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Pathology of Male Genital Pathology of Male Genital SystemSystem
Jan Laco, M.D., Ph.D.
SummarySummary
1. Penis and scrotum
2. Testis and epididymis
3. Prostate
1. Penis and scrotum1. Penis and scrotum
a. malformations
b. inflammatory lesions
c. neoplasms
1a. malformations1a. malformations
Hypospadias + epispadias
= abnormal location of distal urethral orifice
+ outer genital anomaliesepispadias + urinary bladder exstrophycomplications: obstruction
infections
infertility
1a. malformations1a. malformations
Phimosis
= stenosis of prepuce (+ acquired)
smegma infection, urinary retention
Paraphimosis
= stenotic prepuce in coronal sulcus
penis congestion, infarction
1b. inflammatory lesions1b. inflammatory lesions
glans penis – balanitisprepuce – posthitiscavernitis gangrene of penisSTD – syphilis, gonorrhea, HSV, Candidapurulent ulcerations scarring
1c. neoplasms1c. neoplasms
benign x malignant
epithelial x mesenchymal
Benign neoplasmsBenign neoplasms
Condyloma acuminatum (venereal wart)HPV 6, 11 - STDcoronal sulcusG: multiple papillomas, mm – cmM: hyperplasia, akanthosis, parakeratosiskoilocytes – perinuclear halo
Malignant neoplasms – Malignant neoplasms – carcinoma in situ 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 - Malignant neoplasms - carcinomacarcinoma
penis > scrotum Africa, America, Asia > 40 years glans penis, prepuce exophytic x endophytic squamous cell Ca locally aggressive, LN metastases 5-year survival: 70%
SummarySummary
1. Penis and scrotum
2. Testis and epididymis
3. Prostate
2. Testis and epididymis2. Testis and epididymis
a. congenital anomalies
b. regressive changes and scrotal enlargement
c. inflammatory lesions
d. neoplasms
2a. Congenital anomalies – 2a. Congenital anomalies – failure of descentfailure of descent
retroperitoneum inguinal canal scrotum
spontanneous descent until 1st yearadults = cryptorchidism prevalence: 0,3 - 0,8%idiopathic
2a. Congenital anomalies – 2a. Congenital anomalies – failure of descent 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 changes2b. Regressive changes
torsion infarction necrosis acute urological emergency + shock
atrophy – senium– vascular– hormonal
2b. Scrotal enlargement2b. Scrotal enlargement
hydrocele = serous fluid in t. vaginalis
+ inflammation, tumorhematocele = blood in t. vaginalis
+ torsion, injury
varicocele = varices plexus pampiniformis
2c. Inflammatory lesions2c. Inflammatory lesions
epididymis > testis+ urinary tract and prostate infectionchildren: Gramm- bacteriaadults: N. gonorrhoe, Ch. trachomatisold: E. coli. Pseudomonas spp.epididymis = epididymitistestis = orchitis
2c. Inflammatory lesions2c. 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 neoplasms2d. 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 tumors1. Germ cell tumors
seminoma x non-seminomasseminoma: atypic germ cellnon-seminomas: totipotential cell
somatic and/or extraembryonic lines
90% testicular tumorsmalignant
SeminomaSeminoma
most common malignant40 yearsG: solid, homogennous, grey-whiteintratesticular spreadM: polygonal cells + clear cytoplasm
fibrous septa + lymphocytes
Non-seminomasNon-seminomas
embryonal carcinoma (ECa)
yolk sac tumor (YST)
choriocarcinoma (ChCa)
teratomas (T)
Embryonal carcinomaEmbryonal carcinoma
malignant20 – 30 yearsG: small, grey-white
+ hemorrhages, necrosisM: solid, trabecular, papillary, glandular
irregular large cells
hCG
Yolk sac tumor Yolk sac tumor
malignantchildrenG: large, solid, yellow-whiteM: polygonal cells + loose stroma
Schiller – Duvall bodies
AFP
ChoriocarcinomaChoriocarcinoma
malignanttrophoblastG: irregular mass, hemorrhages, necrosisM: irregular cells
hCG
TeratomasTeratomas
somatic cell lineschildren, youngdifferentiated mature – cystic
puberty – benign
> puberty – uncertaindifferentiated immature – uncertain
Mixed germ cell tumorsMixed germ cell tumors
(ECa + YST + T + ChCa) + seminomateratocarcinoma: T + ECaextensive sampling
Clinical featuresClinical features
cryptorchidism: riskunilateralmetastases
– LN – paraaortic
- seminoma
- blood – lungs, liver, brain, bones
- non - seminomas
2. Stromal tumors2. Stromal tumors
Sertoli + Leydig cellsandrogens + estrogensuncommonadults90% benign
SummarySummary
1. Penis and scrotum
2. Testis and epididymis
3. Prostate
3. Prostate3. Prostate
a. inflammatory lesions
b. nodular hyperplasia
c. neoplasms
3a. inflammations - 3a. inflammations - prostatitisprostatitis
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 hyperplasia3b. 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 - 3c. Neoplasms - adenocarcinomaadenocarcinoma
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 - 3c. Neoplasms - adenocarcinomaadenocarcinoma
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%