Week 1 - "Weak Swimmers" Flashcards
1
Q
What kind of organs are the:
1. Scrotum
2. Testes
3. Epididymis
Anatomy
A
Outpouching organs of the lower anterior abdominal wall into the peritoneum
2
Q
What are the internal male genital organs? (5)
Anatomy
A
- Vas deferens
- Seminal vesicle
- Ejaculatory duct
- Prostate gland
- Bulbourethral gland
3
Q
What are the contents of the scrotum?
Anatomy
A
- Testes
- Epididymides
- Lower ends of the spermatic cords
4
Q
What are the walls of the scrotum? (4) (from most superficial to most deep)
Anatomy
A
- Skin –> continuous layer with the anterior abdomen
- Superficial fascia
- Spermatic fascia
- Tunica vaginalis
5
Q
What are the components of the superficial fascia of the scrotum?
Anatomy
A
Fatty and membranous
6
Q
What does the fatty component of the superficial fascia get converted into?
Anatomy
A
Dartos msucle
7
Q
What does the membranous component of the superficial fascia get converted into?
Anatomy
A
Colles’ fascia
8
Q
What are the components of the spermatic fascia?
Anatomy
A
- External spermatic fascia
- Cremasteric fascia
- Internal spermatic fascia
9
Q
Where does the external spermatic fascia arise from?
Anatomy
A
The external oblique aponeurosis
10
Q
Where does the cremasteric fascia arise from?
Anatomy
A
Internal oblique muscle
11
Q
Where does the internal spermatic fascia arise from?
Anatomy
A
Fascia transervsalis
12
Q
What is the main function of the scrotum?
Anatomy
A
Regulation mechanisms for testicular temperature
13
Q
In what temperatures does spermatogenesis occurs, how does the location of the scrotum aid that?
Anatomy
A
Spermatogenesis –> 3 degrees below the abdominal temperature, scrotum is outside the body so helps regulate temperature
14
Q
What are the different mechanisms involved in controlling the temperature of spermatogenesis?
Anatomy
A
- Constriction and relaxation of the Dartos & Cremaster muscles –> pull in or push the scrotum towards the body
- Countercurrent heat exchange between testicular artery and vein
15
Q
What is tunica vaginalis?
Anatomy
A
Fluid-filled sac in the scrotum that surrounds the testes and cushions them
16
Q
Where does tunica vaginalis originate from?
Anatomy
A
Originates as an inferior extension from the peritoneum in the abdomen –> Processus Vaginalis
17
Q
What happens to the processus vaginalis just before birth?
Anatomy
A
Processus vaginalis shuts off and losses continuity with peritoneum to become tunica vaginalis
18
Q
Which section of the testes does the tunica vaginalis not surround and why?
Anatomy
A
The posterior because the epididymis is located there
19
Q
What is hydrocele testis?
Anatomy
A
Excess fluid in tunica vaginalis around the testis
Can be congenital or acquired
20
Q
How can you determine whether or not there is fluid or mass in the testis?
Anatomy
A
Shine a flashlight through it, if light passes through it, then it is fluid –> hydrocele testis
21
Q
What is the treatment for hydrocele testis?
Anatomy
A
Tapping the hydrocele by insertion of a cannula through the scrotal skin into the cavity of tunica vaginalis
22
Q
What are the testes?
Anatomy
A
A firm mobile organ that lies within the scrotum and is responsible for spermatogenesis
23
Q
What are the testes protected by?
Anatomy
A
A tough fibrous capsule: tunica albuginea
24
Q
What is the format of testes internally?
Anatomy
A
Divided into lobules by fibrous septa, about 300 of them, each consisting of seminiferous tubules
25
What is the format of the testes externally?
| Anatomy
Surrounded anterior and on the sides by tunica vaginalis
26
What is the ductal system of the testicular lobules?
| Anatomy
1. Seminiferous tubules
2. Straight ducts (tubules)
3. Rete testis (mediastinum)
4. Efferent ductules
5. Head of epididymis
27
What is the canalization process of rete testis?
| Anatomy
1. During fetal development, the primordial testis forms cords of epithelial cells that are initially solid.
2. Canalization begins when the solid cords start to form lumens, which are hollow spaces within them. This is typically achieved through cell apoptosis in the central cells of the cords, which creates a pathway.
3. The developing lumens align and merge, forming the interconnected network that becomes the rete testis.
28
What are the seminiferous tubules?
| Anatomy
Functional units where sperm is produced
29
What epithelium lines the seminiferous tubules?
| Anatomy
Specialised stratified epithelium
30
What are the two types of specialized stratified epithelium that line the seminiferous tubules?
| Anatomy
1. Nondividing supporting or sustentacular cells (Sertoli cells)
2. Proliferative cells of the spermatogenic lineage
31
What is spermatogenesis?
| Anatomy
Sperm production that includes cell division through meiosis and mitosis
32
What is spermiogenesis, when does it happen?
| Anatomy
The final differentiation of the haploid male germ cells, the LAST differentiation process
33
What does the basement membrane of the seminiferous tubules contain?
| Anatomy
Flattened, smooth muscle-like myoid cells
34
What is the function of myoid cells?
| Anatomy
help sperm cells to be pushed to the next part of the duct system
35
What are Sertoli cells?
| Anatomy
Columnar or pyramidal cells that largely envelop cells of the spermatogenic lineage
36
What is the nucleus of the Sertoli cells like?
| Anatomy
Triangular in outline
37
What is the cytoplasm of Sertoli cells like?
| Anatomy
It has many inclusions of unknown function, crystalloids, or Charcot Bottcher
38
Where do spermatogonia lie?
| Anatomy
In a basal compartment
39
What is the blood-testis barrier?
| Anatomy
Tight junctions between basal components and adjacent Sertoli cells in the seminiferous epithelium, protecting the sperm cells from immune reactions
40
41
Where are Leydig cells located?
What happens to interstitial or Leydig cells during puberty?
| Anatomy
They are found in between seminiferous tubules
They become apparent as either rounded or polygonal cells with central nuclei and eosinophilic cytoplasm rich in lipid droplets
42
When does testosterone secretion by interstitial cells begin?
| Anatomy
begins at puberty, promoted by LH
43
What is the transition of straight tubules from rete testis characterized by?
| Anatomy
Many tall Sertoli cells devoid of germ cells
44
What is the function of the rete testis?
| Anatomy
Drains about 20 efferent ductules which carry sperm to epididymis
45
What is rete testis lined by?
| Anatomy
By a group of nonciliated cuboidal cells alternating with groups of taller ciliated cells
46
What is the purpose of the ciliated cells in the rete tetsis?
| Anatomy
They can move the sperm cells
47
What is the purpose of the nonciliated cells in the rete testis?
| Anatomy
absorb some of the fluid from the lumen of the rete testis which helps with the flow of sperm through the duct system
48
What is characteristic of the appearance of the rete testis epithelium?
| Anatomy
Scalloped appearance
49
What is the epididymis?
| Anatomy
A highly coiled tubule that lies posterior to the testis
50
What are the components of the epididymis?
| Anatomy
1. Expanded head
2. Body
3. Pointed tail
51
What is the relation of vas deferens to the epididymis?
| Anatomy
Vas deferens is a direct continuation of the epididymic tail that ascends up on its medial side
52
What is the function of the epididymis?
| Anatomy
Site for maturation and storage for sperms
53
What is the epithelium of the epididymal duct?
| Anatomy
Psuedostratified columnar epitehlium
54
What are the cell types found in the pseudostratified columnar epithelium of the epididymal duct?
| Anatomy
1. Tall principal cells with stereocilia
2. Small basal cells on the basal lamina
55
WHat kind of immune cells are often seen in the epididymal duct?
