DT4- Exam I- Sigdel 🌴 🌴

Phimosis

narrowing of the opening of the prepuce over the glans penis Congenital or infection acquired. Can predispose to infection.

Seminoma morph KF

Large cells, (three sizes. Small lymphocytes, intermediate normal cells, and large tumor cells.). Thin septa, Sparse lymphocytes.

Leydig cell tumor KF. Histo. Classic pt.

Patient with gynecomastia, high androgens. Micro shows Crystalloids of Reinke******

AFP

Yolk sauce tumor

Cryptorchidism

undescended testicles Reduce sperm count and increase risk of germinal cell tumors. Surgery delayed till after first year.

Seminoma KF*/ Serum markers*** Age***

50% of all germ cell tumors 30 YO **** most common PLAP- Placenta a8 Phosphatease. **** this is marker associated with seminoma.

Teratoma Benign or malignant?

in females it is BENIGN In MALES it is MALIGNANT. AFP, B-HCG

Congenital defect in torsion

Failure of testes to attach to inner lining of scrotu,m

Peyronie's disease.

Fibrous thickening of connective tissue in penis. Curvature in direction of fibrosis.

Adenomatoid tumor

*** benign, no need for orchiectomy

Intratubular germ cell neoplasia KF** Genetics**

********* Atypical germ cells Think of this as CIS- This is the precursor that will most likely lead to invasive tumors. Isochromosome 12p.**

Yolk sac tumor KF. What does it look like on cell?

AFP***. ****SCHILLER DUVAL BODIES. Classic appearance.

Two germ cell tumor markers. What are they usually associated with.

AFP**- Yolk sac tumors. HCG- **CHORIOcarcinomas. Makes sense because placenta release hCG.

Bowen disease refers to condition characterized by..

Carcinoma in situ/

Leukoplakia on shaft of penis

Bowen's disease. HPV. Carcinoma insitu of shaft or scrotum INVASIVE. This precursor lesion to Squamous cell carcinoma.

Embryonal carcinomas KF** Marker***

CD30 positive.**** More aggressive than seminoma s.

Agents of orchitis.

Chlamydia and Gonorrhea- Libido NOT affected because leydig are spared. Teens E. coli and pseudomonas- Older adults after UTI. Mumps virus- Teen males- can risk fertility. Autoimmune orchitis- Granulomas- NON necrotizing.

HCG-

Choriocarcinoma.

Dude has positive pregnancy test.

Choriocarcinoma. HCG positive.

Benign neoplasms of the penis.

Condyloma accuminatum- HPV related (low risk) Giant condyloma- Large cauliflower like, and MULTIPLE.., Low ris HPV>

What test for torsion.

Cremasteric reflex. - If cremasteric tissue is dead due to infarction, it cannot respond.

Main testicular tumors of interest

Germ cell tumors.

Two causes of testicular inflammation. Where?

Gonnorrhea, Classically in epidydimis, abscess formation . Mumps- Can result in atrophy. Syphillis.

Testicular torsion can cause.

Hemorrhagic infarct.

Choriocarcinoma can present with )(KF). Why?

Hyperthyroidism- Because Syncytiotrophoblasts release B-hCG which can activate TSH, or can activate FSH and LH receptors leadings to GYnecomastia.

Two types of urethral malformatio

Hypospadias- Abnormal opening on ventral aspect of penis. Epispadias- Dorsal aspect of the penis Malformations of urethral groove and canal.

Age and testicular tumors **KF

If you see a testicular tumor in a man >60 yo, you should assume LYMPHOMA. Large B-cell type lymphoma

Erythroplasia of queyrat

In situ carcinoma of glans. Erythroplakia. Not white like the shaft. Precursor to squamous cell carcinoma.

Cryptorchidism Morphology

Increased Hyaline tissue, fibrosis, decreased leydig and germ cells and TUbular atrophy. C

Balanoposthitis. Most likely organism

Infection of glans or prepuce. Candida is most common.

Genetics in nearly all testicular tumors.

Isochromosome 12p. Found in nearly all tumors.

Bowen's disease Invasion? KF**

Lesion on skin shaft, plaque like, potential for malignant transformation. This is a CIS- Carcinoma in situ. NO invasion of BM. *** have potential for malignant transformation. Elderly individuals.

Benign testicular tumors

Leydig and Sertoli cell tumors are benign. GERM cell tumors are usually MALIGNANT.

Tumor that produces androgen. What will show clinically in different age groups

Leydig cell tumor produces excess androgen. Young men- Precocious puberty. Older men- Gynecomastia. (Converted to estrone in peripheral adipose tissue)

Male sex cord stroma tumors

Leydig cell tumors. Reinke Crystals. Sertoli cell tumors- Clinically silent.

This disorder is associated with Chlamydia in the penis. What zeroth-especially involved?

Lymphogranuloma Venereum. Necrotizing granulomatous inflammation of Inguinal lymphatics and nodes. L1-L3 are the Chlamydia stereotypes. Perinatal involvement can lead to Rectal constricture.

MOst germ cell tumors are.

MIXED. Prognosis is based on the WORST component of that mix (Choriocarcinoma is worst)

Bowenoid papulosis Vs Bowen Morph Invasion?

Multiple pigmente papules on penis. HISTO= IDENTICAL to Bowens. Usually does NOT progress to invasive carcinoma. ***

Biopsy of testes?

NEVER> you can seed tumor cells into scrotum Also, 95% plus teste tumors are GERM CELL tumors which means they are MALIGNANT. Assume malignancy.

Tiny mass found in teste, LARGE mass found elsewhere in the body.

Normally you can assume th larger mass is primary CHORIOCARCINOMA- not the case. This is because this tumor will seed the blood VERY EARLY ON in its existence.

SCC of penis. Classic clinical Preventative?

Older individual, uncircumcised.***** Classic picture. Slow growing, verrucous growth. Prevent- circumcision, VACCINATION** HPV6,11,16,18.

Classic clinical presentation fo testicular cancer.

PAINLESS testicular mass.

Seminoma KF-*

PLAP + 30-40 yo.

Bowenoid papulosis

Reddish papules on shaft. called bowenoid because it doesn't INVADE like Bowen's disease.

Condyloma ccuminatum morpoh

Remember this is HPV related which means koilocytes**** will show up. Raisinoid, wrinkled nucleus.

Most common malignancy of penis KF*

SSC. Usually associated with HPV 16!!***

Seminoma vs non-seminoma in appearance.

Seminoma- Homogenous mass with NO HEMORRHAGE or NECROSIS. Non-Seminoma- Hemorrhagic mass with necrosis.

Two classes of germ cells and their sub classes.

Seminomatous tumores- Seminoma, spermatocytic seminoma. Non-seminomatous tumors- embryonal carcinoma, yolk sac, chroiocarcinoma, teratoma.

65 yo +

Spermatocytic seminoma

Penis is lined with

Squamous epithelium. if there's a penile cancer, you know its squamous cell carcinoma.

LDH

Tumor burden/volume marker.

How does torsion occur/

Veins are thin, arteries thick. Blood flows in, but if twisted, blood can't flow out.

Types of germ cell tumors.

seminoma and non-seminoma Non-seminoma have poorer prognosis,. Higher stage.

Most common testicular tumor in children. Marker Histo Similar to __ in females.

yolk sac tumor(endodermal sinus) AFP should be elevated. Histo- shows Schiller-Duvall bodies- Glomerulus-like structure. (Same as in ovary).