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%