| Anatomy
Macrophages and intraepithelial lymophocytes
56
What is the arterial blood supply of the testis and the epididymis?
| Anatomy
Testicular artery
57
What is the venous drainage of the testis and the epididymis?
| Anatomy
Pampiniform plexus
58
Which vein is the pampiniform plexus reduced to?
| Anatomy
Testicular vein as it ascends through the inguinal canal
59
What is the lymph drainage of the testis and the epididymis?
| Anatomy
Para-aortic lymph nodes
60
What is torsion of the testis?
| Anatomy
Rotation of the testis around its spermatic cord within the scrotum --> associated with severe pain
61
What is the target population of torsion of testis?
| Anatomy
Young adults
62
What are the complications of torsion of testis?
| Anatomy
1. Obstruction of venous drainage
2. Edema and hemorrhage
3. Obstruction of testicular artery
4. Necrosis
63
What is the management of the torison of testis?
| Anatomy
surgical emergency to correct and fix
64
What is the ductus deferens?
| Anatomy
Fibromuscular tube that is continuous with the ductus epididymis
65
How long is the ductus deferens?
| Anatomy
45cm
66
Where is the ductus deferens located?
| Anatomy
Enters the pelvic cavity through the bilingual canal and passes along the side and down the posterior surface of the urinary bladder toward the prostate gland
67
What happens to the ductus deferens before it reaches the prostate gland?
| Anatomy
Each ductus deferens enlarges to form an ampulla
68
In which portion of the ductus deferens is sperm stored?
| Anatomy
The proximal portion of the ductus deferens, near the epididymis
69
What is the histology of the ductus deferens like? (3)
| Anatomy
1. Narrow lumen
2. Mucosa is folded longitudinally
3. Thick muscularis layer consisting of longitudinal inner and outer layers and a middle circular layer
70
What is the epithelium of the ductus deferens like?
| Anatomy
Pseudostratified columnar epithelium with sparse stereocilia
71
What is the purpose of a very thick muscularis layer in the ductus deferens?
| Anatomy
The direction of movement is going against gravity, so the muscles required for strong peristaltic waves
72
What are seminal vesicles?
| Anatomy
2 lobulated organs on the base of the bladder that is responsible for 65 to 70% of seminal fluid production
73
What is the length of the seminal vesicles?
| Anatomy
Approximately 5 cm
74
What is the epithelium of seminal vesicles?
| Anatomy
Simple to pseudostratified columnar epithelium
75
Where is the prostate gland found?
| Anatomy
At the base of the bladder
76
Where do the ejaculatory ducts open into, and how man of them?
| Anatomy
Two ejaculatory ducts open into the prostatic urethra beside the office of the prostatic utricle, one on each side
77
When is prostatic fluid secreted?
| Anatomy
During ejaculation
78
Where are the bulbourethral glands located?
| Anatomy
Inferior to the prostate
79
How many ejaculatory ducts are there?
| Anatomy
2, one on each side
80
What is the length of each ejaculatory duct?
| Anatomy
ABout 2.5cm each
81
What makes up the ejaculatory duct?
| Anatomy
Vas deferens + duct of the seminal vesicle
82
What is the location of the ejaculatory ducts?
| Anatomy
Pass anterioinferiorly through the posterior part of the prostate along the sides of the prostatic utricle
83
What is the prostatic utricle?
| Anatomy
Embryological remnant of the vagina and the uterus in the males
84
What are the different sections of the penis?
| Anatomy
1. The root
a. The bulb
b. The cura
2. The body
3. The glans
85
What is the root of the penis attached to?
| Anatomy
Attaches the penis to the pubic arch
86
What are the components of the root of the penis?
| Anatomy
The bulb and the cura
87
What does the bulb attach the penis to?
| Anatomy
The urogenital diaphragm
88
What covers the bulb of the penis?
| Anatomy
Bulbospongiosus muscle
89
What does the bulb of the pens continue anteriorly as?
| Anatomy
Corpus spongiosum
90
What is the function of the bulbospongiosus muscle?
| Anatomy
Forcefully propels sperm out of the body from the prostatic urethra to the urethral meatus
91
What is the cura covered by?
| Anatomy
Ischiocavernosus msucle
92
What is the function of the ischiocavernosus muscle?
| Anatomy
Helps stabilize the erection. and prevent blood from flowing out of the venous drainage during erection
93
What is the body of the penis supported by?
| Anatomy
Ligaments; fundiform and supsensory
94
What happens if the ligaments that support the body of the penis get cut?
| Anatomy
The non-erectile penis may look longer
95
What are the columns of the penis?
| Anatomy
Two dorsal columns: the corpora cavernosa. The ventral column: the corpus spongiosum
96
What is the glans of the penis?
| Anatomy
Dilation of the cuprus spongiosum
97
WHere is the glans of the penis located?
| Anatomy
External urethral meatus
98
What is the arterial blood supply of the penis?
| Anatomy
Branches of the internal pudendal artery (internal pudic)
99
What is the venous drainage of the penis?
| Anatomy
Branches of the intrenal pudendal vein
100
What is the lymph drainage of the penis?
| Anatomy
Superficial inguinal nodes
Internal iliac nodes
101
What is the innervation to the penis?
| Anatomy
Pudendal nerve
Pelvic plexus --> both sympathetic and parasympathetic
102
What does the sympahetic innervation of the penis control?
| Anatomy
Ejaculation
103
What does the parasympathetic innervation of the penis control?
| Anatomy
Erection
104
When is genetic sex determined?
| Anatomy
At fertilization but at that point phenotypic sex is not yet determined
105
What occurs between the genetic sex determination and the phenotypic sex appearance?
| Anatomy
A stage of indifferent stage of gonadal development
106
What happens to the mesonephros once the metanephros develop?
| Anatomy
The mesonephros does NOT degrade, instead, it is involved in the formation of the reproductive system
Metanephros: urological
Mesonephros: reproductive
107
What do gonads appear as in the indifferent stage of gonadal development?
| Anatomy
They appear as genital ridges from the intermediate mesoderm
108
What happens to the primordial germ cells during the indifferent stage of gonadal development?
| Anatomy
Primordial germ cells become spermatogonia --> they migrate from epiblasts into genital ridges
109
What happens if there is a failure of primordial germ cells to migrate?
| Anatomy
The embryo will not have gonads
110
What happens just prior to the arrival of the primordial germ cells from the epiblast?
| Anatomy
Genital ridges epithelium proliferates to form primary sex cords
111
What causes the primary sex cords to develop into somniferous tubules and testis?
| Anatomy
The chromosomal SRY gene influences
112
What are the genityal ducts that male and female embryos have at the indifferent stage?
| Anatomy
Mesonephric (Wolffian) duct (male)
Paramesonephric (Mullerian) duct (female)
113
What is the effect of the influence of fetal testosterone from developing testes on the mesonephric and paramesonephric ducts?
| Anatomy
Mesonephric: develops into male genital ducts and connected to rete testis
Parasympathetic ducts disappear
114
Where do the seminal vesicles develop from?
| Anatomy
They devleop from the mesonephric ducts as an outgrowth of the distal end
115
Where do the prostate and bulbourethral glands develop from?
| Anatomy
Urogenital sinus
116
What happens to the development of the male external genitalia under the influence of fetal androgens?
| Anatomy
1. Genital tubercle (which is called phallus when it starts to elongate) elongates to form the penis
2. Urethral folds also elongate and fuse to form penile urethra
3. Genital swelling form the scrotum
117
What could cause the failure of the testes to descend?
| Anatomy
Lack of testosterone
118
What is the descent of the testis?
