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28 Cards in this Set
- Front
- Back
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testicular tumors are classified into two broad tumors. what are they and which of these is more common? which is more aggressive?
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1. germ cell tumor
2. sex-cord/stromal tumor germ cell tumors are more common (95% of testicular tumors) sex-cord tumors are more benign - germ cell tumors are more aggressive |
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cryptorchidism is a common congenital anomaly. where is the testes usually located? and what are two complications associated with cryptorchidism?
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95% inguinal
associated with sterility and testicular cancer (5-10 fold increase) |
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how is cryptorchidism treated?
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orchiepexy - surgical placement of testes in scrotum
may improve fertitility controversial effect on testicular tumor this procedure is preferably done <2 years |
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what is the bell clapper anomaly? what testicular condition is it associated with?
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the bell clapper's anomaly is a shortened connection of the testicles to the dorsal scrotal wall. it can cause testicular torsion
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what the different types of testicular germ cell tumors?
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seminomatous - pure seminoma, spermatocytic seminoma
non-seminomatous - choriocarcinoma, embryonal carcinoma, yolk sac tumor, teratoma |
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a man in his 30s presents with a bulky lobular testicular masses. they are well-circumscribed, tan, and fleshy. what does he have? what histologic features would you expect to find on microscopic examination?
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seminoma
histologically, it is characterized by "fried eggs" cells - large ovoid nuclei with prominent nucleoli and clear cytoplasm, there maybe setpta and lymphocytic infiltration |
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Schiller-Duval bodies are pathognomonic for this type of tumor. what is another histologic feature? what is a clinical feature?
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yolk sac tumor
histologic: lacelike/mycrocytic reticular pattern clinical: increase AFP |
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what is the gross pathological features of a yolk sac tumor in children and adults?
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children: well-circumscribed, tan, yellow, mucoid cut surface
adults: hemorrhagic foci and cystic degeneration |
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what is the most aggressive testicular tumor?
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choriocarcinoma
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what are some features of testicular choriocarcinoma?
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increase bHCG (which can lead to galactorrhea)
2 cell types - cytotrophoblasts & syncytiotrophoblasts (which secrete bHCG) |
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what are the GCT serum markers and what do they indicate?
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1. elevated AFP - yolk sac tumor
2. elevated bHCG - choriocarcinoma 3. PLAP (placental leukocyte alkaline phosphate) - good marker for GCT 4. LDH (lactate deH) - indicator of tumor burden |
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if you had to choose between a seminomatous tumor and a non-seminomatous tumor, which would you prefer? why?
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seminomatous because they are less agreessive. non-seminomatous tumors exhibit both hematogenous and lymphatic spread whereas seminomatous tumors exhibit lymphatic spread > hematogenous spread
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if you see hemorrhagic and necrotic features in a testicular tumor, what do you think of? describe its histologic features
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embryonal carcinoma - 3 forms (solid, papillary, glandular) with ugly cells (highly pleomorphic, hyperchromatic nuclei with multiple prominent nucleoli)
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another name for yolk sac tumors is ______
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endodermal sinus tumor
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what two hormones play a role in testosterone synthesis?
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HCG stimulates Leydig cells in the first 6-12 weeks of fetal development
in fetal month 3 until birth, LH stimulates Leydig cells to synthesize testosterone |
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3 key enzymes involved in testosterone formation are
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1. 17 alpha hydroxylase (pregnenolone --> 17 OH pregnenolone)
2. 5 alpha reductase ( T --> DHT) 3. aromatase (T --> E2) |
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what is a key intracellular molecule in the activation of steroidgenesis? what hormone activates this response?
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cAMP mediated response in response to LH activation
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T has direct and indirect (via conversion) effects on different tissues. discuss the forms of T and their effects.
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1. testosterone on muscles
2. conversion to DHT to act on genitalia, prostate, skin, hair follicles 3. conversion to E2 to act on CNS for negative feedback and libido and on bones (to close epiphysis) 4. conversion to androstenediol to act on kidneys and bone marrow to synthesize erythropoeitin |
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a male with hypogonadism is given T supplements. what are the observed hormonal changes and physiological changes?
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hormonal changes - increased free T, low FSH, low LH
physiological changes - decreased body mass with increased lean muscle mass, increase libido and positive mood |
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3 requirements of spermatogenesis are
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1. lots and lots of testosterone (100 times the plasma level)
2. cooler temp - 1-2 degrees centigrade cooler 3. oxygen |
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in response to ____, Sertoli cells make what products?
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in response to FSH, Sertoli cells make
1. androgen binding hormone 2. inhibin (only in the presence of sperm) 3. transferrin (to pull iron in to tubule) 4. proteoglycans (food) 5. estradiol |
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the blood-testis barrier protects sperm - what cells make up the blood-testis barrier?
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sertoli cells
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how long does spermatogenesis take?
what are the cells called? |
74.5 days
stem cells --> spermatogonia --> spermatocytes --> spermatids |
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semen analysis - what are the normal values?
volume count motility normal forms Kruger forms WBC |
volume: 2-5 mL
count:>20 million (avg: 60 million) motility: >50% normal forms: >70% Kruger forms: >4% WBC: <1 million |
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what are some key clinical findings of Kallman's syndrome?
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hypogonadotropic hypogonadism
- low FSH, low LH, low T - almost prepubertal genitalia |
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what are some key clinical findings of Klinefelter's syndrome?
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- high FSH, LH, PRL
- low T - small firm testes - +/- gynecomastia - abdominal fat distribution - karyotype: 47XXY |
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what are some testosterone treatment options? are there any special concerns with them?
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1. injectible testosterone enanthate (every 2-4 wks)
2. transdermal patch (replace daily) 3. transdermal cream (apply daily) 4. oral methyl testosterone (***goes to liver --> hepatotoxicity) |
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a man comes to you for treatment of his infertility. upon questioning, you find out that he is a bodybuilder who takes steroids and likes to relax by soaking in hot tubs. what do you tell him?
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intratesticular temperature over 100 degrees F decreases mature sperm (OLIGOSPERMIA) and the use of steroids (excess androgens) leads to suppression of gonadotropins, leading to ASPERMIA
tell him to lay off the juice and relax in a cooler environment. sperm cycles are 74.5 days - it may come back then. |
