ERGU: Male Reproductive Pathology

What is a hydrocele?

A hydrocele is an accumulation of fluid in the tunica vaginalis, producing a small, fluid-filled sac attached to the testicle.

What is the most aggressive non-germ cell tumor?

A pure choriocarcinoma is the most aggressive non-germ cell tumor. It may not cause any testicular enlargement, but instead spreads predominantly and rapidly by the bloodstream. Therefore, lungs and liver are involved early in virtually every case.

What is the most common malignant testicular tumor in adults?

A seminoma is the most common malignant testicular tumor in adults, accounting for about 50% of all cases of testicular germ cell tumors.

What is the most common type of testicular tumor?

Germ cell tumors are the most common type of testicular tumor (>90%).

How do germ cell tumors besides a seminoma present metastatically?

Germ cell tumors besides seminomas present with advanced clinical disease (> 60%).

What is the most common location of the undescended testis in cryptorchidism?

The inguinal canal is the most common location of the undescended testis in cryptorchidism. Arrest within the abdomen is uncommon, accounting for approximately 5% to 10% of cases.

What is the nutcracker effect?

The nutcracker effect is compression of the left renal vein between the aorta and SMA.

What is the pathognomonic finding of a yolk sac tumor?

The pathognomonic finding of a yolk sac tumor is a Schiller-Duval body.

What is the scrotal ligament?

The scrotal ligament is a ligament that secures the testis to the scrotum to limit the movement of the testes in the scrotum. If the ligament is abnormal, it can lead to testicular torsion, as it allows the testes to twist.

What is the spermatic cord?

The spermatic cord is a structure that carries arteries, veins, and the ductus deferens that forms at the deep inguinal ring, travels through the inguinal canal, and enters the scrotum through the superficial inguinal ring to end at the testes.

True or False: Even though testicular descent is controlled by hormonal factors, cryptorchidism is only rarely associated with a well-defined hormonal disorder.

True

(1) more often cause inflammation to the testis.

Tuberculosis

Most Sertoli cell tumors are (malignancy).

benign * About 10% are malignant.

The prognosis of a spermatocytic seminoma is _______.

excellent

The prognosis of a yolk sac tumor is _______.

good

Non-germ cell tumors spread _______.

hematogenously

Spermatocytic seminomas peak in the (age).

sixth decade

How does a Schiller-Duval body present?

A Schiller-Duval body is a lace like papillary or cord-like pattern of cuboidal/elongated cells cells have bland nuclei 50% of tumors have Schiller-Duval bodies (central capillary and visceral and parietal layer of cells resembling primitive glomeruli).

How does a Sertoli cell tumor present?

A Sertoli cell tumor presents hormonally silent with a testicular mass.

What is an adenomatoid tumor?

An adenomatoid tumor is the most common benign paratesticular tumor that presents as small nodules that occur near the upper pole of the epididymis.

What is the most common benign paratesticular tumor?

An adenomatoid tumor is the most common benign paratesticular tumor.

How does a Sertoli cell tumor present histologically?

Histologically, Sertoli cell tumors present with cells that are arranged in distinctive trabeculae that tend to form cordlike structures and tubules.

Klinefelter syndrome is associated with a greatly increased risk for the development of ___________________.

mediastinal germ cell tumors NOT testicular tumors

An embryonal carcinoma is ________ aggressive and lethal than a seminoma.

more

A varicocele is associated with ________.

renal cell carcinoma * due to renal vein invasion

Testicular torsion typically occurs after ________.

strenuous exercise

Cryptorchidism is associated with an increased risk of _______.

testicular dysfunction

Classical seminomas peak in the (age).

third decade

Mumps orchitis is generally (lateral).

unilateral

Testicular tumors are most common in (ethnicity).

whites

What is a choriocarcinoma?

A choriocarcinoma is a highly malignant tumor that presents as small, testicular nodules that originate from the proliferation of trophoblast cells.

What is a lipoma?

A lipoma is a benign fatty tumor of the inguinal canal that represents retroperitoneal adipose tissue that has been pulled into the inguinal canal along with a hernia sac.

What is the most common type of testicular germ cell tumor with one pattern (50%)?

A seminoma is the most common type of testicular germ cell tumor with one pattern (50%).

