Testes & Epididymus Disease

3 Q's: 2 Q's Lecture, 1 Q Lab

Cryptochordism

Impaired descent of testes, usually unilateral, 5-10x increased risk of germ cell tumors

Orchiopexy

Surgical repair of cryptochordism

Two types of testicular torsion

Testicular torsion - twisting of the spermatic cord

Appendix testes torsion - twisting of remnant mullerian duct

Bellclapper Deformity

Tunica vaginalis completely encompasses the epididymus and testes

Testicular torsion

Testicular Torsion

Klinefelter syndrome

47XXY, testicular atrophy , gynecomastia and learning difficulties

Testicular Atrophy

Testicular Atrophy; Increased leyding cells

Acute orchitis

Acute Orchitis

Viral causes of orchitis

Coxsackie and mumps

Tuberculosis Orchitis

Noninfectious, unilateral scrotal enlargement in older men often mistaken for neoplasm

Granulomatous Orchitis

Granulomatous Orchitis

Granulomatous orchitis

Most common type of testicular tumor

germ cell tumor (15-35 yo men)

Germ cell tumor genetic deficiency

Isochrome 12P

Germ Cell Tumors and Lab Markers

Beta-HCG - Choriocarcinoma

Alpha Fetoprotein.- Yolk Sac

LDH - Above + Seminoma

Seminoma - 30-40 yo men and good prognosis

Seminoma

Seminoma

Seminoma

PLAP stain Seminoma

Embryonal Carcinoma - puberty to age 30 worse prognosis than seminoma

Embyronal Carcinoma

Yolk Sac - 16 to 17 mo old. Elevated serum AFP 20% of children may have metastasis

Microcystic Yolk Sac Tumor

Schiller-Duval Body Yolk Sac

Hyaline globules of yolk sac tumor

Choriocarcinoma - 25 to 30 years old , elevated B HCG, likes to metastasize early

Choriocarcinoma

Teratoma most important history:

Before or after puberty. After puberty much more likely to be malignant.

Teratoma

Mature teratoma - better prognosis

Immature teratoma - worse prognosis

Spermatocytic Tumor - Male 70 yo

Leydig Cell Tumor

Leydig Cell Tumor

Unique histology feature of leydig cell tumor

Reinke crystal

Sertoli cell tumor

Sertoli cell tumor

Gonadoblastoma

Also happens with chromosome mosaicism (45X and 46XY) , half of these turn into seminoma

Testicular Lymphoma

Hydrocele

Vastitis Nodosa

Vas deferens reacts to vasectomy

Hydrocele

Testicular Atrophy

Testicular Torsion

Seminoma

Seminoma

Teratoma

Yolk sac tumor

Lymphoma

Embryonal Carcinoma