| Anatomy
1. The abdominal testes are pulled down by the Gubernaculum testes (ligament) along with a section of the peritoneum (tunica vaginalis)
2. An evagination of the peritoneum develops ventral to gubernaculum (processus vaginalis)
119
What is the Gubernaculum testes?
| Anatomy
Fibrous tissue that pulls tests down
120
What is the function of Gubernaculum testes?
| Anatomy
To limit the mobility of the testes --> if it fails then torsion occurs
121
What is the incidence of Hypospadias?
| Anatomy
3 to 5 per 1000
122
What is hypospadias?
| Anatomy
Incomplete fusion of urethral folds which form the penile urethra
123
What is the complication of Hypospadias?
| Anatomy
Urethral opening occurs along ventral surface of the pneis
124
What is epispadias?
| Anatomy
A rare condition, where the urethral opening is located on the dorsum of the penis
125
What complications are usually associated with epispadias?
| Anatomy
It can present as an isolated defect or exstrophy of the bladder
126
What is exstrophy of the bladder?
| Anatomy
The bladder is not closed
127
What is cryptorchidism (undescended testis)?
| Anatomy
Absence of one or both testes in the scrotum may be found anywhere along the usual path of descent of the testes (inguinal canal all the way to the abdomen)
128
What are the causes of cryptorchidism?
| Anatomy
Idiopathic in most cases, but deficiency of androgens by testes is a factor
129
What is the incidence of cryptorchidism?
| Anatomy
30% of premature infants and 3% of full-term males
130
What are the consequences of cryptorchidism?
| Anatomy
Risk of testicular cancer
Infertility
131
What is peristent processus vaginalis?
| Anatomy
Failure of closure of the communication between the peritoneal cavity and tunica vaginalis
132
What are the complications of persistent processus vaginalis?
| Anatomy
1. Congenital inguinal hernia
2. Hydrocele of the testes
3. Hydrocele of the spermatic cord
133
What do devleopment abnormalities lead to?
| Anatomy
Difficulty in sex determination at birth, Ambiguous genitalia
134
What is the sexual reproduction?
| Physiology
The process in which organisms produce offspriing by means of uniting gametes
135
136
What are the functions of the male reproductive organs?
| Physiology
Secrete androgen hormones, produce gametes, and facilitate fertilization
137
What are the functions of the female gametes?
| Physiology
Secrete female hormones, produce gametes, facilitate fertilization and sustain growth of the embryo and fetus
138
139
What are the male gonads?
| Physiology
Testes
140
What is the duct system of the male reproductive system?
| Physiology
Epidydimis
Vas deferens
Ejaculatory duct
Urethra
141
What is the purpose of the system of ducts in males?
| Physiology
Transport and store sperm, assist in their maturation aand convey them to the exterior
142
What are the accessory sex glands of males?
| Physiology
Seminal vesicles
Prostate
Bulbourethral glands
143
What is the function of accesory sex glands (males)?
| Physiology
Add secretions to sperm to form semen
144
What are the supporting structures of the male reproductive system?
| Physiology
Scrotum & Penis
145
What is the function of the supporting structures of the male reproductive system?
| Physiology
Scrotum supports the testes and penis delivers sperm into the female reproductive system
146
What are the testes?
| Physiology
Paired oval glands in the scrotum
147
What is the importance of the testes being located in the scrotum.
| Physiology
Kept in temperature less than normal body temperature because sperm production requires temperature 2 to 3oC lower
148
What is the tunica albuginea and what does it form?
| Physiology
The tough capsule surrounding the testes, it forms septa that divide each testis in lobules
149
How many lobules are there, and what do they contain?
| Physiology
200 to 300 lobules each containing 2 to 4 seminiferous tubules
150
What is the purpose of seminiferous tubules?
| Physiology
Sperms are produces, spermatogenesis
151
What are the compartment within each lobule created by seminiferous tubules?
| Physiology
Intralobular compartment
Peritubular compartments
152
What is the intartubular compartment of the lobule?
| Physiology
Composed of seminiferous epithelium
153
What is the peritubular compartment within lobule?
| Physiology
Composed of neuromuscular elements, connective tissue cells, immune cells, and the intestinal cells of Leyidig, whose main function is to produce testosterone
154
What are the two cell types of the seminiferous tubules’ epithelium?
| Physiology
Sperm cells: spermatogonia
Sertoli cells
155
What are Sertoli cells?
| Physiology
Nurse cells in intimate contact with all sperm cells and regulate many aspects of spermatogenesis
Function provide nutrients (nurse cells)
156
What are tight junctions, and what is their function in the Seminiferous epithelium?
| Physiology
Important because they form blood-testis barrier to prevent immunologic reactions from affecting the sperm cells, they are formed between Sertoli cells in the seminiferous tubules
157
What is the purpose of spermatogenesis?
| Physiology
Production of spermatozoa and begins at puberty (Tanner stage: 4)
158
What is the duration of spermatogenesis?
| Physiology
Takes 65 to 75 days and occurs in the testes at a temperature about 2 to 3 degrees below normal body temperature
159
What is the duration of spermatogenesis?
| Physiology
Takes 65 to 75 days and occurs in the testes at a temperature about 2 to 3 degrees below normal body temperature
160
What is spermatogenesis under indirect control of?
| Physiology
FSH and testosterone because spermatozoa do not have androgen receptors
161
What is the process of spermatogenesis like?
| Physiology
It begins with spermatogonia which are sperm stem cell —> primary spermatogenesis —> secondary spermatogenesis —> spermatids —> sperm cells
162
What happens to non-motile sperms?
| Physiology
They are released into lumen of seminiferous tubules and stored in the tail of epididymis and vas deferent for several months
163
What is spermatocytogenesis?
| Physiology
Spermatogonia type B divides by mitosis into primary spermatocyte
164
How many cycles of meiosis take place in spermiogenesis?
| Physiology
2 meiotic cycles
165
What is the release of sperm into the lumen of seminiferous tubules called?
| Physiology
Spermiation, breakdown of junctions between Sertoli cells and spermatogenesis
166
What is spermatogenesis adversely affected by? (6)
| Physiology
1. Temperature
2. Anabolic hormones like exogenous testosterone and steroids
3. Dietary deficiencies
4. X-rays exposure
5. Alcohol and smoking
6. Infections like STDs
167
How many sperms complete the process of spermatogenesis daily?
| Physiology
About 300 million
168
What are the different components of the sperm cells?
| Physiology
1. The head
2. The neck
3. The tail
169
What are the components of the head of sperm cell?
| Physiology
A condensed nucleus containing 23 highly condesnsed chromosomes
An acrosomal vesicle covering the anterior two thirds of the nucleus and containing hydro lyric enzymes that play an important role in fertilisation and the prevention of polyspermy
170
What does the neck of the sperm cell contain?
| Physiology
Two centrioles
171
What is the tail of sperm cells composed of?
| Physiology
Middle piece
Principal piece
End piece
172
What is the middle piece of the sperm cell?
| Physiology
The thickest part and contains a collar of mitochondria that deliver ATP for flagella beating and motility
173
What does the principal piece of the sperm cell contain?
| Physiology
Outer circumference contains dense fibers but no mitochondria
174
How does the principal piece propel the sperm cell?
| Physiology
By interactions between tubulin fibres
175
What is the end piece of the sperm cells like?
| Physiology
Lacks the outer dense fibres and mitochondria
176
What do the Sertoli cells represent?
| Physiology
The true epithelial cells in the seminiferous tubules
177
Where in the seminiferous tubules are the Sertoli cells located?
| Physiology
They extend from the basal laminate to the lumen
178
What kind of receptors do the Sertoli cells express?
| Physiology
FSH receptors
179
What is the function of the Sertoli cells?
| Physiology
Surround sperm, provide structural and functional support within epithelium
180
What kind of junctions do Sertoli cells form with spermatogenic cells?
