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Questions and Answers
What is the most critical time frame for untwisting testicular torsion to prevent necrosis?
What is the most critical time frame for untwisting testicular torsion to prevent necrosis?
What distinguishes a hematocele from other cystic disorders of the tunica?
What distinguishes a hematocele from other cystic disorders of the tunica?
Which germ cell tumor has the highest peak incidence during a man's 30s?
Which germ cell tumor has the highest peak incidence during a man's 30s?
What are common predisposing factors for germ cell tumors?
What are common predisposing factors for germ cell tumors?
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Which type of seminoma has been associated with a tendency to metastasize?
Which type of seminoma has been associated with a tendency to metastasize?
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Which of the following cystic disorders of the tunica is characterized as idiopathic?
Which of the following cystic disorders of the tunica is characterized as idiopathic?
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What is a potential consequence of bilateral testicular atrophy?
What is a potential consequence of bilateral testicular atrophy?
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Which causative organism is commonly associated with non-specific epididymo-orchitis in pediatric patients?
Which causative organism is commonly associated with non-specific epididymo-orchitis in pediatric patients?
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What unique feature do spermatocytic seminomas have compared to classical seminomas?
What unique feature do spermatocytic seminomas have compared to classical seminomas?
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What is the clinical significance of cryptorchidism if untreated?
What is the clinical significance of cryptorchidism if untreated?
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In which category of tumors is teratoma classified according to the WHO classification?
In which category of tumors is teratoma classified according to the WHO classification?
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Which specific inflammation of the testis can lead to fibrosis and possible sterility if both testes are affected?
Which specific inflammation of the testis can lead to fibrosis and possible sterility if both testes are affected?
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What morphological change is NOT typically associated with testicular atrophy?
What morphological change is NOT typically associated with testicular atrophy?
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Which condition typically starts as orchitis in males with syphilis?
Which condition typically starts as orchitis in males with syphilis?
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What is the usual treatment for cryptorchidism if detected early?
What is the usual treatment for cryptorchidism if detected early?
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What is a common outcome of torsion of the spermatic cord?
What is a common outcome of torsion of the spermatic cord?
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Which condition involves the urethral orifice present on the ventral surface of the penis?
Which condition involves the urethral orifice present on the ventral surface of the penis?
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What is the most common type of malignant tumor found in the penis?
What is the most common type of malignant tumor found in the penis?
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What is identified as a risk factor for squamous cell carcinoma of the penis?
What is identified as a risk factor for squamous cell carcinoma of the penis?
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What is a characteristic appearance of Bowen's disease?
What is a characteristic appearance of Bowen's disease?
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Condyloma acuminatum is primarily caused by which type of infection?
Condyloma acuminatum is primarily caused by which type of infection?
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Which term refers to the presence of a small orifice in the prepuce?
Which term refers to the presence of a small orifice in the prepuce?
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What type of inflammation can occur due to specific sexually transmitted infections?
What type of inflammation can occur due to specific sexually transmitted infections?
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Giant condyloma acuminatum is characterized by which of the following features?
Giant condyloma acuminatum is characterized by which of the following features?
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Study Notes
Diseases of Male Genital Organs - Overview
- Presentation of the topic, listing author
Diseases of the Penis
-
Common Congenital Anomalies:
- Hypospadias: Urethral opening on the ventral surface of the penis.
- Epispadias: Urethral opening on the dorsal surface of the penis.
- Phymosis: Narrowing of the prepuce opening, potentially congenital or acquired due to infection.
-
Inflammations:
- Non-specific inflammation
- Specific inflammations: syphilis, gonorrhea, herpes, and granuloma inguinale.
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Tumors:
- Benign: Condyloma acuminatum
- Malignant: Carcinoma in situ (Bowen disease), squamous cell carcinoma
Condyloma Acuminatum (Anal Wart)
- Benign papillomatous squamous tumor with a fibrovascular core.
- Caused by human papillomavirus (HPV) infection (STD).
