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

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

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Page 1: Pathology of Male Genital System Jan Laco, M.D., Ph.D

Pathology of Male Genital Pathology of Male Genital SystemSystem

Jan Laco, M.D., Ph.D.

Page 2: Pathology of Male Genital System Jan Laco, M.D., Ph.D

SummarySummary

1. Penis and scrotum

2. Testis and epididymis

3. Prostate

Page 3: Pathology of Male Genital System Jan Laco, M.D., Ph.D

1. Penis and scrotum1. Penis and scrotum

a. malformations

b. inflammatory lesions

c. neoplasms

Page 4: Pathology of Male Genital System Jan Laco, M.D., Ph.D

1a. malformations1a. malformations

Hypospadias + epispadias

= abnormal location of distal urethral orifice

+ outer genital anomaliesepispadias + urinary bladder exstrophycomplications: obstruction

infections

infertility

Page 5: Pathology of Male Genital System Jan Laco, M.D., Ph.D

1a. malformations1a. malformations

Phimosis

= stenosis of prepuce (+ acquired)

smegma infection, urinary retention

Paraphimosis

= stenotic prepuce in coronal sulcus

penis congestion, infarction

Page 6: Pathology of Male Genital System Jan Laco, M.D., Ph.D

1b. inflammatory lesions1b. inflammatory lesions

glans penis – balanitisprepuce – posthitiscavernitis gangrene of penisSTD – syphilis, gonorrhea, HSV, Candidapurulent ulcerations scarring

Page 7: Pathology of Male Genital System Jan Laco, M.D., Ph.D

1c. neoplasms1c. neoplasms

benign x malignant

epithelial x mesenchymal

Page 8: Pathology of Male Genital System Jan Laco, M.D., Ph.D

Benign neoplasmsBenign neoplasms

Condyloma acuminatum (venereal wart)HPV 6, 11 - STDcoronal sulcusG: multiple papillomas, mm – cmM: hyperplasia, akanthosis, parakeratosiskoilocytes – perinuclear halo

Page 9: Pathology of Male Genital System Jan Laco, M.D., Ph.D

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

Page 10: Pathology of Male Genital System Jan Laco, M.D., Ph.D

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%

Page 11: Pathology of Male Genital System Jan Laco, M.D., Ph.D

SummarySummary

1. Penis and scrotum

2. Testis and epididymis

3. Prostate

Page 12: Pathology of Male Genital System Jan Laco, M.D., Ph.D

2. Testis and epididymis2. Testis and epididymis

a. congenital anomalies

b. regressive changes and scrotal enlargement

c. inflammatory lesions

d. neoplasms

Page 13: Pathology of Male Genital System Jan Laco, M.D., Ph.D

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

Page 14: Pathology of Male Genital System Jan Laco, M.D., Ph.D

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

Page 15: Pathology of Male Genital System Jan Laco, M.D., Ph.D

2b. Regressive changes2b. Regressive changes

torsion infarction necrosis acute urological emergency + shock

atrophy – senium– vascular– hormonal

Page 16: Pathology of Male Genital System Jan Laco, M.D., Ph.D

2b. Scrotal enlargement2b. Scrotal enlargement

hydrocele = serous fluid in t. vaginalis

+ inflammation, tumorhematocele = blood in t. vaginalis

+ torsion, injury

varicocele = varices plexus pampiniformis

Page 17: Pathology of Male Genital System Jan Laco, M.D., Ph.D

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

Page 18: Pathology of Male Genital System Jan Laco, M.D., Ph.D

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

Page 19: Pathology of Male Genital System Jan Laco, M.D., Ph.D

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 !!!

Page 20: Pathology of Male Genital System Jan Laco, M.D., Ph.D

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

Page 21: Pathology of Male Genital System Jan Laco, M.D., Ph.D

SeminomaSeminoma

most common malignant40 yearsG: solid, homogennous, grey-whiteintratesticular spreadM: polygonal cells + clear cytoplasm

fibrous septa + lymphocytes

Page 22: Pathology of Male Genital System Jan Laco, M.D., Ph.D

Non-seminomasNon-seminomas

embryonal carcinoma (ECa)

yolk sac tumor (YST)

choriocarcinoma (ChCa)

teratomas (T)

Page 23: Pathology of Male Genital System Jan Laco, M.D., Ph.D

Embryonal carcinomaEmbryonal carcinoma

malignant20 – 30 yearsG: small, grey-white

+ hemorrhages, necrosisM: solid, trabecular, papillary, glandular

irregular large cells

hCG

Page 24: Pathology of Male Genital System Jan Laco, M.D., Ph.D

Yolk sac tumor Yolk sac tumor

malignantchildrenG: large, solid, yellow-whiteM: polygonal cells + loose stroma

Schiller – Duvall bodies

AFP

Page 25: Pathology of Male Genital System Jan Laco, M.D., Ph.D

ChoriocarcinomaChoriocarcinoma

malignanttrophoblastG: irregular mass, hemorrhages, necrosisM: irregular cells

hCG

Page 26: Pathology of Male Genital System Jan Laco, M.D., Ph.D

TeratomasTeratomas

somatic cell lineschildren, youngdifferentiated mature – cystic

puberty – benign

> puberty – uncertaindifferentiated immature – uncertain

Page 27: Pathology of Male Genital System Jan Laco, M.D., Ph.D

Mixed germ cell tumorsMixed germ cell tumors

(ECa + YST + T + ChCa) + seminomateratocarcinoma: T + ECaextensive sampling

Page 28: Pathology of Male Genital System Jan Laco, M.D., Ph.D

Clinical featuresClinical features

cryptorchidism: riskunilateralmetastases

– LN – paraaortic

- seminoma

- blood – lungs, liver, brain, bones

- non - seminomas

Page 29: Pathology of Male Genital System Jan Laco, M.D., Ph.D

2. Stromal tumors2. Stromal tumors

Sertoli + Leydig cellsandrogens + estrogensuncommonadults90% benign

Page 30: Pathology of Male Genital System Jan Laco, M.D., Ph.D

SummarySummary

1. Penis and scrotum

2. Testis and epididymis

3. Prostate

Page 31: Pathology of Male Genital System Jan Laco, M.D., Ph.D

3. Prostate3. Prostate

a. inflammatory lesions

b. nodular hyperplasia

c. neoplasms

Page 32: Pathology of Male Genital System Jan Laco, M.D., Ph.D

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

Page 33: Pathology of Male Genital System Jan Laco, M.D., Ph.D

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 !!!

Page 34: Pathology of Male Genital System Jan Laco, M.D., Ph.D

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 !!!

Page 35: Pathology of Male Genital System Jan Laco, M.D., Ph.D

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%