Untitled Quiz

Pathology of the Testis

• Inflammation of the epididymis (epididymitis) can be caused by specific infections like gonorrhea, mumps, and tuberculosis, or non-specific infections secondary to bacterial urinary tract infections (UTIs).
• Inflammation of the testis (orchitis) can also be caused by specific or non-specific infections.

Testicular Tumors

• Testicular tumors are generally painless masses affecting around 5 out of every 100,000 males, commonly occurring between ages 15-35.
• There are two main types: germ cell tumors (95%) and sex cord-stromal tumors (5%).
• Germ cell tumors can be further classified into seminomas and non-seminomatous germ cell tumors (NSGCTs).

Germ Cell Tumors

• Germ cell tumors constitute 95% of testicular neoplasms and account for 10% of cancer deaths in young adults.
• Risk factors for germ cell tumors include cryptorchidism (undescended testicle) and gonadal dysgenesis (abnormal development of the gonads).
• An intratubular germ cell neoplasia (precursor), often with a specific chromosomal abnormality (isochromosome in chr.12p), can lead to these tumors.
• Seminomas are different from NSGCTs in terms of their clinical behavior, spread, sensitivity to treatment, and markers.

Seminoma vs NSGCTs

• Seminomas, the most common germ cell tumor, typically occurs in men in their 40s.

• They are characterized by a white-yellow "potato" appearance with clear cells in sheets or tubules.

• Lymphocytes and granulomas are often found.

• Markers for seminomas include PLAP, C-kit, and Oct-4.

• Seminomas spread primarily through lymphatics and are radiosensitive.

• NSGCTs, including embryonal carcinoma, yolk sac tumor, choriocarcinoma, and teratoma, are usually present in later stages.

• NSGCTs spread hematogenously and are radioresistant.

• NSGCTs are associated with the production of serum hCG (human chorionic gonadotropin) and AFP (alpha-fetoprotein).

NSGCT Subtypes

• Embryonal carcinoma: Present in 30% of NSGCTs, often mixed with other subtypes.
• Yolk sac tumor: Most common in children. Contains Schiller-Duval bodies and elevates AFP levels.
• Choriocarcinoma: A highly malignant type, shows trophoblastic differentiation and elevates HCG levels.
• Teratoma: Occurs in both adults and infants, commonly mixed with other subtypes. Shows multipotential differentiation of tissues from all three germ layers (ectoderm, endoderm, and mesoderm) and is generally considered a low-grade tumor.

Gleason Grading & ISUP CaP Grading System

• The Gleason grading system, developed by pathologist Donald Gleason in 1966, is used to assess the degree of differentiation in prostate cancer.
• The ISUP (International Society of Urological Pathology) grading system, introduced in 2016, is now widely used.
• ISUP grade groups range from 1 (low grade) to 5 (high grade).

Carcinoma of the Prostate

• Prostate cancer is one of the most common cancers in men, typically affecting those over 65 years of age.
• The pathogenesis is complex and likely involves a combination of aging, genetics (heredity, ethnicity), and environmental factors (carcinogens, diet).
• Prostate cancer is androgen-dependent, meaning it relies on the male hormone testosterone for growth.
• Treatment options include hormonal therapy (medical castration), surgery, and radiation.
• Serum PSA levels are monitored following treatment.
• PIN (Prostate Intraepithelial Neoplasm) is a precancerous lesion associated with an increased risk of prostate cancer.

PIN

• PIN involves the proliferation of atypical cells with features like nuclear enlargement, overlapping, hyperchromatism (dark-staining), and prominent nucleoli.
• It has a similar incidence, distribution, and cellular features to prostate cancer.
• 70% of cases are associated with prostate cancer.

Pathology of the Prostate: Other Conditions

• Nodular Hyperplasia (BPH): Benign enlargement of the prostate, common in men over 50 years old.
• BPH can cause symptoms like dysuria, frequency, and nocturia.
• BPH is thought to be hormonally dependent, with testosterone playing a role.
• BPH usually does not increase the risk of prostate cancer.

Pathology of the Testis: Other Conditions.

• Cryptorchidism: Undescended testicle, a congenital condition affecting 1% of the population.
• Cryptorchidism can lead to testicular atrophy, germ cell deficiency, and infertility.
• Cryptorchidism is associated with a 3-5 fold increased risk of testicular cancer.
• Testicular Torsion: A medical emergency involving twisting of the spermatic cord, leading to obstruction of the blood supply.