What is a sex cord stromal tumor?

A sex cord stromal tumor is a neoplasm containing epithelial elements of sex cord origin (Sertoli and granulosa cells) admixed with elements of mesenchymal origin (Leydig and theca-lutein cells) in varying combinations and degrees of differentiation.

What is a spermatocele?

A spermatocele is a large epididymal cyst usually found at the head of the epididymis.

How is a spermatocele diagnosed?

A spermatocele is diagnosed with US (black circle on top of the testis).

What is a varicocele?

A varicocele is a dilation of the pampiniform plexus of spermatic veins caused by the obstruction of outflow of the venous blood.

How is a varicocele diagnosed?

A varicocele is diagnosed via US.

What is a yolk sac tumor?

A yolk sac tumor is considered a unilaterally developed teratoma mimicking embryonal yolk sac tissue.

What is the most common germ cell tumor in infants?

A yolk sac tumor is the most common germ cell tumor in infants.

What is the most common malignant testicular tumor in prepubertal children?

A yolk sac tumor is the most common malignant testicular tumor in prepubertal children.

What is cryptorchidism?

Cryptorchidism is a complete or partial undescended testicle/testes found in the abdomen or inguinal canal that can be unilateral (most cases) or bilateral (25%). Histological changes in the malpositioned testis can occur by two years of age.

How does a Leydig cell tumor present grossly?

Grossly, a Leydig cell tumor presents with circumscribed nodules, usually less than 5 cm in diameter. They have a distinctive golden brown, homogeneous cut surface.

How does a Sertoli cell tumor present grossly?

Grossly, a Sertoli cell tumor presents are firm, small nodules with a homogeneous gray-white to yellow cut surface.

How does a choriocarcinoma present grossly?

Grossly, a choriocarcinoma is a small tumor with hemorrhage and necrosis.

Testicular dysgenesis syndrome is associated with _________.

in utero exposures to pesticides and nonsteroidal estrogen

How are germ cell tumors treated? (3)

1. Radical Orchiectomy 2. Radiation: Classic seminomas are treated with radiation to the retroperitoneal and ipsilateral nodes. 3. Chemotherapy: Chemotherapy is used for advanced disease or relapse after radiation.

Familial germ cells tumors are linked to genes encoding (2).

1. KIT. 2. BAK.

What are the two major categories of testicular tumors?

1. Germ Cell Tumors: Most germ cell tumors are aggressive cancers capable of rapid, wide dissemination, although with current therapy, most can be cured. 2. Sex Cord-Stromal Tumors: Sex cord stromal tumors are generally benign.

(2) more often cause inflammation to the testis.

1. Gonorrhea 2. Syphilis

Seminomas stain positive for (3).

1. KIT. 2. OCT4. 3. placental alkaline phosphatase (PLAP).

What are the three types of well-differentiated sex cord stromal tumors?

1. Leydig Cell Tumors 2. Sertoli Cell Tumors 3. Granulosa Cell Tumors

Symptoms of a Varicocele (2)

1. Scrotal Pain and Swelling: The dilated nest of veins feels like a "bag of worms." 2. Swelling increases with Valsalva or standing. Both of these maneuvers increase intra-abdominal pressure, which blocks the outflow of venous drainage from the testicle to lead to more swelling.

What are the two major categories of testicular germ cell tumors?

1. Seminomas 2. Non-Seminomas

How is cryptorchidism treated? (2)

1. The testes may descend on their own by six months of age. 2. If the testes do not descend, then an orchiopexy is used prior to two years of age. An orchiopexy does not guarantee fertility. Deficient spermatogenesis has been reported in 10% to 60% of patients in whom surgical repositioning was performed. It is also unclear if the risk of cancer is reduced.

What are the two morphological and hormonally distinct phases of testicular descent?

1. Transabdominal Phase: In the transabdominal phase, the testis lies in the lower abdomen or the brim of the pelvis. This phase is controlled by mullerian inhibiting factor. 2. Inguinoscrotal Phase: In the inguinoscrotal phase, the testes descend through the inguinal canal into the scrotal sac. This phase is androgen-dependent and is possibly mediated by androgen-induced release of calcitonin gene-related peptide from the genitofemoral nerve.

