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57 Cards in this Set

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What are the three major phases in the development of the testes?
1. Static phase
2. Growth from age 4 - 10
3. Maturation
Testes: describe the static phase
From birth to age 4.
Seminiferous tubules are full of compact, undifferentiated cuboidal cells
Leydig cells appear, disappear, only to reappear later.
Testes: describe the phase of growth between ages 4 and 10
Barely perceptible growth. Increased tortuosity of seminiferous tubules and lumen formation.
Testes: describe the maturation phase
Active spermatogenesis following puberty.

Emergence of leydig cells in the interstitium.
Testes: average size
3.0 x 3.0 cm in size
Name the stages of spermatogenesis
1. Spermatogonia: along the basement membrane, round and dense nuclei with nucleoli -->

2. Spermatocytes: more centrally located, larger than spermatogonia, granular chromatin -->

3. Spermatids: Near the lumen, small cells with darkly stained chromatin -->

4. Spermatozoa: elongated eccentric nucleus with cytoplasmic tail.
In normal testes, where are the leydig cells located?
In the interstitium.
What are the three layers that make up the capsule of the normal testis?
From deep --> superficial

1. Tunica vasculosa
2. Tunica albuginea
3. Tunica vaginalis (visceral)
4. Tunica vaginalis (parietal)
5. Fascia layer
6. Dartos muscle
7. Skin
Describe the three layers that make up the capsule of the normal testis
Tunica vasculosa: loose vascular connective tissue

Tunica albuginosa: a layer of collagen fiber

Tunica vaginalis: a layer of mesothelialous tissue.
Cryptorchidism: definition
Failure of testes to descend.
Cryptorchidism: Incidence
4% at birth, but most descend in the first year of life

<0.4% prevalence in adults
Cryptorchidism: bilateral? unilateral?
Usually unilateral with a slight predeliction to involve the right testis.
Cryptorchidism: congenital?
Usually not. Usually an isolated anomaly.
Cryptorchidism: pathology
If not surgically corrected before puberty, can cause infertility.
Cryptorchidism: increased risk of what?
10 -15x Increased risk of developing germ cell tumors in untreated cryptorchidism.
Cryptorchidism: treatment
Orchiopexy (surgical repositioning of the testes) before age 2.
Torsion of the testes: clinical presentation
Severe scrotal pain followed by swelling.
Torsion of the testes: risk factors
Often associated with congenital abnormalities that cause increased mobility of the testis and epididymis:

1. High attachment of the tunica vaginalis on the spermatic cord.

2. Incomplete descent of the testis.

3. Absence of the scrotal ligaments
Torsion of the testes: if left untreated?
Hemorrhagic infarction --> small, fibrotic testis
Orchitis: mainly caused by infections traveling through what?
Through the blood to the testes.
Epididymitis: mainly caused by infections traveling through what?
Through the spermatic ductal system.
General Classifications of Orchidoepidiymitis
I. Nonspecific Orchioepididymitis
II. Idiopathic Granulmatous Orchitis
III. Specific Inflammation
- TB
- Syphilis
- Mumps
Nonspecific Orchidoepididymitis: most common source
The urinary tract (cystitis, urethritis, and prostatitis)

Reach the epididymis via the vas deferens or the lymphatics of the spermatic cord
Nonspecific Orchidoepididymitis: basic etiology?
Infectious! Not that nonspecific granulomatous prostatitis is NOT associated with inflammation.
Nonspecific Orchidoepididymitis: offending agent in patients < 35 years old
Chlamydia trachomatis (most common)

Neisseria gonorrhoeae (< 5%)
Nonspecific Orchidoepididymitis: offending agent in patients > 35 years old
E. coli, Pseudomonas, Staphylococci, Streptococci
Nonspecific Orchidoepididymitis: offending agent in children?
Congential genitourinary abnormality.
Nonspecific Orchidoepididymitis: clinical findings
Fever, pain
Tenderness of unilaterally swollen testis
Bacterial infection: pyuria
Nonspecific Orchidoepididymitis: what do you use to confirm diagnosis?
Urine culture.
Nonspecific Orchidoepididymitis: acute microscopic findings
A diffuse infiltrate of neutrophils involving both the interstitium and the tubules.