What is their function?
| Physiology
Adherens junctions and gap junctions
Sertoli cells guide sperm cells toward lumen as they advance through later stages
181
What do tight junctions form, where are they found?
| Physiology
They form the blood-testes barrier and they are found between two Sertoli cells
182
What are Leydig cells?
| Physiology
The primary endocrine cells of the testes
Steroidogenic stromal cells that produce testosterone from cholesterol stimulated by LH
183
What % of the circulating testosterone comes from Leydig cells?
| Physiology
95% of circulating testosterone, which is actually a very small of the total testosterone created by the testes
184
Which hormone DIRECTLY acts on spermatogenic cells?
| Physiology
Estradiol
185
What happens to the rest of the testosterone that is NOT circulating in the blood?
| Physiology
80% of the total testosterone will move into the seminiferous tubules which have high affinity to testosterone, 10x the concentration of testosterone in the blood
186
What are the concentrations of testosterone through the day?
| Physiology
In plasma, it follows the circadian pattern (morning concentration are 20 to 40% higher than evening ones)
187
How does testosterone target tissues? What kind of tissues?
| Physiology
Directly and indirectly targets tissues that can be reproductive or non reproductive
188
Which tissues other than the testes produce testosterone and other androgens?
| Physiology
Adipose tissue, brain, muscle, skin, adrenal cortex
189
What other androgens other than testosterone are there?
| Physiology
DHT and estradiol
190
Where is 5a reductive found?
| Physiology
Prostate gland, seminal vesicles, epidisymides, skin, hair follicles and brain
191
What is the function of 5a reductase?
| Physiology
Converts testosterone to DHT that acts locally (interacting and practice effects)
192
Where is aromatase found?
| Physiology
Sertoli cells (20%)
Adipose tissue (80%)
Brain
193
What is the function of aromatase?
| Physiology
To convert testosterone into estradiol
194
What is the concentration of DHT in comparison to testosterone in the plasma?
| Physiology
10 to 20 times less potent than testosterone
195
What is the concentration of DHT in comparison to testosterone in the traget organs?
| Physiology
10 times more potent than testosterone
196
What is the importance of Estradiol in men?
| Physiology
Essential for modulationg libido, erectile function, spermatogenesis (direct effect via estroegn receptors) as well as bone growth and calcification
197
What are the actions of testosterone? (7)
| Physiology
1. Muscle Mass Development
2. Bone Density
3. Abdominal Visceral Fat
4. Sperm Production
5. Liver Effects: Increases VLDL, LDL, and decreases HDL levels.
6. Pubertal Development
7. Feedback Suppression
198
What are the actions of DHT? (6)
| Physiology
1. Intrauterine Differentiation:
Development of male external genitalia (penis, scrotum, urethra, prostate).
2. Secondary Sexual Characteristics
3. Prostate Growth
4. Male Pattern Hair Growth
5. Pubertal Development
6. Epididymis, Vas Deferens, and Seminal Vesicle Maturation.
199
What are the actions of estradiol?
| Physiology
1. Bone Growth: Supports epiphyseal plate closure in bones, contributing to height regulation.
2. Male Behavior: Influences male sexual behavior and libido.
3. Feedback Suppression: Suppresses gonadotropin secretion along with testosterone.
200
What is the role of androgens during the mini puberty in early infancy?
| Physiology
Influence on penile growth, the number of Sertoli cells and body growth
201
What is the influnece of androgens at puberty?
| Physiology
1. Stimulate the development of secondary male sexual characteristics
2. Stimulate the development of sexual functions and sexual drive
3. Stimulate anabolism: protein synthesis --> growth of msucle abdominal bone --> increase in height
202
Which hormone is responsible for changing of the voice dufring puberty?
| Physiology
Testosterone
203
Which hormone is responsible for the development of hair during puberty?
| Physiology
DHT
204
Which hormone is responsible for the enlargment of the penis during puberty?
| Physiology
DHT
205
Which hormone is responsible for the thickining of the skin and increase in sebaceous glands during puberty?
| Physiology
DHT
206
Which hormone is responsible for the maturation of the seminiferous tubules and production of sperm during puberty?
| Physiology
Testosterone
207
What is the hormonal control of testes like?
| Physiology
CNS: hypothalamus (GnRH)
Anterior pituitary: LH and FSH
LH --> Leydig cells
FSH --> Sertoli cells
208
What hormone from the Sertoli cells inhibits the anterior pituitary?
| Physiology
Inhibin
209
What are the effects of FSH on Sertoli cells?
| Physiology
Release of androgen binding protein
Release of estrogens
Spermatogenesis
210
What are the effects of LH on Leydig cells?
| Physiology
Release of androgens, which later on bind to androgen-binding protein
211
How are androgens converted into estrogens?
| Physiology
Through peripheral aromatization
212
What is the secretion of GnRH like?
| Physiology
Pulsatile
213
What is the effect of GnRH?
| Physiology
STimulates thenaterior pituitary to increase the secretion of LH and FSH
214
How is GnRH suppressed, through which negative-feedback mechanism?
| Physiology
Testosterone, it suppressed both GnRH and LH
215
What is the effect of administration of exogenous androgens?
| Physiology
They enter the circulation and exert excessive negative feedback on hypothalamus and pituitary --> insuficient levels of testosterone is testes --> insufficient spermatogenesis
216
What is the effect of short, intensive physicalo exercise?
| Physiology
Can increase plasma testosterone
217
What is the effect of extended, exhausting physical exercise?
| Physiology
Decrease plasma testosterone
218
What are the accessory glands of the male reproductive system?
| Physiology
Prostate
Seminal vesicles
Bulbourethral galnds
219
What is the function of the seminal vesicles?
| Physiology
Secrete a thick viscous, alkaline fluid (mainly during ejaculation), which makes up 60% of total volume of semen
220
What does the thick alkaline fluid from the seminalo vesicles contain? (4)
| Physiology
1. Fructose: for energy
2. Prostaglandins: to stimulate uterine and fallopian tube smooth muscle contraction
3. Vitamin C
4. Clotting proteins: fibrinogens
221
Why is the fluid from the seminal vesicles alkaline?
| Physiology
In order to neutralize the acidity of the male urethra and female reproductive tract
222
What is the prostate?
| Physiology
A chest-nut sized, donut-shaped gland that secretes about 30% of ejaculate volume
223
What is the prostatic fluid like?
