MALE-TESTIS and EPIDIDYMIS INFLAMMTION and CONGENITAL PROBLEM

Question 1

Testis and Epididymis
Distinct pathological conditions affect the testis and epididymis.

In the epididymis, the most
important and frequent conditions are ____________,

Answer 1

• inflammatory diseases

Question 2

whereas in the testis the major
lesions are__________

Answer 2

tumors.

T for T!!!!!

Question 3

CONGENITAL ANOMALIES

Answer 3

Cryptorchidism

Question 4

With the exception of undescended testes (cryptorchidism), congenital anomalies are extremely
rareandinclude absence of one or both testes and fusion of the testes (so-called synorchism).

Answer 4

synorchism

Question 5

• *___________is found in approximately 1% of 1-year-old boys.** [67] This anomaly represents a
• *complete or incomplete failure** of the intra-abdominal testes to descend into the scrotal sac

. It
usually occurs as an isolated anomaly but may be accompanied by other malformations of the
genitourinary tract, such as hypospadias.

Answer 5

Cryptorchidism

Creepy d bumaba un testis

1 %

1 year old

Question 6

Testicular descent occurs in two morphologically and hormonally distinct phases. [68]

During

Answer 6

1. the first, the transabdominal, phase, the testis comes to lie within the lower abdomen or brim of the pelvis.
2. In the second, or the inguinoscrotal, phase, the testes descend through the inguinal canal into the scrotal sac.

Question 7

During
the_______________, the testis comes to lie within the lower abdomen or brim of
the pelvis.

This phase is believed to be controlled by a hormone called müllerian-inhibiting
substance.

Answer 7

first, the transabdominal, phase

Question 8

In the _____________, the testes descend through the inguinal canal into the scrotal sac.

This phase is androgen dependent and is possibly mediated by
androgen-induced release of calcitonin gene–related peptide,from thegenitofemoral nerve.

Answer 8

second, or the inguinoscrotal, phase

Question 9

Although testes may be arrested anywhere along their pathway of descent, defects in
transabdominal descent are uncommon, accounting for approximately 5% to 10% of cases

. In
most patients the undescended testis is palpable in the inguinal canal.

Question 10

Even though testicular
descent is controlled by hormonal factors, cryptorchidism is only rarely associated with a welldefined
hormonal disorder.

The condition is completely asymptomatic, and it is found by the
patient or the examining physician only when the scrotal sac is discovered not to contain the
testis.

Question 11

Cryptorchidism is unilateral in most cases, but it may be bilateral in 25% of
patients

Histologic changes in the malpositioned testis begin as early as 2 years of age.

They are characterized by an_________________( Fig. 21-20
).

Answer 11

• ** arrest in the development of germ cells**
• associated with marked hyalinization and thickening of the basement membrane of the **spermatic tubules **
• Eventually the tubules appear as dense cords of hyaline connective tissue outlined by prominent basement membranes.
• There is concomitant increase in interstitial stroma.
  Because Leydig cells are spared, they appear to be prominent.

Question 12

As might be expected with
progressive tubular atrophy, the cryptorchid testis is small in size and is firm in consistency as
a result of____________

Histologic deterioration, associated with a paucity of germ cells,
has also been noted in the contralateral (descended) testis in males with unilateral
cryptorchidism, supporting an intrinsic defect in testicular development.

Answer 12

fibrotic changes.

Question 13

In addition to sterility, cryptorchidism can be associated with other morbidity.

When the testis lies in the inguinal canal, it is particularly exposed to trauma and crushing against the ligaments and
bones.

A concomitant ____________ accompanies the undescended testis in about 10% to 20% of cases

Answer 13

inguinal hernia

Question 14

. In addition, the undescended testis is at a greater risk of developing____________ than is the descended testis. [69] During the first year of life the majority of inguinal
cryptorchid testes descend spontaneously into the scrotum. Those that remain undescended
require surgical correction, preferably before histologic deterioration sets in at around 2 years
of age. [70]

Answer 14

testicular cancer

Question 15

_____________does not guarantee fertility; deficient
spermatogenesis has been reported in 10% to 60% of patients in whom surgical repositioning
was performed. [67,] [70]

To what extent the risk of cancer is reduced after orchiopexy is also
unclear.

According to some studies, orchiopexy of unilateral cryptorchidism before 10 years of age protects against cancer development. [71] This is not universally accepted, however. [72]

Answer 15

Orchiopexy (placement in the scrotal sac)

Question 16

Malignant change may occur in the_____________.