Epididymitis is commonly related to (2).

1. UTI. Bacteria reach the epididymitis and the testis either through the vas deferens of the lymphatics of the spermatic cord. 2. STI.

How is syphilis diagnosed? (4)

1. VDRL: VDRL is non-specific. 2. fluorescent treponemal ab absorption test (FTA-Abs). 3. microhemagglutination assay for T. Pallidum antibodies (MHATP). 4. FTA-antibodies and MHATP). These antibodies form after 4-6 to weeks indefinitely even after tx.

How is a varicocele treated? (2)

1. Varicocelectomy: The dilated and abnormal veins are isolated and redirected into normal veins. 2. Embolization: Embolization is an interventional radiology procedure in which a catheter is inserted into dilated or abnormal veins, and a coil or sclerosant is used to clot off the veins. As a result, blood flows through normal venous structures.

What are the three types of sex cord stromal tumors?

1. Well-Differentiated Forms 2. Mixed Forms 3. Incompletely Differentiated Forms

Causes of testicular atrophy include: (10).

1. a decrease in blood supply. 2. cryptorchidism. 3. hypopituitarism. 4. malnutrition/cachexia. 5. end-stage of inflammatory orchitis. 6. semen outflow obstruction. 7. radiation. 8. prolonged administration of female sex hormones. 9. exhaustion atrophy (increased FSH). 10. genetic (Klinefelter's syndrome).

Risk factors for developing a germ cell tumor include (3).

1. cryptorchidism. 2. genetic factors. Strong familial predisposition is associated with the development of testicular germ cell tumors. The relative risk of these tumors is 4-times higher than normal in fathers and sons of affected patients and 8- to 10-times higher in brothers. 3. testicular dysgenesis.

The value of biological markers include (3).

1. diagnosis. 2. staging. 3. monitoring response to therapy.

The three cell populations of a spermatocytic seminoma include: (3).

1. medium-sized cells. This is the most numerous cell type containing a round nucleus and eosinophilic cytoplasm. The chromatin in some intermediate-sized cells is similar to that seen in the meiotic phase of nonneoplastic spermatocytes (spireme chromatin). 2. smaller cells with a narrow rim of eosinophilic cytoplasm resembling secondary spermatocytes. 3. scattered giant cells, either uninucleate or multinucleate, with round, oval, or indented nuclei with a typical spiremelike lacy chromatin distribution.

Other tumors arising from the testes include: (3).

1. tumors arising from mesothelium (tunica albuginea) (i.e. malignant mesothelioma). 2. tumors arising from adipose tissue that extends/connected with retroperitoneal space. 3. tumors arising from smooth muscle.

What is a spermatocytic seminoma?

A spermatocytic seminoma is a rare, slow-growing germ cell tumor predominantly affecting older men. Because it is a slow-growing tumor, it does not produce metastases.

How does testicular torsion present grossly?

Grossly, testicular torsion presents with hemorrhagic testicles.

How does an embryonal carcinoma present histologically?

Histologically, an embryonal carcinoma presents with variably, including as sheets fo blue cells forming tubules, sheets of undifferentiated cells, and as well as primitive glandular differentiation. The nuclei are large and hyperchromatic. The neoplastic cells have an epithelial appearance, are large and anaplastic, and have hyperchromatic nuclei with prominent nucleoli. The cell borders are usually indistinct, and there is considerable variation in cell and nuclear size and shape. Mitotic figures and tumor giant cells are frequently seen.

How does an intratubular germ cell neoplasia (ITGCN) present histologically?

Histologically, an intratubular germ cell neoplasia (ITGCN) presents with atypical primordial germ cells with large nuclei and clear cytoplasm, which are about twice the size of normal germ cells.

How does cryptorchidism present histologically?

Histologically, cryptorchidism is characterized by arrested germ cell development associated with marked hyalinization and thickening of the basement membrane of the spermatic tubules. The tubules show Sertoli cells, but no spermatogenesis. There is an increase in the number of interstitial Leydig cells. Similar histologic changes may also be seen in the contralateral testis in males with unilateral cryptorchidism, suggesting that cryptorchidism is a marker of some intrinsic defect in testicular development or function.

How does mumps orchitis present histologically?

