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Testis & Epididymis

Undescended testes ? * Cryptorchidism ...... * Can be Complete – positioned in abdomen or Incomplete – positioned in inguinal canal ....... * Leydig cells are spared.... * Predisposes to testicular Cancer and Sterility
Primary hypogonadism ? * Klinefelter Syndrome (XXY) ..... * usually a couple coming in bc can not get pregnant... * due to male is sterile, tall, slender, lower mental status, and presents with gyno...... * Small testicles and leydig cells are spared again
Epididymitis basics ? * Commonly related to infections in urinary tract (urethritis, cystitis and prostatitis).... * see purulent material and lots of Polys in cross section
Two disease that cause Epididymitis that arise in the epididymis and may extend to the testis ? * Gono and TB
Tuberculous Epididymitis ? * seen in those who have had or currently have TB.... * confluent caseating granulomas in micro.... * also see Sperm extravasation due to traumatic rupture of epididymal ducts (sperm is where it should not be)
Orchitis ? (a type of inflammation) * can be due to Mumps or Syphilis..... * Usually secondary to hematogenous spread of pathogens
Mumps Orchitis stain and what we see ? * Styner stain- spiorchetes .... (looks like a dark yellow stain with brown branching organisms on it)
Syphilis Orchitis and what we see ? * Testis is involved first and then may spread to epididymis (Gono. and TB are oppisite)..... * see gumma formation, infiltrates, and lots of Plasma cells
Torsion ? * twisting of the spermatic cord cutting off the venous drainage of the testis..... * Arterial supply remain intact, and continues to cause the venous engorgement/mass..... * Is a medical EMERGENCY!-- Need fixed within 6 hrs of onset
Lesions of the Tunica Vaginalis ? * All Transilluminate ......* Hydrocele - accumulation of serous fluid in scrotal sac.....* Hematocele - bd in between tunica vaginalis layers..... *Chylocele - from lymph in T.Vaginalis layers (from microfilaria – bd parasites, cause lymph obstruction)
Small cystic accumulation of semen in dilated efferent ducts in the epididymis or ducts of the rete testis ? * Spermatocele - usu asymptomatic (also a tunica vaginalis issue)
Dilation of testicular veins, in which the testes feels like a "Bag of Worms" ? * Varicocele (is a tunica vaginalis issue too)
Lipomas of testes basics ? * 100% benign (never do a testicular biopsy) and seen in the spermatic cord
Adenomatoid Tumor of testes basics ? * Benign and mesothelial in origin... * also seen the spermatic cord
Malignant spermatic cord tumors we see in adults and kids ? * Kids = Rhabdomyocarcoma ....... * Adults = Liposarcomas
Testicular Tumors - Overview ? * Germ Cell tumors are 95% of testicular tumors .... * higher incidence in white males... * need aggressive surgery and radiation
Germ Cell Tumors - Pathogenesis ? * Testicular Dysgenesis Syndrome (TDS) - triad of Cryptorchidism, hypospadias, poor sperm quality..... * Klinefelter Syndrome (mediastinal germ cell tumors – not testicular)
Germ Cell Tumor family patho ? * genetic polymorphism at Xq27 and higher in first degree relatives
Germ Cell Tumor Morphology ? * factors OCT3/4 & NANOG
Intratubular germ cell neoplasia (ITGCN) ? * usually a precursor and seen before the germ cell malignancy ..... * ITGCN develop invasive germ cell tumors within 5 years of diagnosis
Seminoma basics ? * (pic looks like two extra fatty testicles-Know for test)........ * 50% of testicular tumors.... * Gray/White lobulated surface...* IHC – c-KIT+; OCT4+; PLAP+, and PAS+ (bc stains gylcogen).... * Good surgery and radiation outcome if not mixed
Spermatocytic Seminoma ? * Very Rare ...... * usu in men over 65..... * NO association with ITGCN ...... * soft pale, mucoid cyst in testicle
Embryonal Carcinoma ? * 20-30 year old group; more aggressive than seminomas ..... * IHC – OCT3/4+, PLAP+, and c-Kit - ..... * hemorrhage and necrosis ( see bloody/red testicle and slide of RBCs in slide )
Yolk Sac Tumor ? * Endodermal sinus tumor- most common testicular tumor in infants and children up to 3 years....* Prog. is good in kids and not so good if adults have this .....* see Schiller-Duval bodies that look like immature glomeruli.... * + for a-fetoprotein (AFP)
Choriocarcinoma ? * highly malignant.... * see a mix of syncytiotrophoblasts and cytotrophoblasts.... * if HCG+ in syncytiotrophoblasts = worse prognosis ( look at pics )
Teratoma ? * Contains all 3 germ layers .... * Teratomas can be benign, but if seen in the testes, it is considered MALIGNANT.... * not uncommon to see hair or teeth is these
Germ Cell Tumors - Clinical ? * All solid painless enlargements of the testis should be considered neoplastic..... * Lymph Node Spread: : retroperitoneal para-aortic nodes first
Radiosensitive tumor = ? * Seminomas are, NSGCT are not
Tumor that has worst prognosis, and tumor contents ? * Pure Choriocarcinomas have worst prognosis .... * Most tumors are of Mixed origin
Tumors of Sex Cord-Gonadal Stroma -- Leydig Cell Tumor ? * CxSx: 6 yr old going through puberty, or guy develops gyno and testicular swelling...... * Buzz Words are: and rod-shaped crystalloids of Reinke (looks like 3 rods that make a Z)
Tumors of Sex Cord-Gonadal Stroma -- Sertoli Cell Tumors ? * 90+% are benign
Tumors of Sex Cord-Gonadal Stroma -- Testicular Lymphoma ? * most common testicular neoplasm in men over age 60..... * most with disseminated disease – already see in nodes.... NHL type is most common..... * Higher incidence of CNS involvement and Prognosis poor due to stage at diagnosis
Created by: thamrick800