Testes and Penis pathology Flashcards Preview

Genitourinary System > Testes and Penis pathology > Flashcards

Flashcards in Testes and Penis pathology Deck (23):
1

What do we think if we see a scrotal mass? what are the options

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2

Epididymitis

Inflammation of epididymis due to tuberculosis

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3

Haematocoele

Blood collection within scrotum

4

Clinical presentation of testicular tumours

  1. Enlargement or irregularity of testis: usually painless
  2. May be with metastatic disease: neglected or smal primary tumour
  3. Hormonal effects: gynaecomastia

Testis needs to be removed, through inguinal approach, (through scrotum → tumour cells in wound → cancer in inguinal nodes)

5

Testicular Germ cell tumours

Predominating tumour of the testis (really no epithelial tumours)

*there are some ovarian germ cell tumours. 

6/100 000

2% male malignancy but commonest solid tumour

 

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6

Types of Testicular germ cell tumours

Seminoma 40%


NSGCT 60%

1. Embryonal carcinoma: 
2. Teratoma: mixture of tissues
3. Choriocarcinoma: chorion/placenta
4. Yolk sac Tumour
 

 

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7

Origin and sites of germ cell Neoplasms

Origin: Totipotent cells

Sites: testis and ovary, midline site (mediastinum, pineal gland, sacrococcygeal)

8

Age incidence of types

NSGCT: slightly younger
Seminoma: slightly older

None >60years

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9

Genetic factors of testicular tumours

Genetic:

  • Low incidence in africans/black american
  • Slight increase in family members
  • cryptorchidism: undescended testes

**no known environmental factors

10

Predisposing conditions that can cause the pathogenesis of Testicular tumours

  • Cryptorchidism (undescended testes): 40x increased risk, ~12% of GCT patients have this
  • Gonadal Dysgenesis: progressive loss of germ cells in embryonic gonads
  • Intratubular Germ cell Neoplasia (CIS): predisposed by above conditions. in-situ tumor. 

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11

Genetic changes in testicular tumours

Almost always present is increased/amplifide 12p (short arm of chromosome 12)

-Many other chromosomal gains + losses

-Seen in seminoma and NSGCT

 

**not seen in paediatric GCT (pure yolk sac/teratomas, very different!) or spermatocytic seminoma

12

Differentiation of testicular tumours

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13

Embryonic differentiation: NSGCT

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14

Macroscopic appearance of Testicular tumours

Easily seen, expands testis and replaces normal tissue.
Confined within Tunica Albuginea

Seminoma: homogenous cream with granular necrosis

Teratoma: Variegated: cartilagem cycsts, cream/grey necrotic areas

Choriocarcinoma: haemorrhagic

Yolk sac tumours: grey gelantinous

15

This is?

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Teratoma: Lots of variation, cysts, cartilage etc

16

This is?

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Seminoma, relatively homogenous, grey/white

17

this is

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Left: seminoma

Right: embryonal carcinoma

18

How do you get a diagnosis?

Clinical examination

Ultrasound

Inguinal orchidectomy

Pathological exam

19

STaging is done by?

Chest xray

CT scan

serum markers

20

How do the tumours spread

Local invasion is extremely rare.

Lymphatic spread: common iliac and para-aortic

Haematogenous

21

Tumour markers

HCG: in choriocarcinomas, malignant teratomas or some seminomas

AFP: (produced by liver and yolk sac) yolk sac tumours, malignant teratomas

 

will be v v high with tumours!!

22

Management post testis removal

Seminoma: removal + radiation

NSGCT: removal + surveillance +  chemo

Very high cure rates!!!

23

Squamous cell carcinoma of the penis

  • Elderly men
  • HPV found in CIS, invasive carcinoma
  • Circumsion has a protective effect
  • Most common site: coronal sulcus and glans penis
  • Spreads commonly to inguinal nodes (high mortality)

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