Male Pathology Part 1

Question 1

• In the testes, spermatogenesis occurs in the _______ ______
• Mature sperm is then transported to to the epididymis where _________ are added to the sperm membrane
• The sperm then travel to the ____ ______ before entering the prostatic urethra through the ejaculatory ducts

Answer 1

• In the testes, spermatogenesis occurs in the seminiferous tubules
• Mature sperm is then transported to to the epididymis where glycoproteins are added to the sperm membrane
• The sperm then travel to the vas deferens before entering the prostatic urethra through the ejaculatory ducts

Question 2

Name the cell types in the normal testis

Answer 2

Sertoli cells

Germ cells

Leydig cells

Question 3

What is Cryptorchidism?

What types of tumors arise from Cryptorchidism?

Answer 3

When one or both testes fail to descend into the scrotum (hCG dependent process)

Germ cell tumors are most likely (germ cells need cool temperatures to mature into spermatozoa)

Question 4

What are common locations of the testes in cryptorchidism?

What is the most frequent complication?

Answer 4

Found in the inguinal canal (most common), upper scrotum, or within the abdomen

Infertility is the most frequent complication

Question 5

What is Orchitis? What can cause it?

Answer 5

A painful inflammatory condition of the testis caused by TB, mumps, HIV, syphilis, epididymitis

Most cases are unilateral

Question 6

What is Epididymitis? What can cause it?

Answer 6

Painful inflammatory condition caused by UTI or STI

• STIs (<35 YO): N. gonorrhea, C. trachomatis
• UTIs (>35 YO): E. coli, P. aeruginosa
• Tuberculosis

Question 7

What is Prehn’s sign?

Answer 7

Elevation of the scrotum decreases pain (indicates epididymitis)

Question 8

What is testicular torsion?

What are some predisposing factors?

What are the clinical findings?

Answer 8

• What is testicular torsion?
  
  • Twisting of the spermatic cord that cuts off the venous/arterial blood supply
• What are some predisposing factors?
  
  • Violent movement or physical trauma; cryptorchid testis; atrophy of testis
• What are the clinical findings?
  
  • Sudden onset of testicular pain
  • Negative Prehn’s sign

Question 9

Testicular Cancer

What are the risk factors?

What are some clinical findings?

Answer 9

• What are the risk factors?
  
  • Cryptorchid testicle (most common); testicular feminization; XXY (Klinefelter’s syndrome)
• What are some clinical findings?
  
  • Unilateral, painless enlargement of the testis

Question 10

What are the three types of non-invasive Intratubular germ cell neoplasias (ITGCN)?

Answer 10

Seminoma (40%)

Mixed (30%)

Non-seminomatous (30%)

Question 11

Most patients with ITGCN develop an ________ ______ _____ tumor within 7 years

What is absent in involved tubules?

Answer 11

Most patients with ITGCN develop an invasive germ cell tumor within 7 years

Spermatogenesis is absent in involved tubules

Question 12

What is the appearance of an ITGCN?

Answer 12

Atypical cells with nuclear enlargement and large nucleoli (DNA content is aneuploidy)

40% of cases are bilateral

Question 13

Seminoma

• Mean patient age:
• Markers:
• Treatment: (what does it depend on?)

Answer 13

• Mean patient age: 40s
• Markers: α-fetoprotein and β-hCG (can be elevated)
• Treatment: Dependent on location of tumor
  
  • Confined to testis (surgery +/- radiation/chemo)
  • Outside of testis (Radiation +/- chem)

Question 14

How do Seminomas appear?

Answer 14

Arranged in solid nests separated by fibrous septa; lymphoid infiltrate

Question 15

What are differences in treatment between seminomas and non-seminomatous germ cell tumors?

Answer 15

Unlike seminoma, they are chemosensitive but not radiosensitive

Question 16

What are the four types of non-seminomatous germ cell tumors?

Which is most common in infants/children?

Answer 16

Embryonal carcinoma

Yolk Sac tumor (most common gem cell tumor in infants/children)

Teratoma

Choriocarcinoma

Question 17

Embryonal Carcinoma

Age range:

Markers:

Present in pure form or mixed germ cell tumors?:

Metastasis?

