WBR0508
| Author | [[PageAuthor::Gonzalo A. Romero, M.D. [1]]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Embryology, MainCategory::Pathology |
| Sub Category | SubCategory::Reproductive |
| Prompt | [[Prompt::A 10-year-old male teenager is concerned because one of his testis is not in his scrotum. They live in rural Pennsylvania, where health care is not readily available. He tells his mother because sometimes it is embarrassing for him when taking a shower with his swim team peers. He patient finally convinces his mother to take him to the doctor, who is very distant from where they live. The physician has a clinical suspicion just with the chief complaint. This patient is at risk of developing which of the following if left untreated?]] |
| Answer A | AnswerA::Germ cell tumor |
| Answer A Explanation | [[AnswerAExp::Correct. Cryptorchidism increases the risk of developing germ cell tumors. Germ cell tumors represent 95 % of all testicular tumors, are frequently malignant.]] |
| Answer B | AnswerB::Inguinal hernia |
| Answer B Explanation | [[AnswerBExp::Incorrect. A hernia is a protrusion of peritoneum through an opening, frequently due to an area of weakness weakness.]] |
| Answer C | AnswerC::Varicocele |
| Answer C Explanation | [[AnswerCExp::Incorrect. Varicocele are dilated veins in the pampiniform plexus due to increased venous pressure. It is the most common cause of scrotal enlargement in adult males. Frequently presents on the ; most left side due to the increased resistance to flow from left spermatic vein drainage into the left renal vein. Long term it can produce infertility due to increased temperature. On physical examination it has a "bag of worms" appearance. It is diagnosed by ultrasound.]] |
| Answer D | AnswerD::Leydig cell tumor |
| Answer D Explanation | [[AnswerDExp::Incorrect. Leydig cell tumor They frequently secrete androgen resulting in gynecomastia in men, precocious puberty in boys. Macroscopically it presents as a golden brown colored tumor, and histologically it contains Reinke crystals.]] |
| Answer E | AnswerE::Sertoli cell tumor |
| Answer E Explanation | [[AnswerEExp::Incorrect. Sertoli Cell Tumor such as androblastoma arise from the sex cord stroma]] |
| Right Answer | RightAnswer::A |
| Explanation | [[Explanation::This patient is presenting with cryptorchidism, which is the abscence or undescend of one or both testis into the scrotum. Physiologically it impairs spermatogenesis, because sperm cells develop at temperatures below 37C. They have normal testosterone levels, because Leydig cells are not affected by high temperatures, as supposed to the Sertoli cells which are affected. Lab tests reveal Prematurity decreased inhibin (by Sertoli cells), increased FSH and normal LH and testosterone. It is seen more frequent in premature infants.
About 1 in 500 men born with one or both testes undescended develop testicular cancer (seminoma), roughly a 4 to 40 fold increased risk. The risk is higher for intra-abdominal testes and lower for inguinal testes.
The New England Journal of Medicine published in 2007 that orchidopexy performed before puberty resulted in a significantly reduced risk of testicular cancer than if done after puberty. (See https://www.ncbi.nlm.nih.gov/pubmed/17476009)
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| Approved | Approved::Yes |
| Keyword | WBRKeyword::cryptorchidism |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |