Review Questions

1. A 26-year-old man comes to the physician because of a 3-month history of a painless testicular mass. He says that it was the size of a pea when he first noticed it, and it has been growing for the past few months. He is sexually active, but denies ever having a sexually transmitted disease. He does not have dysuria or penile discharge. Physical examination shows a 2-cm, firm mass in the left testes. An ultrasound shows a hypoechoic intratestic-ular mass. Laboratory studies show elevated levels of placental alkaline phosphatase. A radical orchiectomy is performed, and the mass is sent to pathology for evaluation. Gross examination shows a 2.3-cm gray-tan mass. Microscopic examination is the most likely to show which of the following?

A. Ectoderm, endoderm, and mesodermal tissue in a haphazard arrangement

B. Large, primitive cells with hemorrhage and necrosis

C. Polygonal germ cells with clear cytoplasm and round nuclei arranged in lobules

D. Proliferation of syncytiotrophoblasts and cytotrop ho blasts

E. Schilier-Duval bodies

2. A 59-year-old man comes to the physician because of a 6-month history of "difficulty stopping and starting urinary flow." He says that the most troubling part is that he "dribbles" after he urinates, and he should not be doing this because he is not "an old man." Digital examination shows nodules in the transitional and periurethral zones of the prostate. A prostate specific antigen test is 4.2 ng/ml. This condition puts this patient at increased risk for which of the following complications?

A. Carcinoma of the seminal vesicles

B. Lung and fiver metastases

C. Osteoblastic bony metastases

D. Testicular carcinoma

E. Urinary tract infections

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