- Affects both sexes equally, appearing mainly in the third decade of life.
- In females, it may involve the vulva, vagina, or uterine cervix, but the anal canal and perianal skin are the most common sites in both sexes.
- Giant condyloma acuminatum can show deep growth, local destruction, and may become malignant.
- Gross appearance: sessile or pedunculated masses, usually multiple, pink, potentially painful.
- Primarily involving the coronal sulcus (penis).
- Microscopic features: stromal papillae, stratified squamous epithelium with prominent hyperkeratosis, common vacuolation of surface epithelial cells.
Carcinoma in Situ (Bowen Disease)
- Very early form of skin cancer affecting squamous cells in the outer skin layer.
- Red, scaly patch on the skin is the primary symptom.
- May occur in genital regions of both males and females, predominantly after age 35.
- In males, it presents as solitary or multiple plaques on the penile shaft.
- Microscopically shows marked epithelial atypia with loss of surface maturation.
Squamous Cell Carcinoma
- Accounts for more than 95% of all penile cancers.
- Occurs between ages 40-70, with a median age of 58.
- Potential causes (risk factors):
- Smegma accumulation under the prepuce in non-circumcised individuals.
- HPV infection.
- Gross appearance: ulcer or exophytic growth.
- Microscopic features: range from well-differentiated to poorly differentiated.
Diseases of Testes & Epididymis
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Cryptorchidism: Failure of the testicle to descend into the scrotum.
- Occurs in 1% of boys.
- Testicle is present along the normal path of descent from the abdominal cavity to the inguinal canal.
- Mostly unilateral.
- Microscopic: atrophic changes may develop in the testes early at 2 years.
- Clinical significance: prevalence of inguinal hernia, sterility (due to atrophy), and neoplasms.
- Treatment: surgical orchidopexy before age 2.
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Testicular atrophy: Secondary to:
- Cryptorchidism
- Klinefelter syndrome (47 XXY chromosome)
- Vascular disease
- Inflammation
- Hypopituitarism
- Elevated serum female sex hormones
- Radiation
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Morphology of testicular atrophy:
- Sertoli cell only lining of seminiferous tubules.
- Decreased germ cell production (germ cell aplasia).
- Thickening and hyalinization of tubular basement membrane.
- Interstitial fibrosis.
- Bilateral testicular atrophy leads to infertility (azoospermia).
Inflammations of Testes
-
Non-specific epididymo-orchitis:
- Causative organisms:
- Gram-negative organisms (pediatric patients)
- Chlamydia and goncocci (men < 35)
- E. coli and pseudomonas (older men)
- Symptoms: congestion, edema, neutrophilic infiltration.
- Causative organisms:
-
Specific inflammations:
- Gonorrhea: Retrograde inflammation from the urethra, congestion, edema, neutrophilic infiltration, and suppuration.
- Mumps: Common in children, may occur in adults, occurs about a week after the onset of parotitis, may cause sterility if fibrosis occurs in both testes.
- Tuberculosis: Inflammation begins in the epididymis, granulomatous inflammation associated with caseous necrosis.
- Syphilis: Inflammation begins as orchitis, occurs in congenital and acquired syphilis, may produce diffuse or gummatous nodules.
- Granulomatous noninfectious orchitis: Uncommon cause of unilateral testicular enlargement, occurs in middle-aged men, possibly auto-immune origin, sudden onset mass (with or without pain), microscopically resembles tuberculosis but without caseous necrosis.
Vascular Disturbances of Testes (Torsion)
- Occurs due to twisting of the spermatic cord.
- Typically seen in adolescence, but neonatal torsion is known and can occur in utero or shortly after birth.
- Presents as sudden onset of testicular pain.
- Due to increased mobility of the testis.
- Requires untwisting within 6 hours to prevent necrosis.
Cystic or Semi-Cystic Disorders of Tunica and Spermatic Cord
- Hydrocele: Abnormal accumulation of serous fluid in the tunica vaginalis due to local injury (inflammation, tumors), or idiopathic.
