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65 Cards in this Set
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- Back
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Torsion limited to pain palpated on the superior pole of the testis
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Appendix of Epi
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Where does the left spermatic/testis vein drain into?
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L Renal Vein (MC side of varicocele due to > pressure)
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Where does the right spermatic/testis vein drain into?
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IVC
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Phase 1 of testicular descent is controlled by what?
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Mullerian-inhibiting substance (descends to lower abdomen/pelvic brim)
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Inguinoscrotal Phase of testicular descent
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2 (1 is transabdominal)
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Path of Phase 2 of testicular descent
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Through inguinal canal into scrotum
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Phase 2 of testicular descent is dependent upon what?
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Androgens
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Cryptorchid testis is common in what pt population?
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Premature (<2500 gm) infants
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MC location of cryptorchid testis
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High in scrotum
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Cryptorchid testis may predispose one to what?
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Infertility and germ cell tumors
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Levels of testosterone in Cryptorchid testis?
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Normal (Leydig cells are unaffected by temp)
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Describe the histologic changes of a cryptorchid testis
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Germ cell arrest, BM thickening/hyalinaztion, < germ cells in contralteral testis
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What stimulates Leydig cells to produce testosterone?
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LH
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What do Leydig cells produce?
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Testosterone
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What is the fxn of Sertoli cells and what stimulates them?
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support spermatogenesis, stimulated by FSH
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Accounts for 10-20% of testicular bx in infertile males. (What accounts for 40% of infertility?)
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"sertoli only (germ cell aplasia) syndrome"; idiopathic in 40% of cases
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Def of oligospermia
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2-20,000,000/mL
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MC site of obstruction causing oligospermia NOT associated with a vasectomy
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50% in epi due to prior infection
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MCC of bacterial Epidiymo-orchitis in men 40+; in Men < 35?
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BPH or UTI bugs (e-Coli, Klebsiella, Psudomonas in 40+) and STIs in men < 35 (N. gonorheae, Chlamydia, Mycoplasma, Treponema Pallidum which is more likely to go to the testis than the others)
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When do you see mumps associated orchitis?
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post-pubertal
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Caeseating Granuloma, think what?
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TB or Fungal Infection
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Noncaeseating Granuloma, think what?
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Sarcoidosis
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Torsion is MC in arteries or veins?
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Venous
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MC time period to experience a torsion?
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prepubertal (rare in neonates and adults) and often due to abnormal anatomy
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Dilation of veins within pampiniform plexus
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Varicocele
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Bag of worms
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Varicocele
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2 categories of Testicular Germ Cell Tumors
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Seminoma or Non-Seminomatous
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Non-Seminomatous types of Germ Cell Tumor
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Teratoma,Yolk Sac, Embryonal Carcinoma, Choriocarcinoma
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MC solid tuomor in men 15-34
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Germ Cell Tumor
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What race are Germ Cell Tumors highest?
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Whites
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Most Germ Cell tumors are in the testis, but where are the other rare locations?
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Mediastinal or brain, bur rare!
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Differential for a testicular mass that does NOT illuminate
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Cancer
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MC testicular tumor
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Seminoma
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Peak age of Seminoma
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30s
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Best prognosis of all germ cell tumors
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Seminoma (also MC!)
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Painless, homogenous testicular enlargement with a "fried egg" appearance on histology; "fish flesh" and +/- bands of fibrosis
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Seminoma
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Syncytotrophoblasts that produce HcG
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Embryonal Carcinoma
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Age group of Embryonal Carcinoma
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20-30, rare before puberty or after 50
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Pure form is rare, often mixed with other tumors
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Emryonal Carcinoma
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Schiller-Duval bodies
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Yolk Sac Tumor (resemble primiative glomeruli)
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MC testicular tumor in infants/kids < 3, in pure form
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Yolk Sac
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Alpha-FP
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Yolk Sac marker
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Testicular tumor in very young, think what?
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Yolk Sac or Teratoma (Yolk Sac more common)
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Yellow, mucinous Germ Cell Tumor
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Yolk Sac
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Marker for Choriocarcinoma
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BetaHCG
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Distant mets almost universal at time of dx (often to brain); germ cell tumor
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Choriocarcinoma
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Germ cell tumor that may produce gynecomastia
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Choriocarcinoma as hCG is an LH analog
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Never benign in adult males, but often benign in kids
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Teratoma
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What age group is is more common to see a Pure Teratoma?
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infancy/childhood (Rare to see pure form in adults)
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MC type of cancer to follow hematogenous spread
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Choriocarcinoma
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Spread of Seminoma (type)
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Lymphatic
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What nodes are most likely to receive a lymphatic spread of a germ cell tumor?
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Retroperitoneal para-aortic nodes
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Stage 1 of testicular cancer
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Local spread (confined to testis)
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Stage 2 of testicular cancer
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local lymph nodes (by pelvis)
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Stage 3 of testicular cancer
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Parenchymal mets or nodes beyond the pelivs/retroperitoneal
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AFP is > in what two tumors?
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Yolk Sac and Hepatocellular carcinoma
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HCG is > in what two tumors?
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choriocarcinoma or syncitiotrophoblast (15% of seminoma)
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Tx of Stage 1 Seminoma
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Orchiectomy with WW
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Tx of Stage 2 Seminoma (nodes)
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orchiectomy and pelvic/panaortic LN XRT OR orchiectomy and Cisplatin (chemo); note NO RPLND
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Tx of NSGCT
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Chemo after orchiectomy and possible RPLND (Retroperitoneal Lymph Node Dissection)
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Sertoli cell tumor is often associated with what physical presentation?
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gynecomastia
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Leydig cell tumor is associated with what physical presentation in adults?
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gynecomastia; precocious puberty in boys
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Contains Reinke crystals; usually androgen producing
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Leydig Cell Tumor
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MC testicular cancer in older men
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Testicular lymphoma
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Bc testicular lymphoma is not a primary cancer, where are the MC sites of origin?
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Lung and prostate
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