What does it contain?
| Physiology
Thin, milk, slighlty alkaline solution which contains:
1. Citric acid for energy
2. Acid phosphotase
3. Proteolytic enzymes
4. Clotting enzymes: trigger clotting of semen in the vagina during penis withdrawn
5. Prostate-specific antigen: liquifies coagulated semen after a few minutes
224
What is another name for Bulbourethral gland?
| Physiology
Cowper's gland
225
What are the bulbourethral glands?
| Physiology
Pea-seized glands inferior to the prostate
226
What do the bulbourethral glands secrete?
| Physiology
Protective, alkaline, thick, clear mucus that decreases sperm damage in the urethra
1. They pass down the urethrafirst during sexual excitement,
2. Clean the urethra of acidic urine traces prior to ejaculation,
3. Serve as lubricant during sexual intercourse
227
What is semen?
| Physiology
Mixture of sperms and seminal fluid, a liquid that consists of the secretion of the seminiferous tubuules, seminal vesicles, prostate amd bulbourethral glands
228
What is the normal volume of semen?
| Physiology
2 to 6ml
229
What is the normal viscocity of semen?
| Physiology
Liquefaction in 1 hour
230
What is the normal pH of semen?
| Physiology
pH 7 to pH 8
231
What is the normla count of semen?
| Physiology
≥ 20 million/mL
232
What is the normal motility of semen?
| Physiology
≥ 50%
233
What is the normal morphology of semen?
| Physiology
≥ 60% normal
234
What is the male sexual response cpntrolled by?
| Physiology
Parasympathetic --> erection and Sympathetic --> ejaculation divisions of the ANS
235
What are the 4 stages of male/female sexual response?
| Physiology
1. Excitement
2. Plateau
3. Orgasm
4. Resolution
236
How does an erection occur?
| Physiology
Parasympathetic reflex --> local production of nitric oxide --> relaxation of smooth muscle in arterioles supplying the cavernous space --> large amounts of blood enter penis
237
What are the two phases of orgasm?
| Physiology
Emission
Expulsion
238
What is the emission phase of orgasm in sexual response?
| Physiology
Movement of the ejaculate into the prostatic urethra (closure of the sphincter at the base of the urinary bladder, and peristaltic contractions of vas deferens, seminal vesicles, and prostatic smooth msucle)
239
What is the expulsion phase of the orgasm in sexual response?
| Physiology
Forceful expulsion of ejaculate through urethra and out of the penis (facilitated by rhythmic of perineal muscles --> somatic nervous system)
240
What is the resolution phase controlled by in sexual response?
| Physiology
Sympathetic division
241
How does the resolution phase occur in sexual response?
| Physiology
Norepinephrine causes contraction of smooth muscle --> Increase in intracellular Ca2+ --> smooth muscle contraction and vasoconstriction --> decrease in blood flow to cavernous spaces
242
What is the effect of PDE-5 on penile erections?
| Pharmacology
Degrades cyclic GMP, causing vasoconstriction of erectile tissues and resulting in the loss of erection.
243
What are the three main classes of pharmacotherapy of ED?
| Pharmacology
1. PDE-5 inhibitors
2. Vaodilators
3. Androgens
244
What are exmaples of PDE-5 inhibitors?
| Pharmacology
Sildenafil
Tadalafil
Vardenafil
Avanafil
245
How do PDE-5 inhibitors help with ED?
| Pharmacology
Men with ED produce insufficient amounts of NO, producing small amounts of cGMP, PDE-5 inhibitors block PDE-5 --> preventing hydrolysis of cGMP --> accumulation of cGMP which allows for vasodilation
246
What is one of the indications of PDE-5 inhibitors?
| Pharmacology
They require sexual stimulation for activation
247
What is the administration route of the PDE-5 inhibitors?
| Pharmacology
Taken orally as tabelts prior to sexual intercourse
248
What is the MOA of PDE-5 inhibitors?
| Pharmacology
Enhance the effect of nitric oxide in inducing penile vasodilation on sexual simulation, decrease in Ca2+ and accumulation of cGMP
249
Which muscle of the penus does NO relax?
| Pharmacology
Smooth muscle of corpora cavernosa peripherally
250
What are the side effects of PDE-5 inhibitors?
| Pharmacology
Headaches
Dizziness
Flushing
Nasal Congestion
GI
Visual Disturbances
251
What is an example of visual disturbances caused by PDE-5 inhibitors, which one exactly?
| Pharmacology
Blue vision due to non-specific inhibition of retinal PDE-6, Sildenafil (Viagra)
252
What is Sildenafil (Viagra)?
| Pharmacology
Most popularly used PDE-5 inhibitor, administered in 25, 50 and 100mg
253
When is Sildenafil taken?
| Pharmacology
taken 1 hour before sexual intercourse
254
255
What is the maximum dosage of Sildenafil?
| Pharmacology
Once daily
256
What is the window of opportunity for Sildenafil?
| Pharmacology
30 minutes to 4 to 5 hours, effective up to 12 hours
257
What are the side effects of Sildenafil?
| Pharmacology
Headaches
Facial Flushing
Dyspepsia
Dizziness
Rhinitis
Abnormal Vision
258
What is the first class use of PDE-5 inhibitors?
| Pharmacology
Sildenafil
259
What is the impact of fatty meals on different PDE-5 inhibitors?
| Pharmacology
Sildenafil: Delays onset
Tadalafil: No effect
Vardenafil: Dealys onset, unless given sublingual orally
Avanafil: No effect
260
WHich PDE-5 inhibit has the longest period of onset, what is it?
| Pharmacology
Tadalafil, 2 hours but lasts 36 hours, allows for once daily use
261
Which PDE-5 inhibitor is the most potent?
| Pharmacology
Vardenafil, bind most rapidly to PDE-5 compared to the rest --> Onset is 10 minutes
262
Which PDE-5 inhibitor has the fastest onset of action?
| Pharmacology
Avanafil, 10 to 30 minutes and lasts up to 6 hours
263
What are the contraindications of PDE-5 inhibitors?
| Pharmacology
Nitrates
Antihypertensive Drugs
Alpha Blockers
264
Why are nitrates a contraindicatior of PDE-5 inhibitors?
| Pharmacology
PDE-5 inhibitors cause transient hypotension, nitrates should not be taken for at least 48hrs, increased risk of threatening hypotension
265
Why are antihypertensive drugs a contraindication of PDE-5 inhibitors?
| Pharmacology
They already cause mild hypotensive effects
266
Why are alpha blockers a contraindication for PDE-5 inhibitors?
| Pharmacology
Can prodfoundly increase hyotensive, should be initiated at the lowest dosage possible
267
How are PDE-5 inhibitors metabolised?
| Pharmacology
Hepatic CYP450 enzymes so dosage requirement will be required with inducers and inhibitors of CYPs
268
What is the effect of the drugs that inhibit CYP450?
| Pharmacology
Inhibit the metabollic breakdown of PDE-5 inhibitors --> such agents may increase blood levels of PDE-5 inhibitors and thus lower dosage should be given
269
What are examples of CYP3A4 pathway inhibitors? (6)
| Pharmacology
Ketoconazole
Itraconazole
Erythromycin
CLarithromycin
HIV Protease Inhibitors
Grapefruit or grapefruit juice
270
What is the effect of the drugs that induce CYP450?
| Pharmacology
Will enhance the breakdown of PDE-5 inhibitors --> higher dosage of PDE-5 inhibitors required
271
What are examples of CYP3A4 pathway inducers?
| Pharmacology
Rifampin
Phenobarbital
Phenytoin
Carbamazepine
272
What is the local delivery of Vasodilators of ED?
| Pharmacology
Intracavernous injections of vasodilators
273
WHat are examples of vasodilators that are locally administered into the penis?
| Pharmacology
Alpostadil
274
How is Alpostadil administered?
| Pharmacology
injected into the penile shaft or administered as a pallet into the urethra
275
What is the MOA of Vasodilators?
| Pharmacology
Unknown, psosibly through activating adenylate cyclase --> increase cAMO levels --> relax trabecular smooth muscle and dilates the cavernosa arteries --> promoting blood flow
276
What is the onset of action of Vasodilators?
| Pharmacology
Rapid, 5 to 10 minutes
2 to 25 minutes through injections
277
What are the side effects of Vasodilators?
| Pharmacology
Priapism (prolonged, painful erection)
Penile pain
Urethral burning
278
What is Alprostadil?
| Pharmacology
Vasoactive prostaglandin E1 with almost immediate onset of action
279
What is MUSE?
| Pharmacology
REquires insertion of pellet into urethra with plastic applicator
280
What is is Caverject and Edex?
| Pharmacology
For injection directlyy into the penis' corpus cavernosa
281
What is the dosage of Alpostadil (in all forms)?