These
observations suggest that cryptorchidism is associated with a defect in testicular development
and cellular differentiation that is unrelated to anatomic position.

Answer 16

contralateral, normally descended testis

Question 17

REGRESSIVE CHANGES

Answer 17

• Atrophy
• and Decreased Fertility

Question 18

Atrophy is a regressive change that affects the scrotal testis and can have any of several
causes, including

Answer 18

(1) progressive atherosclerotic narrowing of the blood supply in old age,
(2) the end stage of an inflammatory orchitis
(3) cryptorchidism,
(4) hypopituitarism,
(5) generalized malnutrition or cachexia,
(6) irradiation,

(7) prolonged administration of
antiandrogens (treatment for advanced carcinoma of the prostate), and

(8) exhaustion atrophy, which may follow the persistent stimulation produced by high levels of follicle-stimulating pituitary hormone.

The gross and microscopic alterations follow the pattern already described
for cryptorchidism.

Question 19

Atrophy occasionally occurs as a primary failure of genetic origin, such as in
______________ (discussed in Chapter 5 ).

Answer 19

Klinefelter syndrome

Question 20

____________ is an end-stage pattern of testicular injury.

Answer 20

Atrophy

Question 21

Before this terminal histologic appearance is
reached, several other patterns are associated with decreased fertility. [73]

These include
_____________. In some instances a specific cause for the testicular injury can be found, and if it
can be removed before the development of atrophy, testicular function can be restored.

Answer 21

• hypospermatogenesis,
• maturation arrest,
• and findings associated with vas deferens obstruction

Question 22

INFLAMMATION

Inflammations are distinctly more common in the epididymis than in the testis.

Of the three major
specific inflammatory states that affect the testis and epididymis, ______________
almost invariably arise in the epididymis, whereas syphilis affects first the testis.

Answer 22

Epididymis: gonorrhea and tuberculosis

“EGT”

Testis: Syphillis affects first

Question 23

Nonspecific Epididymitis and Orchitis

Epididymitis and possible subsequent orchitis are commonly related to infections in the _urinary
tract (cystitis, urethritis, prostatitis),_whichreach the epididymis and the testis through either the
__________________________________

Answer 23

vas deferens or the lymphatics of the spermatic cord.

(Orchitis is inflammation of the testes)

Question 24

The cause of epididymitis varies with the age of the patient.

Though uncommon in children,
epididymitis in childhood is usually associated with a ______________ and __________________.

Answer 24

congenital genitourinary abnormality and
infection with gram-negative rods

Question 25

In **sexually active men** younger **than age 35 years**, the **sexually transmitted pathogens** \_\_\_\_\_\_\_\_\_\_\_\_are the most frequent culprits.

Answer 25

C. trachomatis and Neisseria gonorrhoeae

Question 26

In men **older than age 35 the common urinary tract pathogens,** such as \_\_\_\_\_\_\_\_\_\_\_\_\_\_ are responsible for most infections.

Answer 26

**E. coli and Pseudomonas,**

Question 27

The bacterial invasion in epididymis induces **nonspecific acute inflammation** characterized by \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 27

congestion, edema, and infiltration by neutrophils, macrophages, and lymphocytes.

Question 28

Although **the infection,** in the **early stage,** is **more or less limited to the interstitial connective tissue**, it r**apidly extends to involve the tubules and may progress to frank abscess formation or complete suppurative necrosis of the entire epididymis** ( Fig. 21-21 ). Usually, having involved the epididymis, the infection extends into the testis to evoke a similar inflammatory reaction. Such inflammatory involvement of the epididymis and testis is often followed by \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_which in **many cases leads to sterility**.

Answer 28

fibrous scarring, Usually the interstitial cells of Leydig are not totally destroyed, **so sexual activity is not disturbed.**

Question 29

Granulomatous (Autoimmune) Orchitis Idiopathic granulomatous orchitis presents in **middle age** as a **moderately tender testicular mass** **of sudden onset sometimes associated with fever**. It may **appear insidiously**, however, as a **painless testicular mass mimicking a testicular tumor,** hence its importance.

