Gu Path - 1 - Testis

Front 1

Tunica vaginalis, Tunica Albuginea

Back 1

Viceral layer of the scrotum
Capsule of the testis

Front 2

The two compartments of the testis and the cells they contain ?

Back 2

The interstitium which contains leydig cells and the Seminiferous Tubules (Setu.) lined by sertoli cells

Front 3

Function of Leydig and Sertoli cells

Back 3

Leydig : secrete testosterone
Sertoli : Spermatogenesis

Front 4

Order of tubules in testes

Back 4

Setu – Tubuli recti – rete testis – mediastinum of testis – mediastinum of the testis – ductuli efferentes – epididymis and then vas deferns

Front 5

Cells involved in mulerian duct regression

Back 5

Sertoli cells, and they secrete mullerian duct inhibitory factor

Front 6

Fxn of testosterone by Leydig cells

Back 6

Leads to the development of the testicular ducts and is also converted to hihydrotestosterone which acts on the penis, scrotum

Front 7

Describe the process of Spermatogenesis

Back 7

Germ cells undergo maturation to become primary spermatocytes. Then they undergo meiosis to secondary spermatocytes. These then undergo a second meiotic division to become spermatids which mature while along the Sertoli cells and then are relased as mature spermatozoa

Front 8

Ratio of sperm : Spermatids
Germ cells to Sertoli

Back 8

2: 1
13:1

Front 9

While infertility can have many causes like abnormal testes , gonadotropin deficiency, abnormal sperm etc, what are normal, immature , maturation, hypospermatogenesis and germ cell aplasia

Back 9

b. Seen in hypopituitary state when testes are not exposed to LSH and FSH
c. Spermatogenesis does not progress beyond the primary spermatocyte
d. Maturations occurs but germ cells are few in number
e. End of hypospermatogenesis and is thought to be irreversible state of infertility

Front 10

Two examples of testicular dysgenesis

Back 10

Testicular Feminization – 46XY karyotype and is familial X-linked recessive. Failure of end organ response to testosterone. Geneticall ymale but phenotypically female ( pseudohermaphroditism)
Klinefelters syndrome – Male hypogonadism. Occurs when XXY happens. This is rarely diagnosed prior to puberty . The characteristic features are elongated body habitus and small atrophic testes. Lacks secondary male characteristics. FSH is increased, Serum testosterone is decreased and testis biopsy may show peritubular fibrosis and Leydig cell hyperplasia

Front 11

Cryptorochism (3)

Back 11

One or both testis fail to descend. Corrected by Orchiopexy. Complications of cryptorchism include infertility and increased risk of germ cell neoplasia

Front 12

Torsion of testis

Back 12

Inguinal defect (bell clapper anomality)
Occurs in 20s-30s
Can be corrected within 6 hrsortherwise hemorrhagic necrosis occurs when venous blood is obstructed and ischemic necrosis if arterial blood flow is.
Contralateral testis also is at a risk for this, so orchiplexy is performed

Front 13

Cause of acute epididymitis or orchitis

Back 13

A bacterial infection due to reflex from a urinary tract infection

Front 14

Mimps Orchitis -5

Back 14

Present in post pubertal boys who contract mumps
Affects 20% of overall boys
Painful, unilateral testicular swelling with edema
The inflammation is lymphoplasmacytic but can be suppurative
Can cause sterility in few cases

Front 15

Idiopathic granulomatous Orchitis – what do you have to rule out first ?

Back 15

Must r/o granulomas, sarcoidosis etc. Must also exclude seminoma because seminomas are associated with a marked granulomatous rxn

Front 16

Malakoplakia

Back 16

Granulamatous rxn seen in the bladder, prostate and epididymis/testis
Gross yellow nodule appearance with granulomatous rxn including intra and extra cellular Michaelis Gutman bodies

Front 17

Neoplasia – intratubular Germ cell neoplasia (ITGCN) – px ? found in ? not found in ?

