Practice questions Male reproductive system II
Practice questions II
Male reproductive system
© Jun Wang, MD, PhD
1. A 45-year-old man
presents with a painless swelling of his right testicle for 3 months. He denies
fever, weight loss and night sweating. His past medical history is
unremarkable. Physical examination reveals a 7.5 cm firm non tender right
testis. Laboratory test results, including CBC, AFP, beta hCG, and LDH, are all
within normal ranges. Sonographic examination reveals a bulky right testicle
with an ill-defined mass. Right orchiectomy is performed. Microscopically, the
mass contains tubules with thickened basement membrane. Many large atypical
cells with clear cytoplasm are seen within the tubules. These cells have a
fried egg appearance. No spermatogenesis is noted. No atypical cells are seen
outside the tubules. What is the diagnosis?
A. Embryonal carcinoma
B. Hairy cell
leukemia
C. Intratubular
germ cell neoplasia
D. Seminoma
E. Teratoma
2. Use this case for next three questions.
A 43-year-old man presents with a painful scrotal mass for 2 weeks. He denies
history of trauma, fever, infection and weight loss. He has cervical Hodgkin
lymphoma 20 years ago that was treated with radiation therapy and
chemotherapy. Physical examination reveal a 2.5 cm firm mass at this left
testis. No lymphadenopathy is noted. His CBC, renal function and liver function tests are within normal range. Sonographic
examination reveals a poorly defined left testicular mass. A few enlarged
periaortic lymph nodes are noted. Left radical orchiectomy is performed.
Microscopically the mass is composed of sheets of large atypical cells with
round nuclei, clear cytoplasm, and well defined cell borders. Per
immunohistochemistry, these cells are positive for OCT3/4 and KIT, but negative
for CD3, CD20, CD30 and CD45. Scattered dilated tubules with thickened basement
membrane are seen. Same large atypical cells are seen in these tubules. No
other abnormalities are noted. What is the diagnosis?
A. Diffuse large B
cell lymphoma
B. Embryonal
carcinoma
C. Mixed germ cell
tumor
D. Seminoma
E. Teratoma
3. A 43-year-old man
presents with a painful scrotal mass for 2 weeks. He denies history of trauma,
fever, infection and weight loss. He has cervical Hodgkin lymphoma 20 years ago
that was treated with radiation therapy and chemotherapy. Physical examination
reveal a 2.5 cm firm mass at this left testis. No lymphadenopathy is noted. His
CBC, renal function and liver function
tests are within normal range. Sonographic examination reveals a poorly
defined left testicular mass. A few enlarged periaortic lymph nodes are noted.
Left radical orchiectomy is performed. Microscopically the mass is composed of
sheets of large atypical cells with round nuclei, clear cytoplasm, and well
defined cell borders. Per immunohistochemistry, these cells are positive for
OCT3/4 and KIT, but negative for CD3, CD20, CD30 and CD45. Scattered dilated
tubules with thickened basement membrane are seen. Same large atypical cells
are seen in these tubules. No other abnormalities are noted. What serum marker
is most likely elevated?
A. AFP
B. CD30
C. hCG
D. PLAP
E. PSA
4. A 43-year-old man
presents with a painful scrotal mass for 2 weeks. He denies history of trauma,
fever, infection and weight loss. He has cervical Hodgkin lymphoma 20 years ago
that was treated with radiation therapy and chemotherapy. Physical examination
reveal a 2.5 cm firm mass at this left testis. No lymphadenopathy is noted. His
CBC, renal function and liver function
tests are within normal range. Sonographic examination reveals a poorly
defined left testicular mass. A few enlarged periaortic lymph nodes are noted.
Left radical orchiectomy is performed. Microscopically the mass is composed of
sheets of large atypical cells with round nuclei, clear cytoplasm, and well
defined cell borders. Per immunohistochemistry, these cells are positive for
OCT3/4 and KIT, but negative for CD3, CD20, CD30 and CD45. Scattered dilated
tubules with thickened basement membrane are seen. Same large atypical cells
are seen in these tubules. No other abnormalities are noted. What is the next
step for his management?
A. Bone marrow
biopsy
B. Flow cytometry
studies
C. Radiation
therapy
D. Watchful waiting
5. A 65-year-old man
presents with a slowly growing painless left testicle mass for 4 months. His
past medical history is unremarkable. Physical examination reveals enlarged
left testicle. Image studies reveals a 5.5 cm well-defined testicular mass. No
other abnormalities are noted. Left orchiectomy is performed. Microscopically,
these mass is composed of sheets of atypical cells with small to intermediate
sized round to oval nuclei. Scattered multinucleated giant cells are seen. All
these cells have eosinophilic cytoplasm. Per immunohistochemistry studies, these
cells are focally positive for KIT, but negative for PLAP, AFP, hCG, CD3, CD20
and CD45. What is most likely the diagnosis?