See interstitial edema and abscess formation.
Nonspecific Orchidoepididymitis: chronic microscopic findings
A diffuse infiltrate of lymphocytes, eosinophils, and plasma cells involving both the interstitium and the tubules.

See fibrosis (if extensive enough, can cause sterility)
Idiopathic Granulomatous Orchitis: etiology
Unknown, but trauma, infection, extravasated sperm, autoimmune diseases may be pathological mechanisms.
Idiopathic Granulomatous Orchitis: what parts are involved?
The epididymis and the tunics may be simultaneously involved.
Idiopathic Granulomatous Orchitis: clinical presentation
Middle-aged men
Unilateral testicular enlargement.
May be accompanied by pain and tenderness.
Idiopathic Granulomatous Orchitis: gross
Moderately enlarged with homogenous cut curface and gray-tan areas of obscuring testicular architecture.
Idiopathic Granulomatous Orchitis: microscopic findings
"granulomas with rupture bubbles and nests of spermatozoa, no necrosis"

Gram stain for bacteria = neg
AFB for mycobacteria = neg
GMS for fungus = neg
Tuberculous orchidoepididymitis: most common etiology/pathogenesis?
Renal TB --> prostatic TB --> tuberculous orchidoepididymitis
Tuberculous orchidoepididymitis: most common etiology/pathogenesis in children?
Through the bloodstream.
Tuberculous orchidoepididymitis: primary site of disease
The epididymis is the primary site of disease, the testis is usually unaffected until later stages of disease.
Tuberculous orchidoepididymitis: bilateral involvement?
In 30% of cases.
Tuberculous orchidoepididymitis: formation of abscesses?
In 50% of cases
Tuberculous orchidoepididymitis: other bugs
Atypical mycobacteria (such as M. avium)
Tuberculous orchidoepididymitis: gross
Nodules with central caseating necrosis
Tuberculous orchidoepididymitis: microscopic findings
Granulomas with caseating necrosis

AFB for mycobacteria = pos
GMS for fungus = neg
Syphilitic orchidoepididymitis: what structure is involved first?
The testis (in congenital syphilis and in tertiary syphilis)
Syphilitic orchidoepididymitis: clincal presentation of testes
Bilateral
Painless testicular enlargement
Syphilitic orchidoepididymitis: classic macrofinding in tertiary syphilis?
Gummas (a soft, non cancerous growth. A form of granuloma).

A circumscribed zone of necrosis surrounded by a fibrous capsule.
Syphilitic orchidoepididymitis: microscopic findings?
- Interstitial inflammation composed of plasma cells and lymphocytes.
- Fibrosis
- Endothetial cell proliferation with endarteritis
Syphilitic orchidoepididymitis: what stain do you use to visualize spirochetes in the "gumatous stage"?
Warthin-Starry stain.
Mumps orchidoepididymitis: caused by what virus?
Paramyxovirus
Mumps orchidoepididymitis: testicular involvement.
Uncommon in children
Complicates 20-30% of adult mumps cases.
Mumps orchidoepididymitis: progression leading up to presentation?
Testicular swelling and pain within 1 week of onset of parotiditis
Mumps orchidoepididymitis: bilateral?
Most commonly unilateral, bilateral in 25%
Mumps orchidoepididymitis: epididymal involvement?
High 85%
Mumps orchidoepididymitis: what percentage of patients will become sterile?
Low percentage (< 2%)
Mumps orchidoepididymitis: gross (early stage vs. late stage)
Early stage: enlarged testis with edema and congestion

Late stage: atrophy
Mumps orchidoepididymitis: microscopic findings
- Multifocal acute and chronic inflammation
- Early stage: interstitial edema
- Late stage: tubular atrophy