Pathology of Male Genital System

Pathology of Male Genital System Jan Laco, M.D., Ph.D.

Summary • 1. Penis and scrotum • 2. Testis and epididymis • 3. Prostate

1. Penis and scrotum • a. malformations • b. inflammatory lesions • c. neoplasms

1a. malformations • Hypospadias + epispadias = abnormal location of distal urethral orifice + outer genital anomalies • epispadias + urinary bladder exstrophy • complications: obstruction infections infertility

1a. malformations • Phimosis = stenosis of prepuce (+ acquired)  smegma  infection, urinary retention • Paraphimosis = stenotic prepuce in coronal sulcus  penis congestion, infarction

1b. inflammatory lesions • glans penis – balanitis • prepuce – posthitis • cavernitis  gangrene of penis • STD – syphilis, gonorrhea, HSV, Candida • purulent  ulcerations  scarring

1c. neoplasms • benign x malignant • epithelial x mesenchymal

Benign neoplasms • Condyloma acuminatum (venereal wart) • HPV 6, 11 - STD • coronal sulcus • G: multiple papillomas, mm – cm • M: hyperplasia, akanthosis, parakeratosis • koilocytes – perinuclear halo

Malignant neoplasms – carcinoma in situ • Bowen disease > 35 years shaft of penis + scrotum: grey-white firm plaque + visceral neoplasms • Erythroplasia de Queyrat glans penis + prepuce: soft, reddish patch • Bowenoid papulosis young men, sex, brown papules, HPV 16

Malignant neoplasms - carcinoma • penis > scrotum • Africa, America, Asia • > 40 years • glans penis, prepuce • exophytic x endophytic • squamous cell Ca • locally aggressive, LN metastases • 5-year survival: 70%

2. Testis and epididymis • a. congenital anomalies • b. regressive changes and scrotal enlargement • c. inflammatory lesions • d. neoplasms

2a. Congenital anomalies – failure of descent • retroperitoneum  inguinal canal  scrotum • spontanneous descent until 1st year • adults = cryptorchidism • prevalence: 0,3 - 0,8% • idiopathic

2a. Congenital anomalies – failure of descent • unilateral x bilateral (25%) • M: tubular atrophy + hyperplasia of Leydig • + changes in contralateral testis – blastoma in situ !!! • infertility • 30 - 50x  risk of germ cell tumor !!! •  orchiopexy < 2 years

2b. Regressive changes • torsion  infarction  necrosis • acute urological emergency + shock • atrophy • senium • vascular • hormonal

2b. Scrotal enlargement • hydrocele = serous fluid in t. vaginalis + inflammation, tumor • hematocele = blood in t. vaginalis + torsion, injury • varicocele = varices plexus pampiniformis

2c. Inflammatory lesions • epididymis> testis • + urinary tract and prostate infection • children: Gramm- bacteria • adults: N. gonorrhoe, Ch. trachomatis • old: E. coli. Pseudomonas spp. • epididymis = epididymitis • testis = orchitis

2c. Inflammatory lesions • suppurative e.: abscesses  scarring  chronic form  infertility • non-suppurative o.: mumps adults (20%) infertility ? • TBC e.: solitary hematogennous metastasis + prostate + seminal vesicles

2d. Testicular neoplasms • 1. germ cell • 2. stromal – Sertoli and Leydig cells • 3. combination (1. + 2.) - gonadoblastoma • 4. other – malignant lymphoma, … • 5. secondary – ALL, Ca prostate, Ca GIT, lungs • incidence 2-3 / 100 000 males !!! most common male tumors in 3rd and 4th decades !!!

1. Germ cell tumors • seminoma x non-seminomas • seminoma: atypic germ cell • non-seminomas: totipotential cell  somatic and/or extraembryonic lines • 90% testicular tumors • malignant

Seminoma • most common • malignant • 40 years • G: solid, homogennous, grey-white • intratesticular spread • M: polygonal cells + clear cytoplasm fibrous septa + lymphocytes

Non-seminomas • embryonal carcinoma (ECa) • yolk sac tumor (YST) • choriocarcinoma (ChCa) • teratomas (T)

Embryonal carcinoma •  malignant • 20 – 30 years • G: small, grey-white + hemorrhages, necrosis • M: solid, trabecular, papillary, glandular irregular large cells  hCG

Yolk sac tumor • malignant • children • G: large, solid, yellow-white • M: polygonal cells + loose stroma Schiller – Duvall bodies  AFP

Choriocarcinoma • malignant • trophoblast • G: irregular mass, hemorrhages, necrosis • M: irregular cells  hCG

Teratomas • somatic cell lines • children, young • differentiated mature – cystic  puberty – benign > puberty – uncertain • differentiated immature – uncertain

Mixed germ cell tumors • (ECa + YST + T + ChCa) + seminoma • teratocarcinoma: T + ECa • extensive sampling

Clinical features • cryptorchidism:  risk • unilateral • metastases – LN – paraaortic - seminoma - blood – lungs, liver, brain, bones - non - seminomas

2. Stromal tumors • Sertoli + Leydig cells • androgens + estrogens • uncommon • adults • 90% benign

3. Prostate • a. inflammatory lesions • b. nodular hyperplasia • c. neoplasms

3a. inflammations - prostatitis • acute bacterial p. – E. coli, Gramm-, N. gonorrhoe from urethra, urinary bladder, cystoscopy • G: enlargement, edema, abscesses, necrosis • M: neutrophiles in glands • chronic p. – bacterial x abacterial • TBC p. – solitary hematogennous metastasis  spread to urinary tract

3b. Nodular hyperplasia •    , > 50 years • hormonal dysbalance • periurethral zone – urethral compression • G: nodules – various collor and consistency • M: proliferation of glands + fibromuscular stroma cysts, bi-layered epithelium, c. amylacea •  trabecular hypertrophy UB, urocystitis !!! NO relationship to carcinoma !!!

3c. Neoplasms - adenocarcinoma • very common • ethiology:  age, androgens • late dg. – dysuria, hematuria, metastasis • per rectum + biopsy + blood: PSA • peripheral zone • G: firm, yellowish • M: various glandular structure • !!! uni-layered epithelium !!!

3c. Neoplasms - adenocarcinoma • local spread – prostate, urinary bladder, rectum, pelvis + perineural spread • LN – pelvic LN • blood – bones (osteoplastic) - lungs, liver • grading – Gleason score: – glandular differentiation + growth structure • 10-year survival: early dg. 90% x late dg. 10-40%

Pathology of Male Genital System