mass in the epididymus of your patient, what might be the type of neoplasm?
Adenomatoid Tumor – always benign
– most commonly found in the epididymis and tunica albuginea
(Think of all the glands present there)
If you are seeing a patient who is 67 years old who recently found a testicular mass, what might be classification if it’s found to have “popcorn-like” nuclei?
— Lymphoma, diffuse large cell lymphoma with popcorn-like nuclei on histology.
most common in 60+ males
Usually from secondary spread
If patient has noticed a painless testicular mass for many months and noted he became worried after he and his wife has been unable to conceive. Upon exam you notice he has increased breast tissue and female fat distribution. What might be a characteristic finding of the biopsy results?
Sertoli Cell Tumor
- Impotence and Gynecomastia
- *- Closely packed cords of cells-**
Remember:
Leydig Cells respond to LH –> Testosterone
Sertoili Cells have aromatase, converting Testosterone to Estrogen/DHT contributing to symptoms
What is consistent with finding after a vasectomy has been performed?
Vasitis Nodosa
- -usually after vasectomy
- resembles adenocarcinoma, but Sperm Present
If an 18 y/o presents to the office complaining of tightness and pain at the head of his penis. The patient has history of several infections over the past couple years and is uncircumsized. What could be causing the symptoms?
Phimosis – prepuce too small to retract over the penis due to scaring from recurrent infections.
– circumcision
If a patient is experiencing leakage of urine from the ventral aspect of his penis, what might have caused this abnormality?
Failure of the urethral folds to close.
– Hypospadias
Epispadias – abnormal closure of the dorsal aspect
If a patient comes into the office complaining of penile pain when he has an erection and during intercourse that has been getting worse over the past year. Upon exam the patient’s penis has lateral curvature. What is the cause of his symptoms?
Peyronie’s Disease
– fibromatosis of the penile tissue causing painful contractures and bending in the direction of the fibrosis
If a patient comes in complaining of some pain on the glans of his penis and change in color. Upon exam the glans has a “glassy” appearance? What might be causing his symptoms?
– Balanitis Xerotica Obliterons
Lichen sclerosis
– typically a purple-blue color with deep dermis inflammation
What are the risk factors for developing invasive squamous cell carcinoma?
- smoking
- lack of circumcision
- Leukoplakia (Bowen’s Disease)
- Erythroplasia of Queyrat
If a young 25 y/o presents to the office with scrotal swelling diagnosed as a varicocele, what might be the most likely location?
Left varicocele is most common due to the left spermatic vein draining into the left renal vein, rather than the IVC directly as the right side does.
What are the clinical manifestations of varicocele?
- swelling, “bag of worms”
- - Infertility, due to the build up of blood and warmth in the scrotum killing the developing spermatids
A 24 year old comes into the office complaining of testicular swelling and pain for the past several weeks. The patient is an avid biker and recently has completed several 100k races. What might be his most likely diagnosis?
Hydrocele – accumulation of fluid around the testis in the tunica vaginalis
- surgery is used to correct and drain the build up
- use US to r/o testicular mass
- Common in Bikers
A patient presents to the office complaining of odd bumps on his penis. Upon exam you notice reddish-brown papules on his penis. Should this patient be concerned?
No. Bowenoid Papulosis – completely benign and does not transform into invasive squamous cell carcinoma
What are the lesions associated with HPV 16 infection?
- Bowen’s Disease (HPV16+18)
- Erythroplasia of Queyrat
- Bowenoid Papulosis (not pre-cursor lesion)
If a patient notices redness on his glans and on the mucosal surfaces of the glans, what might you be concerned of?
– Invasive squamous cell carcinoma
Erythroplasia of Queyrat – precursor lesion to SCC
HPV16 associated
