systems path 2 exam 3 - neoplasia of testicles, scrotum and epididymis (pg 33-46)

when is testicular neoplasia discovered (MC cancer of this age group)?

15-35 (MC 33)

risk for developing testicular neoplasia

family Hx, CA in contralateral testicle, cryptorchidism, Caucasia, gonadal dysgenesis

signs and symptoms of testicular neoplasia

lump/enlargement in testicle, heaviness in scrotum, dull ache, fluid in scrotum, pain/discomfort, enlargement of breast, back pain

does testicular CA usually affect one or both testicles?

one

what testicular tumor is malignant and accounts for 95% of post pubertal testicular tumors?

germ cell tumors (in situ)

types of germ cell tumors

seminomas (testis), nonseminomas (extension to epididymis, spermatic cord, scrotal sac)

What type of germ cell tumor is characterized by a soft and large mass which remains localized, is painless, is sometimes associated with high hCG, is radiosensitive, has late lymphatic mets, and can often be cured ?

seminoma

at what age are seminomas common?

30-40

seminoma cells

large and uniform with round nuclei

what type of germ cell tumor is more aggressive, has a poorer prognosis and is smaller which means it is difficult to palpate and therefore mets sooner, and is chemo sensitive?

nonseminoma

were do nonseminomas GCTs MC metastasize?

liver or lungs

Types of nonseminomas

embryonal carcinoma, teratoma, choriocarcinoma, and yolk sac tumor

what type of cancer accounts for 40% of nonseminoma GCTs, is aggressive and quick to mets, invasive, anaplastic, has indistinct borders and grows rapidly/spreads outside of testicle?

embryonal carcinoma

at what age are embryonal carcinomas common?

20-30

markers of embryonal carcinomas

increased AFP and hCG

what type of nonseminoma GCT is rare, quickly mets via blood, is a small mass but spreads fast and responds poorly to radiation and chemo?

choriocarcinoma

at what age are choriocarcinomas common?

20-30

Marker of choriocarcinoma

high hCG

what type of nonseminoma GCT is common in children around age 3, palpable, large, anaplastic and has a favorable prognosis?

yolk sac tumor

marker of yolk sac tumor

increased AFP

what type of nonseminoma GCT is characterized by a firm mass, found in all ages and has NO marker?

teratoma

mature teratomas in females are ______, but in males are most often associated with mixed with elements such as yolk sac tumor and embryonal carcinoma which means....

benign ; worse prognosis

features of testicular cancer

painless, testicular mass, non-translucent, blood in semen, dull achy pain in groin/abdomen

what type of testicular tumor is benign (in situ) associated with sertoli (nurse) and leydig (testosterone) cells?

sex cord stromal tumor

what type of non germ cell tumor is derived from testicular stroma which may cause elevated androgens and other steroids?

leydig cell tumor

How does a Leydig cell tumor present?

testicular mass, changes to secondary hormonal abnormalities

leydig cell tumor histological feature

intracytoplasmic reinke crystals

what are leydig cell tumors typically associated with?

precocious puberty (children), gynecomastia (adults)

what is a non germ cell tumor composed of sertoli cells or a mixture of sertoli and granulosa cells and secretes both androgens and estrogen?

Sertoli cell tumor

person who specializes in the male and female urinary tract and reproductive system of males

urologist