Back 17

Proliferation of abnormal, neoplastic germ cells within semtub(in-situ tomor)
occurs in association with cryptorchidism, testicular dysgensis, infertility and germ cell tumors (ipsilateral 85%)
Not found in spermatocytic seminoma and teratomas in prepubertal boys

Front 18

Seminoma – Px, %, age, variants, PagF cells

Back 18

30% of all testicular germ cell tumors
most likely to exhibit a pure histologic, non-mixed patter
peak incidence in fourth decade
variants include classic and spermatocytic
seminomas may contain scattered placental like synchiotripblastic cells that stain for hCG

Front 19

Classic Seminoma – gross, micro

Back 19

Gross – homogenous, lobulated, gray white mass w/o hemorrhage or necrosis
Micro – largeu polyhedral tumor cells with ample clear cytoplasm, largue nuclei, prominent nucleoli, cytoplasm contains glycogen. Lymphocytic infiltrate is associated with this tumor in 80% of the cases. Granulomatous infiltrate in 20% of the cases

Front 20

Spermatocytic Seminoma

Back 20

Rare
Older men
No metastasis
Large mass
Tumor cells are pleomorphic
Smaller cells resemble secondary spermatogonia

Front 21

Embryonal carcinoma

Back 21

Peak incidence in 20-30 yr age group
Small poorly demarcated with foci of hemorrhage and necrosis (unlike seminomas)
may penetrate tunica into epididymis and cord

Front 22

Teratoma -%, mets

Back 22

4-9% of testis tumors
metastasize via lymphatics
metastasis may contain non-teratomous elements

Front 23

When are teratomas benign and when malignant

Back 23

These are benign prior to puberty and malignany after puberty

Front 24

What are the variants of teratomas ?

Back 24

Theyse show differentiation along endodermal, mesodermal and ectodermal lines and variants are mature teratoma, immature teratoma, teratoma with malignant transformation

Front 25

Most common testis tumor in infants and children. Marker?

Back 25

Yolk sac tumor – Pure in prepubertal setting but almost always mixed w. another cell type in adults. Tends to contain AFP

Front 26

Choriocarcinoma ? form ? expresses

Back 26

Tumor MUST contain both Synchiotrophoblasts and cytotrophoblasts elements
Rare in pure form in testis, and is usually mixed
Contains and expresses HCG

Front 27

Mixed germ cell tumors ? % and mets

Back 27

Make up approx 40% of testis tumors
Tend to occur around 30 years of age, metastasizes to lymphatics

Front 28

One of the most common forms of cancer in men between the ages of 15-34 but only account for 1% of cancer in men /

Back 28

GCT of the testis

Front 29

Risk of germ cell neoplasia in patients with undescended testes ?

Back 29

14%. Genetic influence is present

Front 30

GCT markers ?

Back 30

AFP, HCG – useful in diagnosis, staging and monitoring response to therapy

Front 31

Treatment of GCT ?

Back 31

Surgery, radiation or chemo depending on histology ( Seminoma vs non seminoma)

Front 32

Staging ?

Back 32

I – tumor confined to testis
II – metastases limited to retroperitoneal nodes below diaphragm
III – metastases outside the retroperitoneal nodes or above the diaphragm

Front 33

Which is more aggressive ?NSGCT or seminomas ?

Back 33

NSGCT – approx 70% of seminomas are clinical stage I, whereas approximately 60% of NSGCTs are clinical stage II or III. Even if primary mass in NSGCTs is small, the metastasis is large, especially choriocarcinomas

Front 34

Sex-cord Gonal Stromal Tumors – Leydig - %, age, secr, prepubertal, PagF, type ?

Back 34

2% of tumors
20s -60s commonly
Secretes androgens, or mixture of androgens, estrogens and other steroids
In prepubertal settings causes sexual precocity
Tumor cells contain crystals of Reinke
Benign

Front 35

Sertoli cell tumors – fxn, gross,micro,type

Back 35

May elaborate androgens or estrogens
Gross : homogenous gray white – yellow mass
Micro : tall columnar cells often forming cords which look like Semtubs
Mostly benign

Front 36

Testicular lymphoma - %, age, type of lymphoma, grade

Back 36

5%
Most common >60yrs old
Non Hodgkins lymphoma
High grade

Front 37

So there is a lymphoma in the testis, what is your first thought regarding the origin of the disease ?

Back 37

Well most lymphomas represent disseminated disease, but primary testis lymphomas can occur