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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

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summary
Summary
  • 1. Penis and scrotum
  • 2. Testis and epididymis
  • 3. Prostate
1 penis and scrotum
1. Penis and scrotum
  • a. malformations
  • b. inflammatory lesions
  • c. neoplasms
1a malformations
1a. malformations
  • Hypospadias + epispadias

= abnormal location of distal urethral orifice

+ outer genital anomalies

  • epispadias + urinary bladder exstrophy
  • complications: obstruction infections

infertility

1a malformations1
1a. malformations
  • Phimosis

= stenosis of prepuce (+ acquired)

 smegma  infection, urinary retention

  • Paraphimosis

= stenotic prepuce in coronal sulcus

 penis congestion, infarction

1b inflammatory lesions
1b. inflammatory lesions
  • glans penis – balanitis
  • prepuce – posthitis
  • cavernitis  gangrene of penis
  • STD – syphilis, gonorrhea, HSV, Candida
  • purulent  ulcerations  scarring
1c neoplasms
1c. neoplasms
  • benign x malignant
  • epithelial x mesenchymal
benign neoplasms
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
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
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%
summary1
Summary
  • 1. Penis and scrotum
  • 2. Testis and epididymis
  • 3. Prostate
2 testis and epididymis
2. Testis and epididymis
  • a. congenital anomalies
  • b. regressive changes and scrotal enlargement
  • c. inflammatory lesions
  • d. neoplasms
2a congenital anomalies failure of descent
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 descent1
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
2b. Regressive changes
  • torsion  infarction  necrosis
  • acute urological emergency + shock
  • atrophy
    • senium
    • vascular
    • hormonal
2b scrotal enlargement
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
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 lesions1
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
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
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
Seminoma
  • most common
  • malignant
  • 40 years
  • G: solid, homogennous, grey-white
  • intratesticular spread
  • M: polygonal cells + clear cytoplasm

fibrous septa + lymphocytes

non seminomas
Non-seminomas
  • embryonal carcinoma (ECa)
  • yolk sac tumor (YST)
  • choriocarcinoma (ChCa)
  • teratomas (T)
embryonal carcinoma
Embryonal carcinoma
  •  malignant
  • 20 – 30 years
  • G: small, grey-white

+ hemorrhages, necrosis

  • M: solid, trabecular, papillary, glandular

irregular large cells

 hCG

yolk sac tumor
Yolk sac tumor
  • malignant
  • children
  • G: large, solid, yellow-white
  • M: polygonal cells + loose stroma

Schiller – Duvall bodies

 AFP

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

 hCG

teratomas
Teratomas
  • somatic cell lines
  • children, young
  • differentiated mature – cystic

 puberty – benign

> puberty – uncertain

  • differentiated immature – uncertain
mixed germ cell tumors
Mixed germ cell tumors
  • (ECa + YST + T + ChCa) + seminoma
  • teratocarcinoma: T + ECa
  • extensive sampling
clinical features
Clinical features
  • cryptorchidism:  risk
  • unilateral
  • metastases

– LN – paraaortic

- seminoma

- blood – lungs, liver, brain, bones

- non - seminomas

2 stromal tumors
2. Stromal tumors
  • Sertoli + Leydig cells
  • androgens + estrogens
  • uncommon
  • adults
  • 90% benign
summary2
Summary
  • 1. Penis and scrotum
  • 2. Testis and epididymis
  • 3. Prostate
3 prostate
3. Prostate
  • a. inflammatory lesions
  • b. nodular hyperplasia
  • c. neoplasms
3a inflammations prostatitis
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
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
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 adenocarcinoma1
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%