A. Diffuse large B
cell lymphoma
B. Embryonal
carcinoma
C. Mixed germ cell
tumor
D. Seminoma
E. Spermatocytic
seminoma
6. A 32-year-old man
presents with pain in left groin for a month. He has progressive left scrotum
swelling for 6 months. He has a history of penile condyloma 5 years ago. His
past medical history is otherwise unremarkable. Physical examination reveals an
enlarged left testis. No lymphadenopathy is noted. Routine laboratory tests are
within normal range. Image studies reveals a heterogeneous left testicular
mass. A few nodules are seen in liver. Additional laboratory tests reveals an
AFP of 5 ng/ml (normal < 10 ng/ml) and hCG of 1.5 mIU/ml (normal <5 mIU/ml).
Left orchiectomy is performed. Grossly the mass is approximately 5.5 cm in
greatest dimension. Hemorrhage and necrosis are seen. Microscopically the mass
is composed of cords of cells with minimal differentiation. Per
immunohistochemistry, these cells are positive for CD30 and cytokeratin. What
is the diagnosis?
A. Choriocarcinoma
B. Embryonal
carcinoma
C. Hodgkin lymphoma
D. Seminoma
E. Spermatocytic
seminoma
7. Use this case for the next two questions.
A 2-year-old boy presents with progressive swelling of left scrotum for a
months. He has no history of trauma or infection. Past medical history is
unremarkable. Physical examination reveals a 3.5 cm firm irregular mass, likely
arising from left testis. Image studies reveal a heterogeneous testicular mass.
Left orchiectomy is performed. Microscopically the lesion is composed primarily
of loosely cohesive immature cells, some surrounding a central thin-walled
blood vessel, with loose connection to other surrounding tumor cells. Vaguely
formed space are seen between these two groups of cells with similar
morphology. No multinucleated cells are seen. What is most likely diagnosis?
A. Choriocarcinoma
B. Embryonal
carcinoma
C. Seminoma
D. Teratoma
E. Yolk sac tumor
8. A 2-year-old boy
presents with progressive swelling of left scrotum for a months. He has no
history of trauma or infection. Past medical history is unremarkable. Physical
examination reveals a 3.5 cm firm irregular mass, likely arising from left
testis. Image studies reveal a heterogeneous testicular mass. Left orchiectomy
is performed. Microscopically the lesion is composed primarily of loosely
cohesive immature cells, some surrounding a central thin-walled blood vessel,
with loose connection to other surrounding tumor cells. Vaguely formed space
are seen between these two groups of cells with similar morphology. No
multinucleated cells are seen. What serum marker is most likely to be elevated?
A. AFP
B. CD30
C. hCG
D. PLAP
E. PSA
9. A 37-year-old man
presents with painless left testicle mass for 4 months. He has no history of
trauma or infection. He has a history of multiple epidermoid cysts of face and back,
that were treated with suegery. Physical examination reveals a 2.5 cm firm left
testicular mass. No other abnormalities are noted. His laboratory tests, including
AFP, hCG and PLAP, are within normal range. Sonographic examination reveals a
heterogenous mass within the left testis. Left orchiectomy was performed.
Microscopically, the tumor is cystic with stratified squamous epithelial
lining, pilosebaceous apparatii, many hair follicles, luminal lamellar keratin,
fibrofatty tissues, and focally bone trabeculae. There are no immature components.
What is the diagnosis?
A. Choriocarcinoma
B. Embryonal
carcinoma
C. Mixed germ cell
tumor
D. Teratoma
E. Yolk sac tumor
10. A 33-year-old
man presents with vague right groin pain for 2 weeks. He does not have other
symptoms. He has a history of cervical Hodgkin lymphoma that was treated with chemotherapy
and radiation therapy 10 years ago. His past medical history is otherwise
unremarkable. Physical examination reveals a larger right testis. Laboratory tests
reveal an AFP of 150 ng.ml (normal < 10 ng/ml), hCG of 5450 mIU/ml (normal
<5mIU/ml), and LDH of 850 U/L (normal 100-190 U/L). Sonographic examination
reveals a 1.5 cm hyperechoic mass in the right testis. Right orchiectomy is
performed. Microscopically, the tumor is composed predominantly of cysts lined
by mature squamous epithelium. Skin adnexa are seen. Focally there are solid
clusters of epithelial cells with minimal differentiation. No multinucleated
cells are seen. Per immunohistochemistry, these epithelioid cells are positive for
CD30, cytokeratin, AFP and hCG. What is the diagnosis?