Histologically, mumps orchitis presents with normal spermatogenesis in the seminiferous tubules, but lymphocytic inflammation is present.

How does syphilitic orchitis present histologically?

Histologically, syphilitic orchitis presents with gummas, obliterative arteritis, reactive swollen endothelial cells, plasma cells, and fibrosis.

How does testicular atrophy present histologically?

Histologically, testicular atrophy presents with hyalinized seminiferous tubules and fibrosis.

How does tuberculous orchitis present histologically?

Histologically, tuberculous orchitis presents with granulomatous inflammation.

How do classical seminomas present?

Classical seminomas presents as a painless mass in the testis with the potential of metastasis at diagnosis (30%).

A spermatocytic seminoma is not related to _______.

ITGCN

Most testicular germ cell tumors, with the exception of (3), originate from a precursor lesions called __________

yolk sac tumors, teratomas, and adult spermatocytic seminomas; intratubular germ cell neoplasia (ITGCN) * ITGCN is believed to arise in utero and stay dormant until puberty, after which it may progress to seminoma or nonseminomatous tumors.

Testicular tumors are most commonly seen in (demographic).

young men

Metastases from seminomas involve ______.

lymph nodes * Hematogenous spread occurs later in the disease course.

Tumor markers of a yolk sac tumor include (2).

1. AFP. 2. alpha-1 antitrypsin.

Symptoms of Spermatocele (2)

1. Asymptomatic (usually) 2. Mass: Spermatoceles are often detected on physical exam as a mass on top of the testicle separate from the testis.

Most testicular tumors are (benign/malignant).

malignant

Types of Orchitis (4)

1. Bacterial Orchitis 2. Syphilitic Orchitis 3. Mumps Orchitis 4. Granulomatous Orchitis

Leydig cell tumors produce (3).

1. androgens. 2. estrogens. 3. corticosteroids.

How do Leydig cell tumors present?

As with other testicular tumors, the most common presenting feature of a Leydig cell tumor is testicular swelling, but in some patients, gynecomastia may be the first symptom. In children, hormonal effects, manifested primarily as sexual precocity, are the dominant features.

What is the histogenesis of a germ cell tumor?

Germ cells can either develop into a seminoma via primary spermatocytes or totipotential stem cells, which can then give rise to an embryonal carcinoma, teratoma, choriocarcinoma, or a yolk sac tumor.

What is the most common type of orchitis?

Gram negative bacterial orchitis is the most common and is often secondary to UTI.

Condyloma acuminatum is associated with ________.

HPV 6 (mostly) and 11

How does a Leydig cell tumor present histologically?

Histologically, a Leydig cell tumor presents with sheets of cells that are large in size and have round or polygonal cell outlines, abundant granular eosinophilic cytoplasm, and a round central nucleus. The cytoplasm frequently contains lipid droplets, vacuoles, or lipofuscin pigment, and, most characteristically, rod-shaped crystalloids of Reinke, which are seen in about 25% of the tumors.

How does a mature teratoma present histologically?

Histologically, a mature teratoma presents with differentiated cells or organoid structures, including cartilage, nerve, and various differentiated epithelium.

What is the pathophysiology of testicular torsion?

In testicular torsion, the spermatic cord is twisted, leading to compression of the thin-walled venous outflow of the testes. However, there is continued outflow through the testicular arteries because the artery is thick walled. This leads to testicular engorgement, forming hemorrhagic infarction.

__________ is a second malignancy that is common after a testicular tumor.

Leukemia (30%)

How do seminomas present metastatically?

Metastatically, seminomas remain localized to the testis for a long time, and hence, approximately 70% present in clinical stage I.

Which testicular tumor has the best prognosis?

Seminomas are radiosensitive, which means that they have the best prognosis.

How is an embryonal carcinoma treated?

Since most patients with an embryonal carcinoma present with metastasis, most patients are treated with chemotherapy, which has a 95 to 98% cure rate.

How is syphilis visualized?

Syphilis is visualized with the Warthin Starry stain early in the disease process.

What is testicular torsion?

Testicular torsion is the rotation of the testicle in the scrotum, which twists the spermatic cord. Because the spermatic cord carries blood vessels, this can lead to vascular compromise of the blood vessels traveling to and from the testicles.

How is testicular torsion treated? (3)

Testicular torsion is treated with urgent surgery via (3): 1. detorsion (manually or surgically). 2. orchiopexy (fixation of the testicle). 3. testicle removal if nonviable. The contralateral testis must also be treated.

What is the adult form of testicular torsion?

The adult form of testicular torsion is a form seen in boys caused by an anatomic defect due to a lack of attachment of the testicle to scrotum. The most common defect is known as the bell clapper deformity, where the tunica vaginalis covers the spermatic cord so the testes cannot attach to the wall of the scrotum. This leads to increased mobility of the testicle in the scrotum.

What is the neonatal form of testicular torsion?

The neonatal form of testicular torsion is a rare form that occurs in the first 30 days after birth in which the testes is not yet attached to the scrotum.

True or False: Testicular tumor metastases can show a different microscopic pattern than a primary tumor.

True

How is the newborn form of hydrocele treated?

Usually, the newborn form of hydrocele resolves spontaneously by one year of age, as the processus vaginalis close.

Germ cell tumors, besides seminomas, are treated with ________.

aggressive chemotherapy

Almost all sex cord stromal tumors are immunoreactive for _______________ with the exception of (3).

alpha inhibin; fibromas, myxomas, and sclerosing stromal tumors

Hematocele

an accumulation of blood located between the visceral and parietal layers of the tunica vaginalis

Infertility may indicate __________ in men.

an occult varicocele

Most Leydig cell tumors are (malignancy).

benign * However, approximately 10% of the tumors in adults are invasive and produce metastases.

Tuberculous orchitis begins in the _______.

epididymis

Inflammation is most commonly seen in the (epididymis/testis) rather than the (epididymis/testis).

epididymis ; testis

In children, mature teratomas have a _______ prognosis.

good; Prognosis is questionable in adults.

A seminoma may present with an ill-defined ________ reaction.

granulomatous

The tumor marker for choriocarcinoma is _____.

hCG

A potential tumor marker for a classical seminoma is ______.

hCG * About 15% of seminomas contain syncytiotrophoblasts.

Testicular torsion leads to __________ infarction.

hemorrhagic

What are the two types of teratoma?

1. Mature Teratoma 2. Immature Teratoma

What are the two forms of testicular torsion?

1. Neonatal Form (Rare) 2. Adult Form

What are the two forms of a hydrocele?

1. Newborn Form 2. Adult Form

Symptoms of Testicular Torsion (2)

1. Painful Swollen Testicle: This is due to hemorrhagic infarction, and the testicle is swollen with blood that cannot exit the scrotum because of vascular compromise. 2. Absent Cremaster Reflex

Symptoms of Testicular Tumors (2)

1. Painless Mass 2. Scrotal Heaviness

Symptoms of a Hydrocele

1. Scrotal Swelling 2. Transillumination with Light

An adenomatoid tumor stains positive for (3).

1. calretinin. 2. D2-40. 3. WT1.

In sexually active men < 35 years, epididymitis is associated with (2).

1. chlamydia. 2. gonorrhea.

Testicular dysgenesis syndrome includes (3).

1. cryptorchidism. 2. hypospadias. 3. poor sperm quality.

Varicoceles are more common on the ________ side. Why?

left; The left spermatic vein drains to the left renal vein, which then crosses the midline to drain into the IVC. As a result, there is a longer course that venous blood must travel from the left testicle than the right testicle to reach the IVC, as the right spermatic vein drains into the IVC.

Gonorrhea can spread to the epididymis via the ____________ and cause (2).

posterior urethra to the prostate and seminal vesicles; abscesses and/or suppurative orchitis

Mumps orchitis is commonly seen in (demographic).

postpubertal males (30%) * Testicular involvement is uncommon in school aged children.

Tuberculous orchitis often has a ____________ present.

primary lung focus

A varicocele on the right side can indicate _______.

renal cell carcinoma

The most common malignant paratesticular tumor in children is a _________.

rhabdomyosarcoma

Mumps most commonly affects (demographic).

school-aged children

Symptoms of Cryptorchidism (3)

1. Asymptomatic: Cryptorchidism is completely asymptomatic and discovered when the scrotal sac is noted to be empty. 2. Inguinal Hernia: A concomitant inguinal hernia accompanies the undescended testis in about 10% to 20% of cases. In the inguinal canal, the testis is prone to trauma and crushing injuries. 3. Testicular Cancer: Cryptorchidism increases the risk of testicular cancer. It is at a greater risk of developing testicular cancer than the descended testis.

