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Testes Pathology
Tes
20
Chemical Engineering
Undergraduate 3
03/18/2011

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Term
Hydrocele?
Definition
Hydrocele referred to as fluid accumulation in the tunica vaginalis
Term
Two layers of testes?
Definition
Two layers: mesothelial lined capsule forms tunica albuginea and outer loose peritoneal sac forms tunica vaginalis
Term
What connects Seminiferous tubules to epididymis and what's the function of Epid?
Definition
Rete testis and efferent ductules connect seminiferous tubules to epididymis - where sperm acquire motility.
Term
QUIZ: sertoli only syndrome
Definition
Germ cell aplasia (e.g. gonadatrophin deficiency, QUIZ: cryptorchidism, estrogen therapy, and chemotherapy), very important for path to dx, ONLY SERTOLI CELLS! NO GERM CELLS! Common cause is cryptorchidism
Term
maturation arrest
Definition
Maturation arrest-maturation to a certain point in spermatogenesis beyond which no more advanced elements are identified-Nonspecific etiology, only see primary spermatogonia
Term
signs of hypospermatogenesis?
Definition
Hypospermatogenesis-altered hormonal states, heat, varicocele (tortuous veins)! or nonspecific, reduced # of Sperm cells
Term
causes of the very common epididymitis?
Definition
Chlamydia trachomatis , Neisseria gonorrhoeae most common
Term
post-pubertal Mumps can result in what condition?
Definition
Orchitis: also caused by Bacterial: E.Coli, Klebsiella, staphylococcus, streptococci, Pseudomonas, Salmonella
Mycobacteria: Usually involves epididymis first, granulomatous caseous inflammation
Fungal: Histoplasmosis-granulomatous inflammation
Viral: Rare, mumps orchitis mainly historical
Term
What's more common testicular tumors or epididymal tumors?
Definition
TESTICULAR tumors! they are 95% germ cell tumors that are aggressive but curable! mostly in 15-34 yo and caucasians.
Term
cryptorchidism is a risk factor for what?
Definition
Testicular Carcinoma
Risk factors:

Cryptorchidism
Incomplete descent of testis
10% of testicular tumors (GCT)
higher the location of undesc testis ( intra abd vs. inguinal)descent, the greater the risk of developing cancer

Testicular Dysgenesis
Testicular feminization
Klinefelters syndrome (47,XXY)
Genetic
Rare in Africans and Black Americans
Familial clustering – 10% siblings risk
Term
GCTs vs. nonGCTs?
Definition
Germ cell tumors (GCT)
Common (95%)
Typically malignant

Non-Germ Cell Tumors - BENIGN
Rare (5%)
Typically benign
Sex Cord Stromal tumors
Sertoli cell tumors
Leydig cell tumors
Lymphoma and Leukemia
Term
Examples of GCTs
Definition
Seminoma

Embryonal carcinoma

Yolk sac tumor

Choriocarcinoma

Teratomas

Mixed germ cell tumor
Term
Of the GCTs what's unique about seminomas?
Definition
Seminoma – most likely to produce uniform population of cells
the others are most commonly a mixture....
but all arise from intratubular germ cell neoplasia (ITGCN)
Term
QUIZ: Characteristics of seminoma?
Definition
Most common (50%)
Homogeneous fleshy, gray white tumor
Peak incidence 3rd to 4th decade
Typically presents as a pure tumor in adults
Extremely sensitive to radiotherapy
Term
Embryonal Carcinoma
Definition
Age range: 20-30 yrs ,
10 yrs < than seminoma
Variegated growth with areas of hemorrhage and necrosis
A component of 87% of mixed germ cell tumors (pure in 2%)
More aggressive than seminoma
Sensitive to chemotherapy
Term
QUIZ: Yolk sac tumor characteristics
Definition
Most common testicular tumor in children up to 3 years
Good prognosis
Elevated AFP in 95% tumors
Rare as a pure tumor in adults; frequently occurs in combination with embryonal carcinoma
Schiller- duval body
Term
Teratoma common in? second to _____ in common....
Definition
Large, heterogenous tumors with solid, crtilagenous and cystic aresa


Pure forms common in infants and children, second only to yolk sac tumor
Rare as pure tumor in adults (2-3%)
Found in 45% of mixed germ cell tumor
Frequently cystic
Term
Px with postpubertal teratoma comes to you...Benign or malignant?
Definition
Postpubertal teratomas are regarded as malignant and has potential to metastasize
Term
QUIZ: Mixed GCTs...
Definition
Composed of more than one type of GCT
Metastasis can be composed of any of the elements, even those not present in the original tumor

70-90% of all non-seminomatous GCTs
Term
QUIZ: AFP, bHCG, LDH (GCT polypeptide hormones) indicate what?
bHCG and AFP elevations combined are what? and what do they suggest?
Definition
GCTs may secrete polypeptide hormones and enzymes that can be detected in serum
AFP : yolk sac tumor
Beta HCG: choriocarcinoma
LDH: not specific, assess tumor burden

Combined elevated serum beta-HCG andAFP strongly suggest NSGT-regardless of histology

Helpful in determining stage, tumor burden and monitoring response to therapy, and recurrence.
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