Dd&t2 Testis Dz

Front 1

What changes occur in testicular atrophy?

Back 1

Seminiferous tubules affected
Leydig cells become more prominent

Front 2

What is it called when the testis is not in the scrotum?

Back 2

Cryptorchidism

Front 3

Cryptorchidism: most common location? clinical course?

Back 3

Inguinal ring, 25% bilateral

Most will descend by age 12 months

Front 4

Cryptorchidism: why is it bad? treatment?

Back 4

Impaired or lost fertility
Increased risk for testicular cancer

Orchiopexy by age 2 years

Front 5

Testicular torsion: 2 forms? not caused by?

Back 5

Neonatal and adult

Not caused by physical activity

Front 6

Testicular torsion: what is occluded? time line? treatment?

Back 6

Vein is occluded (thin wall), artery is not

Emergency: 6 hours within onset of pain - untwisted, will be okay

Bilateral orchiopexy (open the scrotum and reduce the twist)

Front 7

What infections are common under 35? over 35?

Back 7

C. trachomatis, N. gonorrhea

Gram negatives (UTI)

Front 8

What category do most testicular tumors fall in?

Back 8

Germ cell tumors, mostly malignant

Front 9

Sex cord/stromal tumors: describe

Back 9

Majority benign
Endocrine symptoms

Front 10

Germ cell tumors: peak ages? epi? location? race?

Back 10

15-35, second peak 0-4

Most common malignancy in this age group

Scandinavia>U.S.>Japan

Caucasian

Front 11

What are risk factors for testicular germ cell tumors?

Back 11

Cryptorchidism
Abnormal gonadal development (Klinefelter)
Family or personal history
Abnormalities of chromosome 12p

Front 12

Describe the clinical presentation of testicular germ cell tumors?

Back 12

Painless testicular mass
Persistent swelling/discomfort
Abdominal pain, back pain, dyspnea

Front 13

How are testicular germ cell tumors diagnosed?

Back 13

Ultrasound
Serum tumor markers (alpha fetoprotein, beta-HCG, LDH)

Do not biopsy! Just do a radical orchiectomy, not much of a differential diagnosis.

Front 14

What tumors come with no differentiation of neoplastic germ cell?

Back 14

Seminoma

Front 15

What tumors come with embryonic differentiation of a neoplastic germ cell?

Back 15

Embryonal CA
Teratoma

Front 16

What types of tumors come with extra-embryonic differentiation of neoplastic germ cells?

Back 16

Choriocarcinoma
Yolk sac tumor

Front 17

What are the most common germ cell tumors?

Back 17

1. Pure seminoma
2. Mixed germ cell tumors

Front 18

Seminoma: age? presentation?

Back 18

35-45 yo

70% with enlargement, some with pain

Front 19

Describe the gross pathology of a seminoma.

Back 19

No hemorrhage
No necrosis
Brown homogenous tumor mass

Front 20

Describe the microscopic pathology of a seminoma.

Back 20

Nests of spermatogonia with a lymphoid stroma.
PLAP and glycogen positive

Front 21

Seminoma vs. NSGCT (purity, necrosis, treatment)

Back 21

Seminoma: often pure, radiosensitive, no necrosis

NSGCT: not pure, not radiosensitive, necrosis

Both are chemosensitive

Front 22

Embryonal carcinoma: age? location? presentation? immunopositive?

Back 22

3rd decade
Mostly unilateral
1/3 present with metastasis
PLAP, Ki-1 (CD30), cytokeratin

Front 23

Immature teratoma: findings?

Back 23

Often mixed in with mature elements, all primitive layers are classified as IT

Front 24

Immature teratoma: progression? aka?

Back 24

Aggressive behavior

Carcinomatous elements may be present - teratocarcinoma

Front 25

Yolk sac tumor: AKA?

Back 25

Endodermal sinus tumor

Front 26

Yolk sac tumor: purity?

Back 26

Almost always in pure form in infants and children, adults <1% pure form

Front 27

Yolk sac tumor: lab findings?

Back 27

Elevated serum AFP
PAS and PAS-d positive hyaline globules
AFP-positive in cytoplasm

Front 28

What is the characteristic pathology finding of yolk sac tumor?

Back 28

Schiffer-duval body (central capillary with space around it)

Front 29

Choriocarcinoma: purity? progression? size?

Back 29

Extremely rare in pure form
Highly malignant with vascular invasion
Often small - don't have time to get big before they metastasize

Front 30

Choriocarcinoma: findings?

Back 30

Elevated serum beta-HCG
Hemorrhage and necrosis
Syncytiotrophoblasts wrap around aggregates of cytotrophoblasts

Front 31

LDH

Back 31

Nonspecific
Increased in NSGCT
Marker of necrosis

Front 32

Alpha-fetoprotein

Back 32

Typical of yolk sac
Increased in NSGCT

Front 33

Beta-HCG

Back 33

Typical of choriocarcinoma
Increased in NSGCT and seminoma with syncytiotrophoblast elements

Front 34

Carcinoembryonic antigen (CEA)

Back 34

May be elevated in teratoma

Front 35

What is the pattern of metastatic spread of testicular GCTs?

Back 35

Lymphatic: retroperitoneal nodes, mediastinal/supraclavicular (late)
Hematogenous: LUNGS, liver, brain, bone

Front 36

What 2 things determine the prognosis of testicular GCT?

Back 36

STAGE, histologic subtype

Front 37

Where do the R and L testes drain?

Back 37

L- renal vein
R - vena cava

Front 38

Describe the staging of testicular GCT.

Back 38

I: confined to testis
II: + retroperitoneal LN, subdivided by volume
III: distant mets or very high serum markers

Front 39

Adult GCT: most common? teratoma?

Back 39

Pure seminoma, mixed NSGCT

Malignant

Front 40

Child GCT: most common? teratoma? associations?

Back 40

Pure yolk sac tumor, pure teratoma

Depends on maturation
Mature: benign
Immature: malignant

Not associated with IGCN, cryptorchidism, or gonadal dysgenesis