A. Choriocarcinoma
B. Embryonal
carcinoma
C. Metastatic
Hodgkin lymphoma
D. Mixed germ cell
tumor with teratoma and choriocarcinoma
E. Mixed germ cell tumor with teratoma and embryonal carcinoma
E. Mixed germ cell tumor with teratoma and embryonal carcinoma
F. Pure teratoma
11. A 67-year-old
man presents with fatigue, night sweating, 20 pound weight loss and left
testicle swelling for 4 months. He has a history of prostatic adenocarcinoma,
Gleason score 3+3, that was treated with total prostatectomy 8 years ago. He
has no history of trauma or infection. Physical examination reveals a markedly
enlarged left testicle. His laboratory tests, including AFP, hCG and PLAP, are
within normal range. No lymphadenopathy is noted. Image studies reveals diffusely
enlarged left testicle with diffuse hypoechogenicity and increased vascularity.
Left orchiectomy is performed. Microscopically, the testis contains sheets of
markedly atypical cells with variable sized nuclei. Per immunohistochemistry,
these cells are positive for CD20, bcl2 and negative for cytokeratin, AFP,
PLAP, and hCG. What is most likely the diagnosis?
A. Diffuse large B
cell lymphoma
B. Embryonal
carcinoma
C. Mixed germ cell
tumor
D. Seminoma
E. Spermatocytic
seminoma
12. Use this case for the next two cases. A
55-year-old man presents with fever, chills, lower back pain, dysuria and
urinary frequency for 3 days. He has a history of type 2 diabetes. He has a
family history of prostate cancer. Physical examination reveals suprapubic
tenderness and distended bladder. Digital rectal exam reveals diffusely enlarged
prostate. Laboratory tests reveal a white count of 17 x 109/L (normal
4.5 – 10.3 x 109/L), with 85% neutrophils (normal 50-70%), and a PSA
of 3.5 ng/ml (normal < 4 ng/ml). What is most likely the diagnosis?
A. Acute Cystitis
B. Acute prostatitis
C. Diabetic
nephropathy
D. Prostatic
adenocarcinoma
E. Prostatic
hyperplasia
13. A 55-year-old
man presents with fever, chills, lower back pain, dysuria and urinary frequency
for 3 days. He has a history of type 2 diabetes. He has a family history of
prostate cancer. Physical examination reveals suprapubic tenderness and distended
bladder. Digital rectal exam reveals diffusely enlarged prostate. Laboratory tests
reveal a white count of 17 x 109/L (normal 4.5 – 10.3 x 109/L),
with 85% neutrophils (normal 50-70%), and a PSA of 5.5 ng/ml (normal < 4
ng/ml). What is the best test to confirm the diagnosis?
A. Cystoscopy
B. Prostate biopsy
C. Prostate image
studies
D. Urine albumin
test
E. Urine Gram stain
and culture
14. A 48-year-old
man presents with urinary urgency, frequency and dysuria for 2 days. He has a
history of vague suprapubic pain for 15 years. He does not have fever or other
symptoms. General physical examination reveals no significant abnormality.
Digital rectal examination reveals a diffusely enlarged painful prostate.
Laboratory tests reveal a PSA of 4.5 ng/ml (normal < 4 ng/ml). Urinalysis
reveals 7 red blood cells and 11 white cells per high power field. Urine
culture grows E. coli. What is the diagnosis?
A. Acute prostatitis
B. Chronic cystitis
C. Chronic
abacterial prostatitis
D. Chronic bacterial
prostatitis
E. Prostatic
adenocarcinoma
15. A 50-year-old
man presents with moderate to severe lower abdominal pain and intermittent
dysuria for 10 years. His past medical history is unremarkable. He has a family
history of colon cancer. Routine physical examination reveals no significant
abnormality. Digital rectal examination reveals a slightly enlarged painful prostate.
Laboratory tests, include PSA and repeated urine culture, are unremarkable. Image
studies reveals no abnormalities of prostate and other pelvic organs. What is
the most likely diagnosis?