An adenomatoid tumor stains negative for (2).

1. CEA. 2. Factor VIII.

What are the two types of seminoma?

1. Classical Seminoma 2. Spermatocytic Seminoma

In men > 35 years, epididymitis is associated with (2).

1. E. coli. 2. Pseudomonas.

In children, epididymitis is associated with (2).

1. GU abnormality. 2. Gram negative UTI.

What are the four cellular growth patterns seen in an embryonal carcinoma?

1. Glandular 2. Alveolar 3. Tubular 4. Solid These tumors have variable histological patterns.

Mixed germ cell tumors include: (8).

1. embryonal carcinoma and mature teratoma.* 2. yolk sac tumor and mature or immature teratoma. 3. seminoma and teratoma. 4. seminoma and embryonal carcinoma.* 5. choriocarcinoma and embryonal carcinoma. 6. choriocarcinoma and teratoma. 7. choriocarcinoma and seminoma. 8. teratoma, embryonal carcinoma, and seminoma.* * most common

Three major causes of scrotal inflammatory include (3).

1. gonorrhea. 2. syphilis. 3. tuberculosis.

Causes of the adult form of hydrocele include: (4).

1. idiopathic. 2. infection. 3. torsion. 4. trauma.

Predisposing factors to testicular torsion include: (5).

1. incomplete testicular descent. 2. absence of scrotal ligaments on the gubernaculum testis. 3. testicular atrophy. 4. abnormal attachment of the testis to the epididymis. 5. other abnormalities.

Classical seminomas express (chromosome/markers).

1. isochromosome 12p. 2. OCT3/4. 3. NANOG. 4. KIT (25%).

Complications of cryptorchidism include: (4)

1. low sperm counts. When the testes are in the inguinal canal or abdomen, the temperature of the testicle is higher than normal, and higher temperatures decrease sperm production. 2. increased risk of germ cell tumors, especially seminomas. 3. inguinal hernias. This can lead to abnormalities of the spermatic cord and inguinal canal, increasing the risk of inguinal hernias. 4. testicular torsion.

Hematogenously, testicular tumors spread to the (4).

1. lungs. 2. liver. 3. brain. 4. bones.

Testicular tumors spread (2).

1. lymphatically. 2. hematogenously.

Tumors with one histological type include: (6).

1. seminoma. 2. spermatocytic seminoma. 3. embryonal carcinoma. 4. yolk sac tumor (adult and childhood types). 5. teratoma (mature and immature and with overtly malignant component). 6. choriocarcinoma.

What is the adult form of a hydrocele?

During development, the testes descends into the abdomen, pulling an outpouching of the peritoneum called the processus vaginalis. The outpouching eventually obliterates, producing a covering over the testicle called the tunica vaginalis. So, the adult form of hydrocele involves a closed off tunica vaginalis, producing a non-communicating hydrocele. This type is often idiopathic, but may occur secondary to infection, torsion, and trauma.

What is the newborn form of a hydrocele?

During development, the testes descends into the abdomen, pulling an outpouching of the peritoneum called the processus vaginalis. The outpouching eventually obliterates, producing a covering over the testicle called the tunica vaginalis. So, the newborn form of hydrocele is caused by an incomplete closure of the processus vaginalis, forming a "communicating hydrocele" because the scrotum communicates with the abdomen. Peritoneal fluid can collect in the tunica vaginalis.

How does a seminoma present grossly?

Grossly, a seminoma presents as a fairly well-circumscribed, pale, fleshy, homogeneous mass. Seminomas produce bulky masses, sometimes ten times the size of the normal testis. It has a homogeneous, gray-white, lobulated cut surface, usually devoid of hemorrhage or necrosis. Generally, the tunica albuginea is not penetrated, but occasionally, there is extension to the epididymis, spermatic cord, or scrotal sac.

How does a spermatocytic seminoma present grossly?

