Male genital system

MALE GENITAL SYSTEM PENIS SCROTUM, TESTIS, & EPIDIDYMIS PROSTATE

PENIS MALFORMATIONS INFLAMMATORY LESIONS NEOPLASMS

MALFORMATIONS OF THE PENIS Abnormal location of urethral orifice along penile shaft Hypospadias (ventral aspect) Most common (1/250 live male births) Epispadias (dorsal aspect)

Hypospadias (ventral)

Epispadias (dorsal) Epispadias

HYPOSPADIAS AND EPISPADIAS May be associated with other genital abnormalities Inguinal hernias Undescended testes Clinical consequences Constriction of orifice Urinary tract obstruction Urinary tract infection Impaired reproductive function

INFLAMMATORY LESIONS OF THE PENIS Sexually transmitted diseases Balanitis (balanoposthitis) Inflammation of the glans (plus prepuce) Associated with poor local hygiene in uncircumcised men Smegma Distal penis is red, swollen, tender +/- Purulent discharge

INFLAMMATORY LESIONS OF THE PENIS PHIMOSIS PREPUCE CANNOT BE EASILY RETRACTED OVER GLANS MAY BE CONGENITAL USUALLY ASSOCIATED WITH BALANOPOSTHITIS AND SCARRING PARAPHIMOSIS (TRAPPED GLANS) URETHRAL CONSTRICTION

INFLAMMATORY LESIONS OF THE PENIS FUNGAL INFECTIONS CANDIDIASIS ESPECIALLY IN DIABETICS EROSIVE, PAINFUL, PRURITIC CAN INVOLVE ENTIRE MALE EXTERNAL GENITALIA

NEOPLASMS OF THE PENIS SQUAMOUS CELL CARCINOMA (SCC) EPIDEMIOLOGY UNCOMMON – LESS THAN 1 % OF CA IN US MEN UNCIRCUMCISED MEN BETWEEN 40 AND 70 PATHOGENESIS POOR HYGIENE, SMEGMA, SMOKING HUMAN PAPILLOMA VIRUS (16 AND 18) CIS FIRST, THEN PROGRESSION TO INVASIVE SQUAMOUS CELL CARCINOMA

Squamous Cell Carcinoma

SCC OF THE PENIS Clinical course Usually indolent Locally invasive Has spread to inguinal lymph nodes in 25% of cases at presentation Distant mets rare 5 yr survival 70% without ln mets 27% with ln mets

LESIONS INVOLVING THE SCROTUM Inflammation Tinea cruris (jock itch) Superficial dermatophyte infection Scaly, red, annular plaques, pruritic Inguinal crease to upper thigh Squamous cell carcinoma Historical significance Chimney sweeps used to have this

LESIONS INVOLVING THE SCROTUM Scrotal enlargement Hydrocele - most common cause Accumulation of serous fluid within tunica vaginalis Infections, tumor, idiopathic Hematocele Chylocele Filiariasis - elephantiasis Testicular disease

Hydrocele

LESIONS OF THE TESTES CONGENITAL INFLAMMATORY NEOPLASTIC

Cryptorchidism and testicular atrophy Failure of testicular descent Epidemiology About 1% of males (at 1 yr) Right > left, 10% bilateral Pathogenesis Hormonal abnormalities Testicular abnormalities Mechanical problems

Atrophic testes secondary to cryporchidism

Cryptorchidism and testicular atrophy Clinical course When unilateral, may see atrophy in contralateral testis Sterility Increased risk of malignancy (3-5x) Orchiopexy May help prevent atrophy May not eliminate risk of malignancy

Other causes of testicular atrophy Chronic ischemia Inflammation or trauma Hypopituitarism Excess female sex hormones Therapeutic administration Cirrhosis Malnutrition Irradiation Chemotherapy

Inflammatory lesions of the testis Usually involve the epididymis first Sexually transmitted diseases Nonspecific epididymitis and orchitis Secondary to uti Bacterial and non-bacterial Swelling, tenderness Acute inflammatory infiltrate

Inflammatory lesions of the testis Mumps 20% of adult males with mumps Edema and congestion Chronic inflammatory infiltrate May cause atrophy and sterility Tuberculosis Granulomatous inflammation Caseous necrosis

TESTICULAR NEOPLASMS Epidemiology Most important cause of painless enlargement of testis 5/100,000 males, whites > blacks (us) Increased frequency in siblings Peak incidence 20-34 yrs Most are malignant Associated with germ cell maldevelopment Cryptorchidism (10%) Testicular dysgenesis(xxy)

TESTICULAR NEOPLASMS Pathogenesis 95% arise from germ cells ISOCHROMOSOME 12, i(12p), IS A COMMON FINDING Intratubular germ cell neoplasms Rarely arise from sertoli cells or leydig cells These are often benign Lymphoma Men > 60 yo

WHO CLASSIFICATION OF TESTICULAR TUMORS One histologic pattern (60%) Seminomas (50%) Embryonal carcinoma Yolk sac tumor Choriocarcinoma Teratoma Multiple histologic patterns (40%) Embryonal ca + teratoma Choriocarcinoma + other Other combinations

HISTOGENESIS OF TESTICULAR NEOPLASMS (PEAK INCIDENCE) GERM CELL PRECURSOR GONADAL DIFFERENTIATION TOTIPOTENTIAL DIFFERENTIATION (NONSEMINOMA) SEMINOMA (40-50 Y) EMBRYONAL CA (UNDIFFERENTIATED) (20-30 Y) SOMATIC DIFFERENTIATION TROPHOBLASTIC DIFFERENTIATION YOLK SAC DIFF TERATOMA (ALL AGES) CHORIOCARCINOMA (20-30 Y) hCG + YOLK SAC TUMOR (< 3 Y) AFP + MATURE IMMATURE MALIGNANT TX

Seminoma, with focal hemorrhage and necrosis Seminoma, focal hemorrhage and necrosis. These features are usually not seen, and often indicate presence of other more aggressive cell types. Usually soft, well-demarcated, homogeneous, gray-white and bulge from the cut surface.

Normal testicular tissue Normal testicular tissue, showing seminiferous tubules and interstitial stroma

Seminoma Semimona. Large, well-demarcated cells with distinct borders, clear (glygocen rich) cytoplasm, round nuclei, prominent nucleoli. Lymphocytes are prominent.

Semimona. Large, well-demarcated cells with distinct borders, clear (glygocen rich) cytoplasm, round nuclei, prominent nucleoli.

Seminoma Syncytiotrophoblast Seminoma with syncytiotrophoblast, c/w trophoblastic differentiation. Syncytiotrophoblast

Dermoid Cyst Dermoid cyst.

Immature Teratoma With Embryonal Carcinoma

Clinical course Usually present with painless enlargement of testis May present with metastases Nonseminomas (more common) Lymph nodes, liver and lungs Seminomas Usually just regional lymph nodes TUMOR MARKERS (hcg AND AFP) Treatment success depends on histology and stage Seminomas very sensitive to both radio- and chemotherapy

Thank You