- Spermatocele: Presence of serous fluid and sperms in the tunica vaginalis due to dilatation of epididymal tubules.
- Hematocele: Blood in the tunica vaginalis, due to trauma, tumor, torsion, or blood disease.
- Varicocele: Dilatation of veins of pampiniform plexus, potentially idiopathic or due to venous drainage obstruction.
Testicular Tumors
-
A) Germ cell tumors:
- Seminoma (classic type), Spermatocytic seminoma (non-classical type), Embryonal carcinoma, Yolk-sac (endodermal sinus) tumor, Choriocarcinoma, Teratoma.
- B) Sex-cord stromal tumor: Leydig cell tumor, Sertoli cell tumour.
- Predisposing factors for germ cell tumors: Cryptorchidism, Genetic factors, Testicular dysgenesis (e.g., Klinefelter syndrome), Cytogenetic abnormalities involving chromosome 12.
- Germ cell neoplasia in situ (GCNIS) tumors: Seminoma and non-seminoma (NSGCT). NSGCT includes teratoma (post-pubertal), embryonal carcinoma, choriocarcinoma, yolk sac tumors (YST).
- non-GCNIS tumors: Spermatocytic tumors, YST (prepubertal type), teratoma (prepubertal type). Neoplasia in situ means dysplastic changes beyond the basement membrane.
Seminoma
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Classic type (95%): Most common testicular tumor, peak incidence in the 30s, may metastasize.
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Gross appearance: Round, firm, homogeneous, lobulated, tunica albuginea usually intact.
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Microscopic appearance: Large polyhedral cells, abundant clear cytoplasm, large nuclei with prominent nucleoli, fibrous stroma infiltrated by lymphocytes.
-
Spermatocytic type (5%): Occurs in older patients, no tendency to metastasize, neoplastic cells resemble secondary spermatocytes, better prognosis than classic type.
Embryonal Carcinoma
- Peak incidence between 20-30 years.
- More aggressive than seminoma.
- Morphology: Primitive cells forming irregular sheets, tubules, alveoli, and papillary structures.
- 90% of cases have elevated alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) in the blood.
Yolk Sac Tumor
- Primarily in children under 4 years, but may occur in adults.
- Composed of cuboidal cells arranged in a reticular pattern.
- Structures resembling primitive glomeruli in 50% of cases.
- Patients have elevated AFP levels.
Choriocarcinoma
- Rare as a pure form (<5%).
- Can form special elements in some testicular teratomas.
- Occurs in the 2nd and 3rd decades.
- Morphology: Composed of large syncytiotrophoblastic and cytotrophoblastic cells.
- Elevated HCG levels in all patients.
Testicular Teratomas
- Peak incidence in the 2nd and 3rd decades, but also in pediatrics (second most common germ cell type, after yolk sac).
- Morphology: Formed from the three embryonic layers:
- Ectoderm (squamous epithelium, renal tissue)
- Mesoderm (cartilage, smooth muscle, bone)
- Endoderm (GIT & respiratory epithelium)
Types of Teratomas
- Prepubertal: Benign, not associated with GCNIS, normal spermatogenesis, no metastatic potential.
- Postpubertal: GCNIS-derived, metastatic potential (22-37% of cases).
Sertoli Cell Tumor & Leydig Cell Tumor
- Sertoli cell: Rare, usually benign, structures resembling testicular tubules, secretes estrogen leading to gynecomastia.
- Leydig cell: 1-2% of testicular tumors in adults and 3-6% in prepubertal males. Small minority (<10%) are clinically malignant. In children, secretes androgen; in adults, secretes estrogen.
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Description
This quiz focuses on critical medical knowledge related to testicular disorders, including testicular torsion, germ cell tumors, and associated complications. It covers various aspects such as the significance of timely diagnosis and treatment, distinctions between cystic disorders, and the implications of conditions like cryptorchidism. Perfect for students and professionals in medical fields.