| Pharmacology
Between 10 to 20mcg once daily up to a maximum of 3 times per week
282
What are the contraindications of Alpostadil?
| Pharmacology
Phsyical deformities of urethra
Caution if pregnant sexual partner --> PDE can cause abortion
283
What is the use of androgens?
| Pharmacology
Testosterone of benefit with men with hypogonadism to retsore libido and sexual activity. No currently recommendded as monotherapy
284
What is the administration of androgens?
| Pharmacology
Orally
Injected
Cutaneous application via gel or skin patches
285
What is the MOA of Androgens?
| Pharmacology
testosterone promotes growth and development of male sex organs and maintains secondary sex characteristics in androgen-deficient males
286
What are the side effects of Angrogens?
| Pharmacology
Headache
Acne
Aggressive Behaviour
Priapis
Gynecomastia
287
Why is testosterone given in female with sexual dysfunction?
| Pharmacology
Works to stimulate sex desire
Extremely low doses required
288
How is testosterone administered in females?
| Pharmacology
Creams
Transdermal patches
Combinations with estrogen and progesterone
289
What are the side effects of testosterone given to women?
| Pharmacology
Masculinization and could cause liver toxicity in high doses
290
What is Eroxon?
| Pharmacology
Topical gel supplied in single-use tubes, contents are rubbed onto the head of the penis immediately before sexual intercourse
291
What is the MOA of of Eroxon?
| Pharmacology
Combination of volatile solvents (alcohol and water) which evaporate when applied to the penis and stimulate nerve endings through cooling and heating effect. Release of NO
292
What is the Vacuum Constriction Device?
| Pharmacology
Non-pharmacological approach, vacuum is placed over penis, blood is drawn into penis due to cretaion of vacuum pressure around the penis
Constriction band is then placed around the base of the penis to hold blood in place
293
What are complications of Vaccum Constriction Device?
| Pharmacology
Painful ejculation and bruising
294
What are penile implants?
| Pharmacology
Used as non-pharmacological (surgical) treatment when medical treatment fails
Used as last resort therapy
295
What are the two types of penile implants, what are they?
| Pharmacology
Malleable rods: semi-rigid penis, lifted to erect position through mechanical movemnet
Hydraulic: non-visible fluid reservoir-pump system connects to two cylinders implanted in the penile shaft to allow for erection; deflation via manual valve)
296
What are the structures of the male reproductive organs?
| Pathology
The testes
The duct system (epididymis and vas deferends)
The accessory glands (prostate, seminal vesicles & bulbourethral glands)
The penis
297
What is the gross appearance of the testis?
| Pathology
Orange yellow appearance of the testis
298
What are the main causes of male infertility? (16)
| Pathology
1. Vericocele
2. Infection
3. Ejaculaton Issues
4. Tumors
5. Cryptorchidism
6. Testicular tumors
7. Hormone Imbalances
8. Tubular transport defects
9. Chromosome defects
10. Problems with sexual intercourse
11. Celiac disease
12. Medications
13. Prior surgeries
14. Radiation/ X-Ruas
15. Environmental Exposures
16. Lifetsyle
299
What is Cryptorchidism?
| Pathology
Most common congenital abnormality; The failure of testicles to descend from abdomen into scrotal sac
300
In the case of cryptorchidism, where can the testes be found?
| Pathology
Abdomen, inguinal canal or high in the scrotum
301
Is cryptorchidism unilateral or bilateral?
| Pathology
Usually unilateral, can be bilateral (10% of cases)
302
What are the causes of cryptorchidism? (4)
| Pathology
Multifactorial:
1. Genetic syndromes
2. Preterm babies
3. Small birth weight
4. Environmental factors (pesticides & hormones)
303
What is the treatment for cryptorchidism?
| Pathology
Spontaneous resolvemnet before 2 years of age, if not, orchipexy is required at 18 months
304
What are the complications of cryptorchidism?
| Pathology
Infertility & sterility
Increased risk of intratubular germ cell neoplasmia in the atrophic tubules & subsequent invasive tumor
305
Why is infertility a complication of cryptorchidism?
| Pathology
Due to tubular atrophy, increase in temperature because testes is not outside of the body --> inadequate conditions for spermatogenesis
306
What is the gross appearance of the testis in the case of cryptorchidism?
| Pathology
Small atrophic with white yellowish cut section
307
What is the microscopic appearance of the testis in the case of cryptorchidism?
| Pathology
Thickened, hyanalised basement membrane, arrested germ cells development, prominent Leydig cells
308
What is testicular atrophy and decreased fertility associated with?
| Pathology
1. Progressive atherosclerotic changes and decreased testiclar blood supply (aging)
2. Inflammation, end stage orchitis
3. Irradiation & chemotherapy
4. Antiandrigens (treatment for prostate cancer)
5. Hypopituitarism
6. Trauma
7. Malnutrition and cachexia
8. Exhaustion atrophy: persistent stimulation by pituitary FSH
9. Cirrhosis due to increased estrogen
309
What is Epididymo-orchitis?
| Pathology
Most common cause of scrotal pain in adults, infflammation of the epididymis and the testes. Inflmmation is more prominent in the epididymis than in the testis
310
311
311
How does epididymo-orchitis present as?
| Pathology
1. Localised testicular pain with tenderness and swelling on palpation of affected epididymis, which is located on the posterior aspect of the testis
2. Scrotal wall erythema and a reactive hydrocele
3. Postive Prehn sign
4. Cremasteric reflex is positive
312
313
What is a positive Prehn sign?
| Pathology
Mannual elevation of the scrotum relieves pain
314
What is a positive cremasteric reflex?
| Pathology
When the inner thigh is touched, the testis elevate
315
What can be the causes of epididymo-orchitis?
| Pathology
1. Specific infectious agents
2. Non-specific to an infection in the area such as cystitis, urethritis or prostatis
3. Granulomatous, ususally noncaseating granuloma
316
WHat kind of specific infectious agents can cause epididymo-ochitis?
| Pathology
1. Mumps (in children patchy and does not result in complete atrophy or infertility, in teenagers or children > 10 it will lead to infertility)
2. Syphilis & TB (necrotizing, caseating granuloma)
317
What agents cause infection in the area which could then lead to epididymo-orchitis?
| Pathology
Children: Gram - rods, especially in cases with congenital abnormalities
Young adults (< 35): C. trachomatis & N. gonorrhea
Older adults (> 35): E. coli & Psuedomonas (UTI organisms)
318
How is epididymo-orchitis diagnosed?
| Pathology
Clinical diagnosis: urine analysis, urethral swab culture and sensitivity, NAAT for gonorrhea/chlamydia
319
What is NAAT, and why is it used to test for epididymo-orchitis?
| Pathology
Nucleic acid amplification testing, used as initial investigation for chlamydia and gonorrhea, possible cause in young adults
320
What is the management of epididymo-orchidism?
| Pathology
Antibiotics (based on common causes), NSAIDs, ice and scrotal elevation
321
What is testicular torsion?
| Pathology
Twisting of the spermatic cord --> thin wall veins become obstructed (while arteries are not) --> congestion and hemorrhagic infraction (EMERGENCY)
322
Why does testicular torsion present with HEMORRHAGIC infraction?
| Pathology
The blood entered the area but because of occlusion of the testicular vein it cannot be drained
323
Why is there venous obstruction in testicular torsion whilst the arteries are not yet occluded?
| Pathology
Veins are thin-walled and low-pressure vessels, making them more susceptible to compression when the spermatic cord twists.
