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TESTIS AND EPIDIDYMIS

 CRYPTORCHIDISM:
o Failure of descent of testis into scrotal sac
o Seen in 1% of 1 -year old boys
o Most common site of arrest of testis is Inguinal
o M/E of undescended testis:
 Germ cell development arrest [Germ cells are normally +nt in
seminiferous tubules]
 Basement membrane thickening [of seminiferous tubules]
 Leydig cells appear prominent because relatively germ cells
decrease [Therefore, Leydig cells do not increase actually in
number]

o Complications:
 Decrease in fertility
 Increased risk of cancer [most commonly seminoma]
o Rx:
 Orchiopexy [pulling of testis down into scrotal sac] can be done
from 6 months – 24 months to restore fertility
 Orchiopexy does not reduce risk of cancer

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 ORCHITIS AND EPIDIDYMITIS

 Orchitis – inflammation of testis

 Epididymitis – inflammation of epididymis
 Diseases which causes orchitis and epididymitis:
o Mumps [also affects parotid gland, pancreas]
o TB [1 s t affects epididymis then testis]
o Syphilis [1 s t affects testis then epididymis]
 Mnemonic:
o T: TB
o E: Epididymis
o T: testes
o S: Syphilis
 C/F:
o Pain
o PREHN SIGH  Pain decreases on lifting the scrotum
 TORSION OF TESTES:
o Twisting of spermatic cord due to Bell clapper anomaly that is
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increased mobility of spermatic cord
o Because of Torsion:
 Arterial supply remains normal
 Venous drainage is cut off  leading to Haemorrhagic
Infarction
o C/F:
 Painful
 PREHN SIGN  Pain increases on lifting the scrotum

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TESTICULAR TUMOURS
 Risk Factors:
o Cryptorchidism
o Klinefelter Syndrome [Extra X]
o i12 p [isochromosome]
o OCT ¾ NANOG
 Precursor lesions:
o Intra tubular germ cell neoplasia [ITGCN] is a precursor lesion for all
testicular tumours except
 Spermatocytic seminoma
 Teratoma
 C/Fs:
o Painless enlargement
o Para aortic lymph node enlargement [1 s t lymph node to be involved]
o If pt. shows hematogenous spread, then it will most commonly involve
lungs
 Classification of testicular tumours:
o Germ cell Tumour
 Seminomatous Tumours
 Radiosensitive
 Less aggressive
 Lymphatic spread  includes Seminoma which be:
o Classical
o Anaplastic Seminoma
o Spermatocytic seminoma
 Non- Seminomatours Tumours
 Radio – resistant
 More aggressive

Hematogenous Spread; includes:
o CHORIOCARCINOMA
o EMBRYONAL CARCINOMA
o YOLK SAC TUMOUR
o TERATOMA
o Sex Cord stromal tumours
 Sertoli cells tumours
 Leydig cell tumours
o Others
 Lymphoma
 Metastasis to testes
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 SEMINOMA [CLASSICAL]
 Most common germ cell tumours in males
 Female counterpart  Dysgerminoma
 Gross – Fleshy, lobulated bulging tumour
 M/E:
o Nests of Tumour Cells
o Tumour cells = clear cytoplasm due to glycogen
o These tumour cells due to +nce of glycogen stain PAS +
o In between nests there is +nce of fibrous septae  within fibrous
septae lymphocytes + plasma cells are +nt,

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o Tumours Markers: PLAP, LDH, βHCG

 SPERMATOCYTIC SEMINOMA:
o Tumour which occurs in late age > 65 years
o Slow growing, no metastasis
Excellent prognosis
 M/E:
o 3 types of cells
 Small cells [Resemble 2 o spermatocytes]  Therefore, named
Spermatocytic Seminoma
 Medium cells
 Large cells

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 NON SEMINOMATOUS GERM CELL TUMOUR

1. CHORIOCARCINOMA:
 Gross  Extensive areas of hemorrhage & necrosis
 M/E:
 Cytotrophoblast [cell with single nucleus]
 Syncitiotrophlasts [cell with multiple nuclei]
 NO VILLI FORMATION
 Tumor marker  βHCG [β subunit is specific to HCG while α
subunit is common to HCG, FSH, LH, TSH]
 Aggressive, Poor prognosis
 Highly sensitive to chemotherapy
2. EMBRYONAL CARCINOMA:
 Microscopically  shows +nce of Primitive cells
 On immunohisto -chemistry which particular tumor is CD30 + ? Ans.
Embryonal carcinoma
3. YOLK SAC TUMOR (YST) / Endodermal sinus tumor:
 Most common testicular tumor seen in children < 3 years age
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 M/E: SCHILLER – DUVAL BODY / GLOMER ULOID BODY
 A capillary in center
 Surrounded by tumor cells layer [similar to visceral Bowman’s
capsule]
 Then there is a space [similar to bowman’s space]
 Outermost layer of tumor cells [~ parietal layer]

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Tumor Marker:
 AFP
 α 1 – antitrypsin [ α 1 -AT]
4. TERATOMA:
 Arises from > =2 germ layers [Ectoderm, mesoderm, endoderm]
 Teratoma can be of 3 types:
 Mature  occurs in prepubertal male
 Immature  occurs in pubertal males
 Teratoma with malignant transformation  most commonly
squamous cell carcinoma

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 SEX CORD STROMAL
TUMOURS

 Two types:
o Sertoli cell tumours: Hormonally silent tumours
o Leydig cell tumours: produces androgens & estrogens  causing
gynecomastia
 Gross  Golden yellow colour
 M/E  +Leydig cells; which have:
o Lipid
o Lipofuscin
o REINKE’S CRYSTALLOIDS
 Others:
o Lymphoma of testis:
 Always bilateral
 Most common testicular tumour in elderly pts.

Most common lymphoma which can occur is DLBCL [Diffuse large
B cell lymphoma]
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o Metastasis to testes
 Summary:
o Most common germ cell tumour – SEMINOMA
o Most common germ cell in adults – SEMINOMA
o Most common germ cell in < 3 years – YOLK SAC TUMOUR
o Most common testicular tumour in elderly – Lymphoma [bilateral]

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PROSTATE

 Normal Prostate:
o Weight – 20gram
o Parts of Prostates:
 Zones:
 Peripheral  shows cancer
 Transitional [between peripheral central]  shows
hyperplasia; known earlier]
 Central
 Anterior fibromuscular stroma
o Urethra passes through prostate
o M/E:
 +nce of glands having 2 layers:
 Basal layer [cuboidal] [lost in cancer]
 Columnar layer [secretory cells]

 In between glands fibromuscular stroma is +nt

 Note: In breast similar glands with 2 layers are +nt but
fibromuscular stroma is -nt between them instead fibro -
adipose stroma is +nt

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 BPH/ NODULAR HYPERPLASIA PROSTATE

 BPH = Benign Prostatic Hyperplasia [old term]

 Nodular Hyperplasia prostate [new term]
 Most common prostatic disease in male
 Not premalignant [important]
 Pathogenesis:
o Testosterone  (5α Reductase II)  Dihydrotestosterone [DHT] 
act on epithelial cells & stromal cells, Both of them contains Androgen
receptors
o When DHT act on stromal cells they release FGF -7, TGF-β which
increases stromal cells & decreases apoptosis of epithelial cells
 C/Fs: increase urinary frequency nocturia [because hyperplasia occurs in
transitional zone which compress urethra]
 Gross – Enlarged Prostate [60 -100 grams usually]
 M/E –
o Increase hyperplasia of glands
o Increase hyperplasia of stroma

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R x – Inhibitor of 5 α Reductase type II  FINASTERIDE