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What type of testicular tumour fits this description? – A homogenous and painless mass with the absence of haemorrhage. On histology, findings include large cells in lobules with clear cytoplasm ‘fried egg appearance’.
Leydig cell tumour
Question 1 Explanation:
Seminoma fits this description. It is the most common testicular tumour. It is malignant, metastasises late, responds to radiotherapy and has an excellent prognosis.
What is the best description for the area of the prostate that the carcinoma usually affects?
Posterior and peripheral region
Anterior and peripheral region
Entire anterior region
Question 2 Explanation:
Prostatic cancer typically arises from the posterior lobe and on the periphery. This is why it is often asymptomatic as it does not compress the urethra producing no urinary symptoms at an early stage. The prostate is located anterior to the rectum. Thus, on digital rectal exam (DRE), a mass can be felt as the posterior and peripheral region is affected.
Do varicoceles typically appear on the right side or the left side?
Question 3 Explanation:
Varicoceles are caused by the dilation of the spermatic vein due to increased venous pressure. It is usually left sided because there is an elevated resistance to flow on the left side as the left gonadal vein drains into the left renal vein compared to the right which drains into the inferior vena cava. Sometimes it is associated with a left sided renal cell carcinoma. It causes scrotal enlargement in adults with a classic ‘bag of worms’ appearance. It can lead to infertility due to the increased temperature.
What is the causative agent of condyloma acuminatum?
HPV 6 or 11
Question 4 Explanation:
Condyloma acuminatum is characterized by the growth of benign genital warts. On histology, there will be koilocytic change. This condition is caused by HPV type 6 or 11. Infection with HPV is also a risk factor for development of squamous cell carcinoma of the penis.
How does testicular torsion present?
Sudden pain in the scrotum and an absent cremasteric reflex
Swelling of the scrotum and fever
A painless testicular mass that cannot be transilluminated
‘Bag of worms’ appearance of the scrotum
Question 5 Explanation:
Testicular torsion is usually seen in adolescents and presents as sudden pain in the scrotum. On physical examination the cremasteric reflex will be absent. It is caused by the twisting of the spermatic cord containing the pampiniform plexus, vas deferens and testicular artery. The blood supply is impaired leading to congestion and necrosis of the testicle. It is a surgical emergency.
Is benign prostatic hyperplasia (BPH) a risk factor for prostate adenocarcinoma?
Question 6 Explanation:
BPH is not premalignant. It is common in men over the age of 50. It occurs as a result of hyperplasia of the prostatic periurethral stroma and glands.
What area does prostate cancer spread to most frequently?
Question 7 Explanation:
Metastasis commonly involves the lumbar spine in late stages of the cancer creating osteoblastic lesions on the bone. It presents as lower back pain. Serum alkaline phosphatase (ALP) will be raised as well as prostatic specific antigen (PSA).
What is the grading system for prostatic cancer?
Question 8 Explanation:
The Gleason grading system is used to categorise prostate adenocarcinoma and focusses on architecture of the tumour. A score of 2 -10 is obtained; the higher the score, the worse the prognosis.
What is the most common congenital male reproductive disorder?
Question 9 Explanation:
Cryptorchidism is where the person has undescended testis; it can involve one testicle or both. Testicles are formed in the abdomen and descend into the scrotum during foetal development. Failure to descend, results in this abnormality. Affected persons have an increased risk for development of germ cell tumours and infertility. Some cases self-resolve whereas orchiopexy is done to treat others.
What are risk factors for developing germ cell tumours?
Hydrocoele and Varicocele
Klinefelter syndrome and Cryptorchidism
Hypospadias and Epispadias
Question 10 Explanation:
Most frequently occur in young men with either Klinefelter syndrome or cryptorchidism. Cryptorchidism is the failure of the testicle to descend into the scrotum. Klinefelter syndrome: a chromosomal abnormality (47 XXY) leading to dysgenesis of seminiferous tubules causing testicular atrophy, gynecomastia, infertility and eunuchoid body shape.
What is hypospadias?
Opening of urethra on the ventral surface of the penis
Opening of urethra on dorsal surface of the penis
Inflammation of the testicle
Benign warty growth on genital skin
Question 11 Explanation:
Hypospadias is due to failure of the urethral folds to fuse resulting in an abnormal opening of the urethra on the inferior/ventral surface of penis. Epispadias is the condition associated with the opening of urethra on superior/dorsal surface of penis, and it is linked with bladder exstrophy.
What is priapism?
Inability to void the bladder
Abnormal curvature of the penis
Painful erection lasting > 4 hours
Cyst due to a dilated testicular duct
Question 12 Explanation:
Priapism is a prolonged and painful erection of the penis. Sickle cell disease, trauma and medications for erectile dysfunction e.g. sildenafil are all potential causes of this condition. It requires prompt treatment to prevent ischemia. Treatment options include phenylephrine injection, surgical decompression and corporal aspiration.
Are testicular tumours usually biopsied?
Question 13 Explanation:
Usually they are not biopsied as there is a high risk of seeding the scrotum. Instead, investigations include a scrotal ultrasound and blood tests for tumour markers. Treatment is radical orchiectomy as most testicular tumours are malignant.
What tumour is characterised by findings of ‘Schiller Duval bodies’ on histology and raised levels of AFP on blood tests?
Yolk sac tumour
Sertoli cell tumour
Question 14 Explanation:
Yolk sac tumour is the most common testicular tumour in boys. An elevated AFP and Schiller Duval bodies (resemble glomerulus) are important features to differentiate from the other types of testicular tumours.
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