324
What is the population target of testicular torsion?
| Pathology
In neonates --> happens in utero or after birth, no anatomical abnormalities
In adolescence --> due to bilateral anatomical abnormality, abnormally anchored in the scrotal sac, bell clapper abnormality)
325
What is a bell-clepper abnormality of the testes?
| Pathology
The orientation of the testis is completely horizontal opposed to normal where it should be slightly upwards
326
How does testicular torsion present?
When it usually occur?
| Pathology
Acute scrotal pain or pain localised to lower abdomen is also common, scrotal swelling, high riding testicle with negative cremasteric reflex
--> Commonly seen after trauma or physical exercise
327
What is high-riding testicle?
| Pathology
One of the two testicles is in place whilst the other one is lifted
328
How does the negative cremasteric reflex help with the diagnosis of testicular torsion?
| Pathology
Help differentiate between testicular torsion and epididymo-orchitis
329
What is the diagnosis of testicular torsion like?
| Pathology
Done clinically, but U.S can be used in indeterminate cases
330
What is the treatment for testicular torsion?
| Pathology
Orchiopexy --> detorsion and fixation of both testis before infraction, window of opportunity is 6 to 8 hours
331
In the case of infraction of the testis, in testicular torsion, what is the treatment?
| Pathology
Orchiectomy, removal of testes
332
What are the complications of testicular torsion?
| Pathology
Teesticular infraction,
Testicular comprtment syndrome (edema after repair),
Infertility (even if unilateral testis due to immunological exposure)
333
What is the gross appearance of testicular torsion?
| Pathology
Hemorrhagic necrosis
334
What is the microscopical apperance of testicular torsion?
| Pathology
Components of testes are not identfied because of necrosis
335
What is varicocele?
| Pathology
Dilated tortious vein (testicular vein) in the pampiniform plexus surrounding the spermatic cord of the scrotum due to impaired drainage
336
Which side is varcocele most likely to appear in, and why?
| Pathology
Usually left-sided because the left testicular vein drains into the left renal vein at 90o, whilst the right testicular drains directly to IVC at an obtuse angle, facilitating flow
337
What medical condition may vericocele be associated with?
| Pathology
Renal cell carcinoma, as it ofetn invades the renal vein
338
What are the clinical presentations of varicocele?
| Pathology
SCrotal swelling with fullness especially while standing, decsribed as a "bag of worms" appearance
339
What is the common population of vericocele? Why?
| Pathology
Infertile male, temperature change due to increased blood flow becuase of vein dilation
340
What is the treatment of vericocele?
| Pathology
Cna be srgically repaired, drainage, or laparoscopically
341
What is hydrocele?
| Pathology
Fluid collections within the parietal and visceral layers of tunica vaginalis
342
What are the different types of hydrocele?
| Pathology
Can be communicating or non-communicating
343
What is a communicating hydrocele?
| Pathology
Incomplete closure of the processus vaginalis --> communication with peritoneal cavity in infants
344
What is a non-communicating hydrocele?
| Pathology
Idiopathic or associated with cystitis that leads to lymphatics blockage in adults
345
How does hydrocele present?
| Pathology
Scrotal swelling that can be transilluminated
346
What is the treatment of hydrocele?
| Pathology
Surgical repair is inidcated for communicating hydroceles taht persist beyond one or two years of age and for idiopathic, noncommunicating, symptomatic hydroceles
347
What is Intratubular germ cell neoplasia?
| Pathology
Also known as germ cell neoplasia in situ, precuror of germ cell tumors, they have genetic alterations
347
348
Intratubular germ cell neoplasia is a precursor of germ cell tumors except of?
| Pathology
Yolk sac, teratoma and spermatocytic seminomas
349
When does intratubular germ cell neoplasia begin?
| Pathology
Usually in utero and stay dormant until puberty
350
What is the relation between intratubular germ cello neoplasia and germ cell tumors?
| Pathology
50% of patients with intratubular gern cell neoplasia will develop germ cell tumors within 5 years, practically all patients will develop invasive tumors
351
How is intratubular germ cell neoplasia diagnosed?
| Pathology
Usually incidental, in the case that one teste is affected, careful follow-up is required for the other one
352
Why is biopsy not done in the cases of testicular cancers?
| Pathology
In the case of tumors, the mass can desiminate and spread and metastasize
353
What is the morphology of intratubular germ cell neoplasia and germ cell neoplasia in situ?
| Pathology
Atypical large germ cells with large nuclei, clear cytoplasm & prominent dark nucleoli (fried egg apperance)
354
What is the traget population of testicular tumors?
| Pathology
90% of cases, diagnosis occurs between 25 to 45 years of age
355
How do testicular tumors present?
| Pathology
Painless firm testocular masses,
Swelling,
Sharp or dull pain in the testes and lower abdomen,
356
How are testicular tumors diagnosed?
| Pathology
Radical orchiectomy since bbiopsy cannot be done
357
What is the importance of tumor markers?
| Pathology
Diagnosis and monitoring
358
What are tumor markers of importance when it comes to testicular tumors?
| Pathology
hCG, a-fetoprotein, LDH
359
Which chromosomal abnormality is usually present in virtually all germ cell tumors?
| Pathology
Extra copies of short arm of chromosome 12, usually due to presence of an isochromosome 12
360
What is the metastasis of testicular tumors like?
| Pathology
Para-aortic lymph nodes
361
What is the prognosis of testicular tumors like?
| Pathology
Treatment prognosis is good
362
What are the risk factors of testicular tumors? (3)
| Pathology
1. Testicular dysegenesis syndrome
2. In utero exposure to environmental factors (pesticides, synthetic sex hormones in contaminated water and food)
3. Genetic mutations (Klinefelter syndrome)
363
What is the familiar predisposition of testicular tumors like?
| Pathology
Strong: 4x higher in father and sons of affected persons
8 to 10x higher in brothers
364
How do testicular tumors that secrete hCG present?
| Pathology
Gynecomastia
Testicular atrophy
Loss of libido
Erectile dysfunction
365
When do the complications of testicular tumors arise?
| Pathology
When malignant tumor invades nearby tissues (metastasis)
366
What are the complications of testicular tumors?
| Pathology
Lungs: dyspnea, cough, hemoptysis
Lower back pain: if it metastasizes to the retroperitoneal lymoh nodes
367
What are the classifications of testicular tumors?
| Pathology
1. Germ cell tumors (95%) --> usually malignant
2. Sex - cord / Stromal tumors --> usually benign
368
What are the categories of germ cell tumors?
| Pathology
1. Seminomatous
2. Non-seminomatous
369
What are examples of seminomatous germ cell tumors?
| Pathology
1. Classical seminoma
2. Spermatocytic seminoma
370
What are examples of non-seminomatous germ cell tumors?
| Pathology
1. Embryonal carcinoma
2. Yoc sac tumor
3. Choriocarcinoma
4. Teratoma
371
What are examples of sex-cord / stromal tumors?
| Pathology
Leydig cell tumors
Sertoli cell tumors
372
Which category of tumors is most common?
| Pathology
Germ cell tumors --> 10% of cancer deaths
373
What is the target population of germ cell tumors?
| Pathology
15 to 34 years of age
More common in whites than black individuals
374
What is the most common type of germ cell tumors
| Pathology
Seminoma --> 50% of germ cell tumors
375
What is the target population of seminoma germ cell tumors?
| Pathology
Peak in 3rd decade
376
What are the secretions of seminoma germ cell tumors like?
| Pathology
May secrete hCG (10% of cases) but MILD elevation
PLAP may be elevated
377
What is PLAP?
| Pathology
Placenta alkaline phosphotase
378
What are seminomas like?
| Pathology
Indolent (causing little to no pain) and likely to present with localised disease, metastasis is late
379
What is the prognosis of seminomas?
