Pathology of Male Genital System

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Pathology of Male Genital System

• Jan Laco, M.D., Ph.D.

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Summary

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

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1. Penis and scrotum

• a. malformations
• b. inflammatory lesions
• c. neoplasms

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1a. malformations

• Hypospadias epispadias
• abnormal location of distal urethral orifice
• outer genital anomalies
• epispadias urinary bladder exstrophy
• complications obstruction
  infections
• infertility

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1a. malformations

• Phimosis
• stenosis of prepuce ( acquired)
• ? smegma ? infection, urinary retention
• Paraphimosis
• stenotic prepuce in coronal sulcus
• ? penis congestion, infarction

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1b. inflammatory lesions

• glans penis balanitis
• prepuce posthitis
• cavernitis ? gangrene of penis
• STD syphilis, gonorrhea, HSV, Candida
• purulent ? ulcerations ? scarring

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1c. neoplasms

• benign x malignant
• epithelial x mesenchymal

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Benign neoplasms

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

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Malignant neoplasms carcinoma in situ

• Bowen disease
• gt 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

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Malignant neoplasms - carcinoma

• penis gt scrotum
• Africa, America, Asia
• gt 40 years
• glans penis, prepuce
• exophytic x endophytic
• squamous cell Ca
• locally aggressive, LN metastases
• 5-year survival 70

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Summary

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

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2. Testis and epididymis

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

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2a. Congenital anomalies failure of descent

• retroperitoneum ? inguinal canal ? scrotum
• spontanneous descent until 1st year
• adults cryptorchidism
• prevalence 0,3 - 0,8
• idiopathic

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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 lt 2 years

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2b. Regressive changes

• torsion ? infarction ? necrosis
• acute urological emergency shock
• atrophy
• senium
• vascular
• hormonal

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2b. Scrotal enlargement

• hydrocele serous fluid in t. vaginalis
• inflammation, tumor
• hematocele blood in t. vaginalis
• torsion, injury
• varicocele varices plexus pampiniformis

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2c. Inflammatory lesions

• epididymis gt testis
• urinary tract and prostate infection
• children Gramm- bacteria
• adults N. gonorrhoe, Ch. trachomatis
• old E. coli. Pseudomonas spp.
• epididymis epididymitis
• testis orchitis

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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

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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 !!!

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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

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Seminoma

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

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Non-seminomas

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

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Embryonal carcinoma

• ? malignant
• 20 30 years
• G small, grey-white
• hemorrhages, necrosis
• M solid, trabecular, papillary, glandular
• irregular large cells
• ? hCG

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Yolk sac tumor

• malignant
• children
• G large, solid, yellow-white
• M polygonal cells loose stroma
• Schiller Duvall bodies
• ? AFP

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Choriocarcinoma

• malignant
• trophoblast
• G irregular mass, hemorrhages, necrosis
• M irregular cells
• ? hCG

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Teratomas

• somatic cell lines
• children, young
• differentiated mature cystic
• ? puberty benign
• gt puberty uncertain
• differentiated immature uncertain

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Mixed germ cell tumors

• (ECa YST T ChCa) seminoma
• teratocarcinoma T ECa
• extensive sampling

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Clinical features

• cryptorchidism ? risk
• unilateral
• metastases
• LN paraaortic
• - seminoma
• - blood lungs, liver, brain, bones
• - non - seminomas

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2. Stromal tumors

• Sertoli Leydig cells
• androgens estrogens
• uncommon
• adults
• 90 benign

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Summary

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

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3. Prostate

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

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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

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3b. Nodular hyperplasia

• ? ? ? , gt 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 !!!

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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 !!!

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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