Answer 17

• Age range: 20s - 30s
• Markers: Serum AFP is normal, β-hCG is elevated (in 60% of cases)
• Present in pure form or mixed germ cell tumors?:
  
  • Present in the majority of mixed germ cell tumors (10% pure form)
• Metastasis: 40%

Question 18

Describe the appearance of an embryonal carcinoma

Answer 18

Fleshy-gray white tumor with prominent necrosis; cells are large with vascular nuclei, prominent nucleoli and glandular structures

Question 19

Yolk Sac Tumors

• Treatment:
• Markers:
• Present in pure form or mixed germ cell tumors?:

Answer 19

• Treatment: Orchiectomy alone cures 90%
• Markers: AFP
• Present in pure form or mixed germ cell tumors?: Occurs as component of mixed germ cell tumor in adults; pure form in children

Question 20

Describe the appearance of a Yolk Sac Tumor

What is the characteristic finding?

Answer 20

White to tan masses with myxoid and cystic change

Deposition of basement membrane material, and characteristic Schiller Duval bodies (central vessel rimmed by loose connective tissue that is in turn lined by malignant epithelium)

Question 21

Teratoma

• Mean age of diagnosis:
• Present in pure form or mixed germ cell tumors?:
• Metastasis?

Answer 21

Mean age of diagnosis: 20 months
Present in pure form or mixed germ cell tumors?: Pure form in children; in adults, occurs in mixed germ cell tumor (>50% of mixed tumors)
Metastasis?: no metastases

Question 22

What are the differences between Mature and Immature teratomas in terms of what they contain?

Which has the worse outcome?

Answer 22

• Mature form is composed of somatic-type tissues that can include intestine-type glands, respiratory epithelium, cartilage, muscle, squamous epithelium
• Immature teratomas contain immature neuroepithelium, blastemal, carcinoid, or cellular stroma (worse outcome)

Question 23

• What makes choriocarcinoma so aggressive?
• What are markers?
• Treatment?
• What types of cells are present?

Answer 23

• What makes choriocarcinoma so aggressive?
  
  • Metastases to the brain or lungs
• What are markers?: Serum β-hCG is elevated (stain
• Treatment?: Confers a poorer prognosis – but sensitive to chemotherapy
• What types of cells are present?
  
  • Multinucleated syncytiotrophoblastic cells and mononuclear cytotrophoblasts or intermediate trophoblast

Question 24

What are the two sex cord-stromal tumors?

Answer 24

Sertolic cell tumors

Leydig cell tumors

Question 25

Sertoli tumors produce _______ which can result in _______ and \_\_\_\_\_\_\_\_ What is a defining feature on histology?

Answer 25

Sertoli tumors produce **estrogen** which can result in **gynecomastia** and **impotence** ## Footnote **Closely packed cords**

Question 26

Leydig cell tumor * Majority in (adults/children)? * Unilateral or Bilateral? * Difference in treatment between benign and malignant forms? * Histology?

Answer 26

* Majority in (adults/children)?: **Adults (80%)** * Unilateral or Bilateral?: **Unilateral** (with rare exceptions) * Difference in treatment between benign and malignant forms? * Benign tumors treated by orchiectomy * Malignant ones require retroperitoneal lymph node dissection * **Histology**: clear cytoplasm; cells not nested

Question 27

Lymphomas * Usually the result of _________ spread * How often is it bilateral? * Survival is dependent on \_\_\_\_\_\_\_

Answer 27

* Usually the result of secondary spread * How often is it bilateral?: Bilateral in 20% of cases * Survival is dependent on stage

Question 28

Describe the appearance of a testicular lymphoma

Answer 28

* White to tan fleshy tumor * Interstitial growth pattern with sparing of seminiferous tubules * Most are diffuse large cell types with B phenotype

Question 29

Adenomatoid tumors typically involve what structure in the testes? Are they benign or metastatic? Tissue of origin?

Answer 29

* Adenomatoid tumors typically involve what structure in the testes? * Epididymis (may also be identified in tunica albuginea) * Are they benign or metastatic?: **Always benign** * Tissue of origin?**:** Probable **mesothelial** origin

Question 30

What is the most common cause of scrotal swelling?

Answer 30

Hydrocele

Question 31

What is a papillary mesothelioma?

Answer 31

A mesothelioma that has papillary excrescences present within the tunica vaginalis – forms hydrocele sac papillae lined by bland cells with large nuclei and nucleoli

Question 32

Vasitis nodosa Usually observed after what procedure? What distinguishes its appearance from an invasive adenocarcinoma?

Answer 32

* Usually observed after what procedure? * Vasecotmy (blind end of transected vas deferens) * What distinguishes its appearance from an invasive adenocarcinoma? * Presence of sperm containing ductules, chronic inflammation, and the lack of atypia

Question 33

What type of cancer is the number one cause of metastases to the testes?

Answer 33

Prostate cancer