A. Acute prostatitis
B. Chronic cystitis
C. Chronic
abacterial prostatitis
D. Chronic bacterial
prostatitis
E. Prostatic
adenocarcinoma
16. Use this case for the three two cases. A
66-year-old man presents with progressive low urinary tract symptoms, including
urinary frequency, urgency, hesitancy and incomplete bladder emptying for 8
years. He has a history of bladder papilloma 5 years ago that was treated by
local resection. He has multiple family members with prostate adenocarcinoma
and bladder cancer. Physical examination reveals distended bladder. Digital
rectal exam reveals markedly enlarged prostate with irregular surface. Laboratory
tests reveal a PSA of 2.1 ng/ml (normal < 4 ng/ml). Cystoscopy examination reveals
linear bulging of bladder mucosa surface. Biopsy of prostate reveals
proliferation of glands with increased buds and infoldings. Basal layers are
intact. What is the diagnosis?
A. Adenocarcinoma of
bladder involving prostate
B. Adenocarcinoma of
prostate
C. Papilloma of
bladder
D. Prostate nodular
hyperplasia
E. Urothelial
carcinoma
17. A 66-year-old
man presents with progressive low urinary tract symptoms, including urinary
frequency, urgency, hesitancy and incomplete bladder emptying for 8 years. He
has a history of bladder papilloma 5 years ago that was treated by local
resection. He has multiple family members with prostate adenocarcinoma and
bladder cancer. Physical examination reveals distended bladder. Digital rectal
exam reveals markedly enlarged prostate with irregular surface. Laboratory
tests reveal a PSA of 2.1 ng/ml (normal < 4 ng/ml). Cystoscopy examination reveals
linear bulging of bladder mucosa surface. Biopsy of prostate reveals
proliferation of glands with increased buds and infoldings. Basal layers are
intact. What is most likely associated with these prostate changes?
A. Amplification of
androgen receptor
B. Aneuploidy of
urothelial cells
C. Gain-of-function
mutation of androgen receptor
D. Mutation of FGFR3
E. Over activity of
type II 5-a-reductase
18. A 66-year-old
man presents with progressive low urinary tract symptoms, including urinary
frequency, urgency, hesitancy and incomplete bladder emptying for 8 years. He
has a history of bladder papilloma 5 years ago that was treated by local
resection. He has multiple family members with prostate adenocarcinoma and
bladder cancer. Physical examination reveals distended bladder. Digital rectal
exam reveals markedly enlarged prostate with irregular surface. Laboratory
tests reveal a PSA of 5.1 ng/ml (normal < 4 ng/ml). Cystoscopy examination reveals
linear bulging of bladder mucosa surface. Biopsy of prostate reveals
proliferation of glands with increased buds and infoldings. Basal layers are
intact. What is most likely associated with these bladder changes?
A. Aneuploidy of
urothelial cells
B. Benign smooth
muscle proliferation
C. Chronic
inflammatino
D. Mutation of FGFR3
E. Over activity of
type II 5-a-reductase
19. Use this case for the three two cases. A
63-year-old man presents with elevated PSA of 7.3 ng/ml found through screening
test. He has a history of long adenocarcinoma diagnosed at age 59, that was
treated with surgery and chemotherapy. Physical examination is compatible with
previous surgery but otherwise unremarkable. Digital rectal exam reveals a slightly
enlarged prostate. Laboratory tests are within normal range, except a PSA of
7.2 ng/ml (normal <4 ng/ml). Prostate biopsy reveal many small glands lined
by single layer of cells with mild cytological atypia, irregularly distributed
in a fibrotic stroma. Per immunohistochemistry studies, these glandular cells
are positive for racemase. No reactivity to TTF1, p63 or 34betaE12 is detected.
What is the diagnosis?
A. Chronic
abacterial prostatitis
B. Chronic bacterial
prostatitis
C. Metastatic
adenocarcinoma of lung
D. Prostate adenocarcinoma
E. Prostate nodular
hyperplasia
20. A 63-year-old
man presents with elevated PSA of 7.3 ng/ml found through screening test. He has
a history of long adenocarcinoma diagnosed at age 59, that was treated with
surgery and chemotherapy. Physical examination is compatible with previous surgery
but otherwise unremarkable. Digital rectal exam reveals a slightly enlarged
prostate. Laboratory tests are within normal range, except a PSA of 7.2 ng/ml
(normal <4 ng/ml). Prostate biopsy reveal many small glands lined by single
layer of cells with mild cytological atypia, irregularly distributed in a
fibrotic stroma. Per immunohistochemistry studies, these glandular cells are
positive for racemase. No reactivity to TTF1, p63 or 34betaE12 is detected. What
is most likely associated with these bladder changes?
A. Amplification of
androgen receptor
B. Bacterial
spreading from urinary tract
C. BCG treatment
D. Mutation of FGFR3
E. Over activity of
type II 5-a-reductase
Back to contents
Comments
Post a Comment