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This pdf is part-1 of UG lectures on Male genital tract pathology.
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Male Genital Tract Pathology-1
Dr.CSBR.Prasad, M.D.
Testis
CSBRP-July-2012
CONGENITAL ANOMALIES
• Cryptorchidism (Undescended testes )
• Synorchism (Fused testes)
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Cryptorchidism
(Undescended testes)
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• Frequency:1% (at the end of 1st year)
• Bilateral in 25%
• May be associated with: • GUT abnormalities
– Hypospedias
• Testicular descent:
– Transabdominal phase
• Müllerian-inhibiting substance
– Inguinoscrotal phase
• Androgen induced release of Calcitonin gene related peptide
from genitofemoral nerve
Histology:
• Arrest in maturation of germ cells
• Hyalinization of basement membrane
• Prominent Leydig cells
• Paucity of germ cells is also seen in the
contralateral descended testis
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Cryptorchidism
(Undescended testes)
Normal testis
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The seminiferous tubules in this cryptorchid testis are completely atrophic.
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Complications:
– Sterility
– Inguinal hernia
– Testicular cancers
– Prone for trauma (inguinal testis)
Surgical correction: (Orchiopexy)
– Before 2years of age – for fertility
– Before 10yrs of age – for protection against cancer
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Cryptorchidism
(Undescended testis)
• When you are faced with intriguing
intraabdominal / retroperitoneal tumor,
always examine the scrotum / testis
REMEMBER
• Scrotum is 10th compartment of abdomen
• Abdominal examination is never complete
without scrotal examination
CSBRP-July-2012
Pathology Pearls
Torsion - testis
•Twisting of spermatic cord with occlusion of veins and
patent arterial supply – results in vascular engorgement and
hemorrhagic infarction
•Two types: neonatal, adult (seen in adolescents)
•Anatomic defect: testis exhibits increased mobility (bell-
clapper abnormality)
•Should be untwisted within 6hrs to restore viability
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This testis has undergone infarction following testicular torsion. CSBRP-July-2012
Torsion of testis
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Testicular torsion: In this case, the condition has proceeded to
hemorrhagic infarction. Note the outlines of the tubules remaining, but
there is loss of nuclear detail, and the interstitium is hemorrhagic.
Testicular atrophy
• Atherosclerosis
• Inflammatory lesions (Orchitis)
• Cryptorchidism
• Hypopituitarism
• Malnutrition
• Irradiation
• Excessive Estrogens:
• Antiandrogens in Tx of prostatic cancer
• Cirrhosis of liver
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Note that the testis on the left is small and pale white while the opposite testis appears
normal. The left testis did not descend into the scrotum during development, but
remained in the abdomen, a condition called a cryptorchid testis.
On the left is a normal testis.
On the right is a testis that has undergone atrophy.
Here is another example of focal atrophy of seminiferous tubules along with a few residual
normal tubules in which there is active spermatogenesis. There is focal atrophy of the testicular
tubules seen here. The most common infectious cause for this finding is mumps orchitis.
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Hydrocele • Accumulation of serous fluid in tunica
vaginalis
• No apparent cause
• Mistaken for tumors
• Transillumination is positive
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Upon physical examination, the scrotum appears enlarged. This enlargement is not
painful, and there is no firm mass palpable. The enlargement is due to a fluid collection
around the testis known as a hydrocele. CSBRP-July-2012
One diagnostic technique to detect a hydrocele is transillumination of the
fluid-filled space with a light applied to the scrotum. The fluid will
transmit the light, while a solid mass will not.
There is scrotal enlargment with fluid density from a hydrocele on the
right. A hydrocele is a painless collection of clear fluid around the testis.
Hydroceles generally develop over years.
A large hydrocele of the testis.
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A cross section through a frozen hydrocele demonstrates the relationship of the fluid to
the testis. The fluid in a hydrocele accumulates slowly but can produce a mass effect
and discomfort.
Hematocele
Chylocele
Spermatocele
Varicocele
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Varicocele • Prominent dilation of the pampiniform
plexus of veins posterior to the testis
• The increased blood flow increases the
temperature of testicular tubules, thus
inhibiting spermatogenesis
• One possible cause for infertility is a
varicocele
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Varicocele, a lesion that consists of a prominent dilation of the
pampiniform plexus of veins posterior to the testis. CSBRP-July-2012
Acute LEFT varicocele
RCC growing into renal vein causes
obstruction to left testicular vein which
drains into it, there by causing engorgement
of left pampiniform plexus.
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Pathology Pearls
Name some tumors that enter the
major vessels and even reach right
side of the heart?
Renal cell carcinoma
Hepatocellular carcinoma
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Pathology Pearls
Calcinosis of scrotum
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Granulomatous orchitis
• Seen in middle aged men
• Unilateral testicular enlargement
• Usually tender
• Granulomas confined to seminiferous
tubules (cf: TB orchitis)
• Probably autoimmune
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Testicular Tuberculosis
[Tuberculous Orchitis]
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Tuberculosis almost invariably
begins in the epididymis and may
spread to the testis
Syphilis, primarily involves the testis
Pathology Pearls
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E N D
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Contact:
Dr.CSBR.Prasad, M.D.,
Associate Professor of Pathology,
Sri Devaraj Urs Medical College,
Kolar-563101,
Karnataka,
INDIA.