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Male genital system

Male genital system. MALE GENITAL SYSTEM. PENIS SCROTUM, TESTIS, & EPIDIDYMIS PROSTATE. PENIS. MALFORMATIONS INFLAMMATORY LESIONS NEOPLASMS. MALFORMATIONS OF THE PENIS. Abnormal location of urethral orifice along penile shaft Hypospadias (ventral aspect)

timothyjones
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Male genital system

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  1. Male genital system

  2. MALE GENITAL SYSTEM • PENIS • SCROTUM, TESTIS, & EPIDIDYMIS • PROSTATE

  3. PENIS • MALFORMATIONS • INFLAMMATORY LESIONS • NEOPLASMS

  4. MALFORMATIONS OF THE PENIS Abnormal location of urethral orifice along penile shaft • Hypospadias (ventral aspect) • Most common (1/250 live male births) • Epispadias (dorsal aspect)

  5. Hypospadias (ventral)

  6. Epispadias (dorsal)

  7. HYPOSPADIAS AND EPISPADIAS • May be associated with other genital abnormalities • Inguinal hernias • Undescended testes • Clinical consequences • Constriction of orifice • Urinary tract obstruction • Urinary tract infection • Impaired reproductive function

  8. INFLAMMATORY LESIONS OF THE PENIS • Sexually transmitted diseases • Balanitis (balanoposthitis) • Inflammation of the glans (plus prepuce) • Associated with poor local hygiene in uncircumcised men • Smegma • Distal penis is red, swollen, tender • +/- Purulent discharge

  9. INFLAMMATORY LESIONS OF THE PENIS • PHIMOSIS • PREPUCE CANNOT BE EASILY RETRACTED OVER GLANS • MAY BE CONGENITAL • USUALLY ASSOCIATED WITH BALANOPOSTHITIS AND SCARRING • PARAPHIMOSIS (TRAPPED GLANS) • URETHRAL CONSTRICTION

  10. INFLAMMATORY LESIONS OF THE PENIS • FUNGAL INFECTIONS • CANDIDIASIS • ESPECIALLY IN DIABETICS • EROSIVE, PAINFUL, PRURITIC • CAN INVOLVE ENTIRE MALE EXTERNAL GENITALIA

  11. NEOPLASMS OF THE PENIS • SQUAMOUS CELL CARCINOMA (SCC) • EPIDEMIOLOGY • UNCOMMON – LESS THAN 1 % OF CA IN US MEN • UNCIRCUMCISED MEN BETWEEN 40 AND 70 • PATHOGENESIS • POOR HYGIENE, SMEGMA, SMOKING • HUMAN PAPILLOMA VIRUS (16 AND 18) • CIS FIRST, THEN PROGRESSION TO INVASIVE SQUAMOUS CELL CARCINOMA

  12. Squamous Cell Carcinoma

  13. SCC OF THE PENIS • Clinical course • Usually indolent • Locally invasive • Has spread to inguinal lymph nodes in 25% of cases at presentation • Distant mets rare • 5 yr survival • 70% without ln mets • 27% with ln mets

  14. LESIONS INVOLVING THE SCROTUM • Inflammation • Tinea cruris (jock itch) • Superficial dermatophyte infection • Scaly, red, annular plaques, pruritic • Inguinal crease to upper thigh • Squamous cell carcinoma • Historical significance • Chimney sweeps used to have this

  15. LESIONS INVOLVING THE SCROTUM • Scrotal enlargement • Hydrocele - most common cause • Accumulation of serous fluid within tunica vaginalis • Infections, tumor, idiopathic • Hematocele • Chylocele • Filiariasis - elephantiasis • Testicular disease

  16. Hydrocele

  17. LESIONS OF THE TESTES • CONGENITAL • INFLAMMATORY • NEOPLASTIC

  18. Cryptorchidism and testicular atrophy • Failure of testicular descent • Epidemiology • About 1% of males (at 1 yr) • Right > left, 10% bilateral • Pathogenesis • Hormonal abnormalities • Testicular abnormalities • Mechanical problems

  19. Atrophic testes secondary to cryporchidism

  20. Cryptorchidism and testicular atrophy • Clinical course • When unilateral, may see atrophy in contralateral testis • Sterility • Increased risk of malignancy (3-5x) • Orchiopexy • May help prevent atrophy • May not eliminate risk of malignancy

  21. Other causes of testicular atrophy • Chronic ischemia • Inflammation or trauma • Hypopituitarism • Excess female sex hormones • Therapeutic administration • Cirrhosis • Malnutrition • Irradiation • Chemotherapy

  22. Inflammatory lesions of the testis • Usually involve the epididymis first • Sexually transmitted diseases • Nonspecific epididymitis and orchitis • Secondary to uti • Bacterial and non-bacterial • Swelling, tenderness • Acute inflammatory infiltrate

  23. Inflammatory lesions of the testis • Mumps • 20% of adult males with mumps • Edema and congestion • Chronic inflammatory infiltrate • May cause atrophy and sterility • Tuberculosis • Granulomatous inflammation • Caseous necrosis

  24. TESTICULAR NEOPLASMS • Epidemiology • Most important cause of painless enlargement of testis • 5/100,000 males, whites > blacks (us) • Increased frequency in siblings • Peak incidence 20-34 yrs • Most are malignant • Associated with germ cell maldevelopment • Cryptorchidism (10%) • Testicular dysgenesis(xxy)

  25. TESTICULAR NEOPLASMS • Pathogenesis • 95% arise from germ cells • ISOCHROMOSOME 12, i(12p), IS A COMMON FINDING • Intratubular germ cell neoplasms • Rarely arise from sertoli cells or leydig cells • These are often benign • Lymphoma • Men > 60 yo

  26. WHO CLASSIFICATION OF TESTICULAR TUMORS • One histologic pattern (60%) • Seminomas (50%) • Embryonal carcinoma • Yolk sac tumor • Choriocarcinoma • Teratoma • Multiple histologic patterns (40%) • Embryonal ca + teratoma • Choriocarcinoma + other • Other combinations

  27. HISTOGENESIS OF TESTICULAR NEOPLASMS (PEAK INCIDENCE) GERM CELL PRECURSOR GONADAL DIFFERENTIATION TOTIPOTENTIAL DIFFERENTIATION (NONSEMINOMA) SEMINOMA (40-50 Y) EMBRYONAL CA (UNDIFFERENTIATED) (20-30 Y) SOMATIC DIFFERENTIATION TROPHOBLASTIC DIFFERENTIATION YOLK SAC DIFF TERATOMA (ALL AGES) MATURE IMMATURE MALIGNANT TX YOLK SAC TUMOR (< 3 Y) AFP + CHORIOCARCINOMA (20-30 Y) hCG +

  28. Seminoma, with focal hemorrhage and necrosis

  29. Normal testicular tissue

  30. Seminoma

  31. Seminoma Syncytiotrophoblast

  32. Dermoid Cyst

  33. Immature Teratoma With Embryonal Carcinoma

  34. Clinical course • Usually present with painless enlargement of testis • May present with metastases • Nonseminomas (more common) • Lymph nodes, liver and lungs • Seminomas • Usually just regional lymph nodes • TUMOR MARKERS (hcg AND AFP) • Treatment success depends on histology and stage • Seminomas very sensitive to both radio- and chemotherapy

  35. Thank You

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