Testicular Neoplasia - Fremont-Smith

Question 1

germ cell tumors

Answer 1

seminomatous

non-seminomatous

Question 2

sex cord stromal tumors

Answer 2

leydig cell tumor

sertoli cell tumor

Question 3

lymphoma

Answer 3

older men

non-hodgkin diffuse B cell lymphoma

Question 4

seminomatous

Answer 4

seminoma - young men

spermatocytic seminoma - older men

Question 5

non-seminomatous

Answer 5

embryonal carcinoma - common
yolk sac tumor
choriocarcinoma
teratoma

often mixed

Question 6

torsion of testicle

Answer 6

breakdown of blood/testicle barrier

• immune system recognize germ cells/sperm as foreign
• 10% develop infertility

get immune response against unaffected testicle
-poor sperm quality

Question 7

cryptorchidism
hypospadius
poor sperm quality

Answer 7

testicular dysgenesis syndrome

associated with seminomatous and non-seminomatous germ cell tumors

Question 8

tunica albuginea

Answer 8

surrounding seminiferous tubules

contains the germ cells and sperm

sertoli cell surround germ cell
leydig cells - surrounding fibrosis

Question 9

sertoli cell

Answer 9

surround maturing sperm

-important interaction

Question 10

germ cell CIS

Answer 10

exist before boy is born

• CIS child born with
• idiopathic

Question 11

90% tumors in male

Answer 11

germ cell

• seminoma - majority
• embryonal - NSGCT
• mixed - both

malignant

Question 12

malignant

Answer 12

germ cell tumors
yolk sac tumor
teratoma
spermatocytic seminoma

Question 13

benign

Answer 13

sertoli cell tumor
leydig cell tumor
sex cord stromal tumor

Question 14

i12p

Answer 14

genetic marker in germ cell tumors

Question 15

germ cell tumors

Answer 15

good response to chemotherapy

Question 16

most common neoplasm young adult men

Answer 16

germ cell tumors of testis

GCT

Question 17

risk factors for GCT

Answer 17

abnormal testis
fam hx - KT and BAK
white
brothers 8-10x risk

Question 18

path of GCT

Answer 18

precursor malignant cell develops in fetus and is activated at puberty

abnormal chromosome i12p

Question 19

spermatogonia GCT

Answer 19

seminoma

Question 20

primitive germ cell GCT

Answer 20

embryonal carcinoma

Question 21

mets of GCT

Answer 21

periaortic abdominal lymph nodes

Question 22

painless testicular mass with HCG, LDH, aFP

Answer 22

GCT

Question 23

most common GCT

Answer 23

seminoma

slow growing with late spread

LDH and HCG

Question 24

AFP

Answer 24

non-seminomatous GCT

Question 25

staging seminoma

Answer 25

good - no mets | intermediate - mets

Question 26

tx of seminoma

Answer 26

sperm preserved - radical orchiectomy - node dissection low risk - no mets - very radiosensitive intermediate risk - mets - platinum chemo

Question 27

large cell with distinct borders, prominent nucleoli, watery cytoplasm, lymphoid infiltrate, in a nested pattern

Answer 27

seminoma histo**

Question 28

spermatocytic seminoma

Answer 28

rare tumor men >65yo slow-growing, non-met looks like seminoma

Question 29

non-senimonatous GCT

Answer 29

mixed germ cell tumor usually more aggresive and worse prognosis hematogenous and lymph spread respond well to chem

Question 30

mixed GCT

Answer 30

50-60% of all testicular tumors

Question 31

yolk sac tumor

Answer 31

produce AFP most common GCT in children <3 years old

Question 32

schiller duval bodies

Answer 32

yolk sac tumors

Question 33

hemorrhagic, aggressive, HCG

Answer 33

choriocarcinoma hematogenous spread** prognosis - depend on mets and serum marker levels tx - radical orchiectomy

Question 34

use of serum markers in NSGCT

Answer 34

evaluate masses staging assessing tumor burden response to therapy

Question 35

zones of prostate

Answer 35

transition - BPH and obstruction peripheral - cancers - most posterior** feel with rectal exam central zone

Question 36

acute prostatitis

Answer 36

E. coli gram neg rods, enterococci reflux of urine fever, chills, cysuria tx antibiotics

Question 37

chronic prostatitis

Answer 37

recurrent UTIs, dysuria, localized pain PMNs in urine** diagnosis

Question 38

granulomatous prostatitis

Answer 38

most secondary to ruptured acini

Question 39

BPH

Answer 39

enlarged prostate transition zone 60-100 g (normal DHT > grwoth factor

Question 40

treatment of BPH

Answer 40

alpha blockers - decreased smooth m tone 5 alpha reducatese inhibitor - decreases DHT tissue destruction

Question 41

5-hydroxy-reductase

Answer 41

T > DHT

Question 42

compress urethra into slit-like lumen

Answer 42

BPH glands and stroma proliferate

Question 43

malignant vs. benign prostate gland

Answer 43

look for the basal layer (bark) and if cells have invaded from gland

Question 44

imaging of prostate

Answer 44

U/S IVP

Question 45

phenazopyridine

Answer 45

drug given if urinary procedure makes pee dark orange

Question 46

urinary bladder muscle

Answer 46

hypertrophies with BPH to push urine past prostate

Question 47

complications of BPH

Answer 47

obstruction - cystitis, pyelonephritis, nephropathy infection - prostatitis, epididymitis urosepsis

Question 48

serum Cr level doubles

Answer 48

regardless of initial value indicates serious renal issue

Question 49

adenocarcinoma of prostate

Answer 49

posterior wall tissue 2nd leading cause cancer death in men risk >50yo, AA, fam hx androgen dependent** precursor - prostatic intraepithelial neoplasm (PIN) screening - DRE and PSA

Question 50

predictive value

Answer 50

likelihood a positive test respresents disease

Question 51

pararectal US with needle

Answer 51

can biopsy prostate mass

Question 52

prominent nucleoli

Answer 52

necessary for dx of adenocarcinoma of prostate

Question 53

PSA velocity

Answer 53

change of PSA over time

Question 54

PSA

Answer 54

organ specific not cancer specific more free PSA - more likely benign

Question 55

prostate mets

Answer 55

osteoblastic - bone

Question 56

gleason scoring

Answer 56

for prostate cancer

Question 57

staging of prostate

Answer 57

T3 - through capsule N1 - node mets present M1 - distant mets present