Answer 29

Granulomatous (Autoimmune) Orchitis

Question 30

Histologically the **orchitis** is d**istinguished by\_\_\_\_\_\_\_\_\_\_\_**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ The lesions **closely resemble tubercle**s but**differ in that the *_granulomatous reaction is present diffusely throughout the testis_* and is _confined to the seminiferous tubules._** Although an autoimmune basis is suspected, the cause of these lesions remains unknown.

Answer 30

granulomas restricted to spermatic tubules.

Question 31

What are your nonspecific cause of inflammation in the testis?

Answer 31

Epididymitis Granulomatous (Autoimmune) Orchitis

Question 32

Specific Inflammations

Answer 32

1. Gonorrhea 2. Mumps 3. Tuberculosis 4. Syphilis

Question 33

Extension o**f infection from the posterior urethra** to the **prostate, seminal vesicles, and then to the epididymis**is the**usual course of a \_\_\_\_\_\_\_\_\_\_\_\_\_\_.**

Answer 33

neglected gonococcal infection

Question 34

Inflammatory changes in Gonorrhea **similar to those described for nonspecific infections occur,** with the development of **frank abscesses in the epididymis**, which may**lead to extensive destruction of this organ**. In neglected cases, the **infection may spread to the testis and produce \_\_\_\_\_\_\_\_\_\_\_\_\_**

Answer 34

suppurative orchitis.

Question 35

\_\_\_\_\_\_\_\_\_\_\_\_\_ is a systemic viral disease that most commonly affects **school-aged children.** **Testicular involvement is extremely uncommon** in this age group. In **postpubertal males**, however, **orchitis may develop and has been reported in 20% to 30%**of male patients. Most often, **acute interstitial orchitis**develops**about 1 week**after the**onset of swelling of the parotid glands.**

Answer 35

Mumps

Question 36

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **almost invariably begins in the epididymis** **and may spread to the testis**. The infection invokes the **classic morphologic reactions of caseating granulomatous inflammation** **characteristic of tuberculosis elsewhere.**

Answer 36

Tuberculosis

Question 37

The **testis and epididymis** are **affected in both acquired and congenital syphilis**, but almost **invariably the \_\_\_\_\_\_\_\_\_\_\_\_\_is involved *_first by the infection_****_. _*

Answer 37

TESTIS Testi**S**yphillis!!!!

Question 38

In many cases of Syphillis, the **orchitis is not accompanied by epididymitis.** The **morphologic pattern** of the reaction takes two forms:

Answer 38

1. the production of **gummas or a diffuse interstitial inflammation characterized by edema** 2. and** lymphocytic and plasma cell infiltration** with the **characteristic hallmark of all syphilitic infections** (i. e., o**bliterative endarteritis with perivascular cuffing of lymphocytes and plasma cells)**.

Question 39

Vascular DO

Answer 39

Torsion

Question 40

Torsion **Twisting of the spermatic cord** typically **cuts off the venous drainage of the testis.** The **thickwalled arteries remain patent,** so that the i**ntense vascular engorgement may be followed by hemorrhagic infarction**.

Answer 40

Torsion

Question 41

There are two types of testicular torsion.

Answer 41

1. Neonatal torsion 2. Adult torsion

Question 42

\_\_\_\_\_\_\_\_\_\_\_\_\_\_ occurs either in **utero or shortly after birth**. It **lacks any associated anatomic defect to account for its occurrence.**

Answer 42

Neonatal torsion

Question 43

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ is typically **seen in adolescence presenting as *_sudden onse_*t of testicular pain.** It often occurs **without any inciting injury; sudden pain heralding the torsion may even occur during sleep**. Torsion is one of the few urologic emergencies

Answer 43

Adult torsion

Question 44

If the testis is explored surgically and manually untwisted within **approximately \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_,** there is a **good chance that the testis will remain viable**.

Answer 44

**6 hours after the onset of torsion**

Question 45

In contrast to neonatal torsion, * *adult torsion results from a bilateral anatomic defect** where the **testis has increased mobility,** * *giving rise to what is termed the** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_. To prevent the catastrophic occurrence of subsequent torsion in the contralateral testis, the **testis unaffected by torsion is surgically fixed to the scrotum (orchiopexy).**

Answer 45

bell-clapper abnormality

Question 46

Depending on the duration of the process, the morphologic changes range from **intense congestion to widespread extravasation of blood into the interstitial tissue to hemorrhagic testicular infarction** ( Fig. 21-22 ). In these late stages the testis is markedly enlarged and is converted virtually into a sac of soft, necrotic, hemorrhagic tissue.