Grossly, a spermatocytic seminoma presents with a soft, pale gray, cut surface that sometimes reveal mucoid cysts. Most tumors are confined to the testis with few showing invasion or penetration of the tunica.

How does a teratoma present grossly?

Grossly, a teratoma presents as a large, multinodular, heterogeneous structure including solid, cartilaginous, and cystic components.

How does a yolk sac tumor present grossly?

Grossly, a yolk sac tumor is a nonencapsulated, homogenous, yellow-white, mucinous, soft, multicystic tumor with hemorrhage and necrosis in adult cases.

How does an adenomatoid tumor present grossly?

Grossly, an adenomatoid tumor presents as a well-circumscribed firm, grayish-white paratesticular tumor.

How does an embryonal carcinoma present grossly?

Grossly, an embryonal carcinoma presents with gray/white bulging necrosis and hemorrhage. On cut surfaces, the tumor is often variegated, poorly demarcated at the margins, and punctuated by foci of hemorrhage or necrosis.

How does gonorrheal epididymitis present grossly?

Grossly, gonorrheal epididymitis presents with abscess formation.

How does a choriocarcinoma present histologically?

Histologically, a choriocarcinoma presents with trophoblastic cell proliferation. Syncytiotrophoblasts are large multinucleated cells with abundant eosinophilic vacuolated cytoplasm containing hCG, which is readily detected by immunohistochemistry. Cytotrophoblasts (arrow) are more regular and tend to be polygonal, with distinct borders and clear cytoplasm. They grow in cords or masses and have a single, fairly uniform nucleus.

How does a seminoma present histologically?

Histologically, a seminoma presents with sheets of large round and polyhedral uniform cells with distinct cell borders, pale nuclei, and prominent nucleoli divided into poorly demarcated lobules by delicate fibrous septa containing a lymphocytic infiltrate. The cytoplasm of these cells contain varying amounts of glycogen.

How does a spermatocytic seminoma present histologically?

Histologically, a spermatocytic seminoma presents with minimal to no lymphocytic infiltrate or granulomatous reaction. Unlike a classic seminoma, collagenous septation is not observed. Three cell populations are observed. In contrast to typical seminomas, spermatocytic seminomas lack lymphocytes, granulomas, syncytiotrophoblasts, extra-testicular sites of origin, admixture with other germ cell tumors, and association with ITGCN.

How does an adenomatoid tumor present histologically?

Histologically, an adenomatoid tumor presents with minimal invasiveness into the adjacent testis. The cellular proliferation ranges from cuboidal to flattened cells that form solid cords with an epithelial appearance and channels having dilated lumina, simulating vascular structures. The stroma has abundant smooth m and elastic fibers.

How does an immature teratoma present histologically?

Histologically, an immature teratoma have foci resembling embryonic or fetal structures, usually without cytologic atypia. This includes primitive neuroectoderm, poorly formed cartilage, neuroblasts, loose mesenchyme, and primitive glandular structures.

What is a complication of mumps in the genitourinary system?

Mumps can lead to orchitis is approximately 20% of male patients. Usually, orchitis develops about one weeks following swelling of the parotid glands. Unilateral testicular enlargement with patchy, inflammatory interstitium is seen in 70% of patients.

What is the most common form of orchitis caused by a virus?

Mumps orchitis is the most common form of orchitis caused by a virus.

What is the most common testicular tumor in men older than 60 years?

Non-Hodgkin lymphoma is the most common testicular tumor in men older than 60 years.

The most common malignant paratesticular tumor in adults is a _________.

liposarcoma

Embryonal carcinoma is seen in patients aged _____.

20 to 30 years

Leydig cell tumors are common seen in (demographic).

20 to 60 year olds

The adult form of testicular torsion is seen in ______.

boys 12 to 18 years * These boys are entering puberty, and the testes are growing in size. This can allow for torsion.

A hydrocele is associated with ______.

indirect inguinal hernia

If left untreated, testicular torsion can lead to ________.

infertility

A varicocele can cause ________ due to ________.

infertility; the venous backflow increasing the temperature of the scrotum, causing decreased sperm production, and decreasing blood flow, causing decreased sperm production

Lymphatically, testicular tumors spread to the ________.

para-aortic lymph nodes