| Pathology
Highly responsive to radiotherapy, has excellent prognosis
380
What is the gross appearance of seminomas?
| Pathology
Bulky large tumot with homogenous lobulated surface, no hemorrhage and no necrosis (in rare cases: coagulative necrosis)
381
What is the microscopy of seminomas? (3)
| Pathology
1. Sheets of cells divided by delicate fibrous speta containing lymphocytes
2. Large & uniform cells with distinct cell borders, clear, glycogen-rich cytoplasm, round nuclei, and conspicuous nucleoli (fried egg)
3. Sometimes granulomas & syncytiotrophoblasts may be present
382
What are spermatocytic seminomas?
| Pathology
Differ from classic seminoma both clinically and histologically
Rare --> 1 to 2% of GCT
Slow growing, do not metastasize
383
What is the target population of spermatocytic seminomas?
| Pathology
Older age groups, > 65
384
What is the prognosis of spermatocytic seminomas like?
| Pathology
Excellent prognosis
385
What are examples of non-seminomatous germ cell tumors?
| Pathology
Embryonal carcinoma
Yolktumors sac
Choriocarcinomas
Teratoma
386
What are non-seminomatous germ cell tumors like in comparison to seminomatous?
| Pathology
More aggressive and spread earlier than seminomatous
Radioresistant
387
How do nonseminomatous tumors spread?
| Pathology
Both lymphatic and blood vessels spread
388
What is the age population of embyonal carcinomas?
| Pathology
20 to 30 years of age
389
How are embryonal carcinomas treated?
| Pathology
Radiotherapy is not effective and is treated with chemotherapy
390
What may embryonal carcinomas be associated with?
| Pathology
Germ cell tumor components such as yolk sac and choriocarcinoma
391
How do embryonal carcinomas metastasize?
| Pathology
Lymphatic and homogenou spread
392
What is the gross apperance of embryonal carcinomas?
| Pathology
Poorly demarcated margins, variegated with hemorrhage and necrosis
393
What is the microscopical appearance of embryonal carcinomas?
| Pathology
1. Sheets of highly aplastic, large tumor cells with basophilic cytoplasm
2. Indistinct cell borders and large vesicular nuceli, prominent nucleoli and atypical mitotic figures
3. May be arranged in glandular or papillary like structures
394
What is the most common testicular neoplasm in CHILDREN?
| Pathology
Yolk sac tumors --> Endodermal sinus tumor
395
How do yolk sac tumors present in adults?
| Pathology
No pure form in adults, component with other germinal cell tumors
396
What are the secretions of yolk sac tumors like?
| Pathology
May secrete AFP (used in diagnosis and monitoring)
397
What is the prognosis of yolk sac tumors?
| Pathology
Usually good prognosis
398
What is the gross appearnce of yolk sac tumors?
| Pathology
Large, well demarcated, homogenous, yellow-white
399
What is the microscopical appearance of yolk sac tumors?
| Pathology
Distinctive feature is the presence of structures resembling primitive glomeruli or endodermal sinus --> Schiller-Duvall bodies
400
What are choriocarcinomas like?
| Pathology
Highly malignant & most aggressive type from the germ cell tumors
401
What are the secretions of choriocarcinomas like? What are the effects?
| Pathology
Secrete hCG which can lead to gynecomatia and hyperthyroidism
402
Why can choriocarcinomas present with hyperthyroidism?
| Pathology
Secrete hCG which is of the same structural family as TSH
403
What are the presentations of choriocarcinomaS?
| Pathology
Small size mass & no testicular enlargment (only presents with a scar, the tumor has already regressed)
404
What is the metastasis of choriocarcinomas like?
| Pathology
Early metastasis via blood vessels --> lung, liver, GIT, brain, spleen and adrenals
405
What is the gross appearance of choriocarcinomas?
| Pathology
Commonly presents with hemorrhage and necrosis
406
What is the microscopical appearance of choriocarcinomas like?
| Pathology
Tumour composed of syncitrophoblasts and cytotrophoblasts but absent villi
407
What are teratomas like?
| Pathology
Composed of diferent types of cell or organ components, composed of mature cells from endodermal, mesodermal and ectodermal lines
408
What is the population of teratomas?
| Pathology
Pure form appears in children, second most common type, whilst mixed teratomas appear with other GCTs in adults
409
What are the secretions of teratomas like?
| Pathology
No elevation in tumor markers, if elevated it indicates coexistence with other germ cell tumors
410
What can the elements of teratomas be like?
| Pathology
Mature --> resembling various tissues in adults (teeth, hair etc.)
Immature --> sharing histologic features with fetal or embryonal tissues
411
What is the relation between age and the malignancy of teratomas?
| Pathology
Prepubertal males --> mature teratomas are benign, immature teratomas are malignant
Postpubertal males --> all teratomas are malignant, associated with germ cell neoplasia in situ and chromosomalo abnormalities
412
What is the gross appearance of teratomas?
| Pathology
Heterogenous, solid and cystic areas
Sometimes bone, cartilage, teeth might be present
413
What is the microscopical appearance of teratomas?
| Pathology
All three germ layers: ectoderm (skin, CNS in cases of mature teratomas), mesoderm (muscle, bone, CT, blood), and endoderm (internal organs) can be seen
414
Why are ultrasounds used in testicular tumors diagnosis?
| Pathology
To differentiate it from cysts and mark the size and border of the mass
415
Why is CT/MRI used in testicular tumor diagnosis?
| Pathology
Evidence of metastasis
416
Why are blood tests used in testicular tumor diagnosis?
| Pathology
Measure levels of tumor markers
417
What are testicular sex cord stromal tumors like?
| Pathology
They show differentiation towards Leydig cells, Sertoli cells, and/or other types of sex-cord stromal cells
418
What are other types of sex-cord stromal cells?
| Pathology
Granulosa cells
419
What are the types of testicular sex-cord stromal tumors?
| Pathology
Leydig cells
Sertoli cells
Other types of sex-cord stromal cells
420
What is the most common type of sex cord stromal tumor?
| Pathology
Leydig cell tumor
421
What is the age population of Leydig cell tumors?
| Pathology
Any age, mostly between 20 to 60
422
What are Leydig cell tumors like?
| Pathology
Usually benign, 20% are malignant
423
How do Leydig cell tumors present?
| Pathology
As testicular swelling
424
What are the secretions of Leydig cell tumors like?
| Pathology
May secrete hormones as androgens --> precocious puberty in children and gynecomastia in adults
425
What is the microscopical appearance of Leydig cell tumors?
| Pathology
Rod shaped pink cytoplasmic inclusion --> Crystalloids of Reinke
426
What age group is testicular lymphoma the most common type of testicular tumors in?
| Pathology
Males > 60
427
What are testicular lymphomas like?
| Pathology
1. Mostly part of disseminated disease
2. Sometimes present with only tesTes involvement --> mimics other tumors
428
What is the most common type of testicular lymphoma?
| Pathology
Diffuse large B-cell type is the most common
429
What is Condyloma Acuminatum?
| Pathology
Benign warty growth on genital skin
430
What is Condyloma acuminatum secondary to?
| Pathology
HPV type 6 or 11
431
What is the histology of condyloma acuminatum like?
| Pathology
Koilocytic changes
432
What are the risk factors of penile squamous cell carcinoma?
| Pathology
1. High riske HPV type (16 & 18)
2. Lack of circumcision & poor hygiene
3. Smoking
433
What are the precursors of penile squamous cell carcinoma in situ lesions?
What do they present as?
| Pathology
Bowen disease --> insitu carcinoma. presents as leukoplakia in shaft
Erythroplasia of Queyrat --> insitu carcinoma presents as erythroplakia in glans
