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Pathology of Male Genital System

Pathology of Male Genital System. Assoc. Professor Jan Laco, MD, PhD. Summary. 1. Penis and scrotum 2. Testis and epididymis 3. Prostate. 1. Penis and scrotum. a. malformations b. inflammatory lesions c. neoplasms. 1a. malformations. Hypospadias + epispadias

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Pathology of Male Genital System

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  1. Pathology of Male Genital System Assoc. Professor Jan Laco, MD, PhD

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

  3. 1. Penis and scrotum • a. malformations • b. inflammatory lesions • c. neoplasms

  4. 1a. malformations • Hypospadias + epispadias = abnormal location of distal urethral orifice + outer genital anomalies • epispadias + urinary bladder exstrophy • complications: obstruction infections infertility

  5. 1a. malformations • Phimosis = stenosis of prepuce (+ acquired)  smegma  infection, urinary retention • Paraphimosis = stenotic prepuce in coronal sulcus  penis congestion, infarction

  6. 1b. inflammatory lesions • glans penis – balanitis • prepuce – posthitis • cavernitis  gangrene of penis • STD – syphilis, gonorrhea, HSV, Candida • purulent  ulcerations  scarring

  7. 1c. neoplasms • benign x malignant • epithelial x mesenchymal

  8. Benign neoplasms • Condyloma acuminatum (venereal wart) • HPV 6, 11 - STD • coronal sulcus • G: multiple papillomas, mm – cm • M: hyperplasia, akanthosis, parakeratosis • koilocytes – shrinkage of nucleus + perinuclear halo

  9. Malignant neoplasms – carcinoma in situ (PeIN) • 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

  10. Malignant neoplasms - carcinoma • penis > scrotum (chimney sweepers) • Africa, America, Asia • > 40 years, poor hygiene, phimosis, balanitis, HPV • glans penis, prepuce • exophytic x endophytic • squamous cell carcinoma • locally aggressive, LN metastases • 5-year survival: 70 %

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

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

  13. 2a. Congenital anomalies – failure of descent • retroperitoneum  inguinal canal  scrotum • spontanneous descent until 1st year • adults = cryptorchidism • prevalence: 0.3 – 0.8 % • mechanical x hormonal x idiopathic

  14. 2a. Congenital anomalies – failure of descent • unilateral x bilateral (25 %) • M: tubular atrophy + Leydig cells hyperplasia • + dysplastic germ cells (blastoma in situ) !!! • + changes in contralateral testis • infertility • 30 - 50x  risk of germ cell tumor !!! •  orchiopexy < 2 years

  15. 2b. Regressive changes • torsion  infarction  necrosis • acute urological emergency + shock • atrophy • senium • vascular • hormonal

  16. 2b. Scrotal enlargement • hydrocele = serous fluid in t. vaginalis + inflammation, tumor • hematocele = blood in t. vaginalis + torsion, injury • chylocele = lymph accumulation • spermatocele = sperms in dilated tubuli (ep.) • varicocele = varices of plexus pampiniformis

  17. 2c. Inflammatory lesions • epididymis> testis • + urinary tract and prostate infection • children: Gram- bacteria • adults: N. gonorrhoe, Ch. trachomatis • old: E. coli, Pseudomonas spp. • epididymis = epididymitis • testis = orchitis

  18. 2c. Inflammatory lesions • suppurative epididymitis • abscesses  scarring  chronic form  infertility • non-suppurative orchitis • mumps - adults (20 %) - infertility ? • TBC epididymitis • solitary hematogennous metastasis • + prostate + seminal vesicles

  19. 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 of prostate, GIT, lungs • incidence 2-3 / 100,000 males !!! most common male tumors in 3rd and 4th decades !!!

  20. 1. Germ cell tumors • seminoma x non-seminomas • seminoma: atypical germ cell • non-seminomas: totipotential cell  somatic and/or extraembryonic lines • 90 % testicular tumors • malignant

  21. Seminoma • most common • malignant • peak - 40 years • G: solid, homogennous, grey-white • intratesticular spread • M: polygonal cells + clear cytoplasm fibrous septa + lymphocytes

  22. Non-seminomas • embryonal carcinoma (ECa) • yolk sac tumor (YST) • choriocarcinoma (ChCa) • teratomas (T)

  23. Embryonal carcinoma •  malignant • 20 – 30 years • G: small, grey-white + hemorrhages, necrosis • M: solid, trabecular, papillary, glandular irregular large epithelial cells

  24. Yolk sac tumor • malignant • children • G: large, solid, yellow-white • M: polygonal cells + loose stroma Schiller – Duvall bodies  AFP

  25. Choriocarcinoma • malignant • trophoblast • G: irregular mass, hemorrhages, necroses • M: irregular trophoblastic cells    hCG

  26. Teratomas • somatic cell lines • children, young • differentiated mature – cystic  puberty – benign > puberty – uncertain behaviour • differentiated immature – uncertain behaviour

  27. Mixed germ cell tumors • (ECa + YST + T + ChCa) + seminoma • teratocarcinoma: T + ECa • extensive sampling !!!

  28. Clinical features • risk factor: cryptorchidism • unilateral • metastases – LN – retroperitoneal paraaortic - seminoma - blood – lungs, liver, brain, bones - non - seminomas

  29. 2. Stromal tumors • Sertoli + Leydig cells • androgens + estrogens • uncommon • adults • 90 % benign

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

  31. 3. Prostate • a. inflammatory lesions • b. nodular hyperplasia • c. neoplasms

  32. 3a. inflammations - prostatitis • acute bacterial prostatitis • E. coli, Gram-, N. gonorrhoae • from urethra, urinary bladder, cystoscopy • G: enlargement, edema, abscesses, necroses • M: neutrophils in glands • chronic prostatitis • bacterial x abacterial • TBC prostatitis • solitary hematogennous metastasis  spread to urinary tract

  33. 3b. Nodular hyperplasia •    frequent, > 50 years • hormonal dysbalance • periurethral zone – urethral compression • G: nodules – various colour and consistency • M: proliferation of glands + fibromuscular stroma cysts, bi-layered epithelium, corpora amylacea •  trabecular hypertrophy of UB, urocystitis !!! NO relationship to carcinoma !!! CAVE: co-incidence !!!

  34. 3c. Neoplasms - adenocarcinoma • very common • etiology:  age, androgens • late dg. – dysuria, hematuria, metastasis • per rectum (DRE) + biopsy + blood: PSA • peripheral zone • G: firm, yellowish • M: various glandular structure • !!! uni-layered epithelium !!!

  35. 3c. Neoplasms - adenocarcinoma • local spread – prostate, urinary bladder, rectum, pelvis + perineural spread • LN – pelvic LN • blood – bones (osteoplastic) - lungs, liver • grading – Gleason score (2-10) + ISUP grading: – glandular differentiation + growth structure • 10-year survival: early dg. 90% x late dg. 10-40%

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