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57 Cards in this Set
- Front
- Back
What are the three major phases in the development of the testes?
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1. Static phase
2. Growth from age 4 - 10 3. Maturation |
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Testes: describe the static phase
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From birth to age 4.
Seminiferous tubules are full of compact, undifferentiated cuboidal cells Leydig cells appear, disappear, only to reappear later. |
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Testes: describe the phase of growth between ages 4 and 10
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Barely perceptible growth. Increased tortuosity of seminiferous tubules and lumen formation.
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Testes: describe the maturation phase
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Active spermatogenesis following puberty.
Emergence of leydig cells in the interstitium. |
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Testes: average size
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3.0 x 3.0 cm in size
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Name the stages of spermatogenesis
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1. Spermatogonia: along the basement membrane, round and dense nuclei with nucleoli -->
2. Spermatocytes: more centrally located, larger than spermatogonia, granular chromatin --> 3. Spermatids: Near the lumen, small cells with darkly stained chromatin --> 4. Spermatozoa: elongated eccentric nucleus with cytoplasmic tail. |
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In normal testes, where are the leydig cells located?
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In the interstitium.
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What are the three layers that make up the capsule of the normal testis?
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From deep --> superficial
1. Tunica vasculosa 2. Tunica albuginea 3. Tunica vaginalis (visceral) 4. Tunica vaginalis (parietal) 5. Fascia layer 6. Dartos muscle 7. Skin |
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Describe the three layers that make up the capsule of the normal testis
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Tunica vasculosa: loose vascular connective tissue
Tunica albuginosa: a layer of collagen fiber Tunica vaginalis: a layer of mesothelialous tissue. |
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Cryptorchidism: definition
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Failure of testes to descend.
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Cryptorchidism: Incidence
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4% at birth, but most descend in the first year of life
<0.4% prevalence in adults |
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Cryptorchidism: bilateral? unilateral?
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Usually unilateral with a slight predeliction to involve the right testis.
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Cryptorchidism: congenital?
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Usually not. Usually an isolated anomaly.
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Cryptorchidism: pathology
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If not surgically corrected before puberty, can cause infertility.
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Cryptorchidism: increased risk of what?
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10 -15x Increased risk of developing germ cell tumors in untreated cryptorchidism.
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Cryptorchidism: treatment
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Orchiopexy (surgical repositioning of the testes) before age 2.
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Torsion of the testes: clinical presentation
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Severe scrotal pain followed by swelling.
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Torsion of the testes: risk factors
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Often associated with congenital abnormalities that cause increased mobility of the testis and epididymis:
1. High attachment of the tunica vaginalis on the spermatic cord. 2. Incomplete descent of the testis. 3. Absence of the scrotal ligaments |
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Torsion of the testes: if left untreated?
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Hemorrhagic infarction --> small, fibrotic testis
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Orchitis: mainly caused by infections traveling through what?
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Through the blood to the testes.
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Epididymitis: mainly caused by infections traveling through what?
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Through the spermatic ductal system.
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General Classifications of Orchidoepidiymitis
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I. Nonspecific Orchioepididymitis
II. Idiopathic Granulmatous Orchitis III. Specific Inflammation - TB - Syphilis - Mumps |
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Nonspecific Orchidoepididymitis: most common source
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The urinary tract (cystitis, urethritis, and prostatitis)
Reach the epididymis via the vas deferens or the lymphatics of the spermatic cord |
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Nonspecific Orchidoepididymitis: basic etiology?
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Infectious! Not that nonspecific granulomatous prostatitis is NOT associated with inflammation.
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Nonspecific Orchidoepididymitis: offending agent in patients < 35 years old
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Chlamydia trachomatis (most common)
Neisseria gonorrhoeae (< 5%) |
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Nonspecific Orchidoepididymitis: offending agent in patients > 35 years old
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E. coli, Pseudomonas, Staphylococci, Streptococci
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Nonspecific Orchidoepididymitis: offending agent in children?
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Congential genitourinary abnormality.
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Nonspecific Orchidoepididymitis: clinical findings
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Fever, pain
Tenderness of unilaterally swollen testis Bacterial infection: pyuria |
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Nonspecific Orchidoepididymitis: what do you use to confirm diagnosis?
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Urine culture.
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Nonspecific Orchidoepididymitis: acute microscopic findings
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A diffuse infiltrate of neutrophils involving both the interstitium and the tubules.
See interstitial edema and abscess formation. |
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Nonspecific Orchidoepididymitis: chronic microscopic findings
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A diffuse infiltrate of lymphocytes, eosinophils, and plasma cells involving both the interstitium and the tubules.
See fibrosis (if extensive enough, can cause sterility) |
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Idiopathic Granulomatous Orchitis: etiology
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Unknown, but trauma, infection, extravasated sperm, autoimmune diseases may be pathological mechanisms.
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Idiopathic Granulomatous Orchitis: what parts are involved?
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The epididymis and the tunics may be simultaneously involved.
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Idiopathic Granulomatous Orchitis: clinical presentation
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Middle-aged men
Unilateral testicular enlargement. May be accompanied by pain and tenderness. |
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Idiopathic Granulomatous Orchitis: gross
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Moderately enlarged with homogenous cut curface and gray-tan areas of obscuring testicular architecture.
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Idiopathic Granulomatous Orchitis: microscopic findings
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"granulomas with rupture bubbles and nests of spermatozoa, no necrosis"
Gram stain for bacteria = neg AFB for mycobacteria = neg GMS for fungus = neg |
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Tuberculous orchidoepididymitis: most common etiology/pathogenesis?
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Renal TB --> prostatic TB --> tuberculous orchidoepididymitis
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Tuberculous orchidoepididymitis: most common etiology/pathogenesis in children?
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Through the bloodstream.
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Tuberculous orchidoepididymitis: primary site of disease
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The epididymis is the primary site of disease, the testis is usually unaffected until later stages of disease.
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Tuberculous orchidoepididymitis: bilateral involvement?
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In 30% of cases.
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Tuberculous orchidoepididymitis: formation of abscesses?
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In 50% of cases
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Tuberculous orchidoepididymitis: other bugs
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Atypical mycobacteria (such as M. avium)
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Tuberculous orchidoepididymitis: gross
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Nodules with central caseating necrosis
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Tuberculous orchidoepididymitis: microscopic findings
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Granulomas with caseating necrosis
AFB for mycobacteria = pos GMS for fungus = neg |
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Syphilitic orchidoepididymitis: what structure is involved first?
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The testis (in congenital syphilis and in tertiary syphilis)
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Syphilitic orchidoepididymitis: clincal presentation of testes
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Bilateral
Painless testicular enlargement |
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Syphilitic orchidoepididymitis: classic macrofinding in tertiary syphilis?
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Gummas (a soft, non cancerous growth. A form of granuloma).
A circumscribed zone of necrosis surrounded by a fibrous capsule. |
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Syphilitic orchidoepididymitis: microscopic findings?
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- Interstitial inflammation composed of plasma cells and lymphocytes.
- Fibrosis - Endothetial cell proliferation with endarteritis |
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Syphilitic orchidoepididymitis: what stain do you use to visualize spirochetes in the "gumatous stage"?
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Warthin-Starry stain.
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Mumps orchidoepididymitis: caused by what virus?
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Paramyxovirus
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Mumps orchidoepididymitis: testicular involvement.
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Uncommon in children
Complicates 20-30% of adult mumps cases. |
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Mumps orchidoepididymitis: progression leading up to presentation?
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Testicular swelling and pain within 1 week of onset of parotiditis
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Mumps orchidoepididymitis: bilateral?
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Most commonly unilateral, bilateral in 25%
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Mumps orchidoepididymitis: epididymal involvement?
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High 85%
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Mumps orchidoepididymitis: what percentage of patients will become sterile?
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Low percentage (< 2%)
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Mumps orchidoepididymitis: gross (early stage vs. late stage)
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Early stage: enlarged testis with edema and congestion
Late stage: atrophy |
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Mumps orchidoepididymitis: microscopic findings
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- Multifocal acute and chronic inflammation
- Early stage: interstitial edema - Late stage: tubular atrophy |