Male Genital System 1 Dr. Amitabha Basu MD

Penis Mal formations Inflammatory conditions Premalignant lesions and malignant conditions

Mal formations of penis Hypospadias Urethral opening below tip of penis on ventral surface. Epispadias : Urethral opening above the tip of penis on dorsal surface.

Epispadias: Infection and urinary incontinence.

Inflammation of penis and prepuce Banalities & Balanoprosthitis : Hyperemia and exudates.

Banalities & Balanoprosthitis Complications : Phimosis and Paraphimosis

Genital candidiacis Etiology: Diabetes Mellitus

Penis Premalignant lesions Malignant conditions

Premalignant lesions Etiology Carcinogens in smegma HPV type 16

Types of Premalignant lesions : Penis Carcinoma in situ ( Following types). Bowen disease (HPV type 16). Erythroplasia of Queyrat (HPV type 16) Bowenoid Papulosis (Etiology = Venerally transmitted diseases)

Bowen disease : gross – Solitary plaque like lesion

10 % progress to invasive carcinoma Bowen disease : micro – in situ carcinoma ; intact basement membrane ; severely dysplastic epithelium 10 % progress to invasive carcinoma

Malignant lesion pf Penis Etiology Types of malignancy Morphology Clinical features Squamous cell carcinoma Verrucous carcinoma

Etiology of carcinoma penis Carcinogens in smegma HPV type 16

Squamous cells carcinoma : penis This is a squamous cell carcinoma of the penis ( penectomy specimen )

Keratinized squamous cell carcinoma

Verrucous carcinoma : Papillary growth pattern- good prognosis.

Scrotun , Testis and epididymis Cryptorchidism Inflammatory conditions of testis Male infertility Hydrocele Hematocele, chylocele, elephantiasis Testicular torsion

Cryptorchidism : Definition Definition: crypto=hidden, orchid= testicle, Testis fails to descend in the scrotum by age 12 months. Cause: Hormonal abnormality Intrinsic testicular abnormality. Mechanical obstruction in inguinal canal.

Morphology ( Testicular atrophy) Right testis more commonly involves. Small testis. Tubular atrophy with hyalinization present.

Microscopy of Atrophic Tubules ( diffuse) of testis.

Complication ; Cryptorchidism Infertility Seminoma ( malignancy) particularly with unilateral undescended testis.

Causes of testiculate atrophy and that may lead to Infertility Cryptoorchitism ( unilateral / bilateral). Chronic alcoholism ( Bilateral) Chronic Ischemia ( unilateral / bilateral) Chemotherapy or radiation ( Bilateral) Mumps orchitis ( focal atrophy) Never forget

Inflammatory lesion of testis Epididymitis Orchitis.

Testis : infection Epididymitis Acute: < 35 yr: N. Gonorrhoea, Chlamydia >35 yr: E. coli Chronic: Tuberculosis Orchitis Viral: Mumps Association: parotid and pancreas involvement

Orchitis. Etiology Mumps ( mumps orchitis ) : common in adult. Plasma cells and lymphocytes are present.

Focal atrophy of the testis tubules ; Mumps orchitis NORMAL

Laboratory Sperm count will be low BUT not NIL. Infertility do not occur usually.

Tuberculosis Epithelioid cell granuloma is present with cassation necrosis.

Causes of Male Infertility 1 of 2 Mumps (unilateral / Bilateral)- temporary infertility. Cryptoorchitism ( unilateral / bilateral). Chronic alcoholism ( Bilateral) Chronic Ischemia ( unilateral / bilateral) Chemotherapy or radiation ( Bilateral) Hydrocele and Varicocele Never forget

Other causes of male infertility 2 of 2 Klienfelter syndrome : patient present with gyenecomastia. Sertoli cell-only syndrome : No Sperm-Producing Cells, tubules contain only Sertoli cells.

Sertoli cell-only syndrome; sperm count NIL.

Hydrocele : etiology Inflammation Idiopathic

Hydrocele : Accumulation of serous fluid in tunica vaginalis.

Hematocele, chylocele, elephantiasis Hematocele : blood in tunica vaginalis ( in trauma) Chylocele : lymph in tunica vaginalis ( in lymphatic obstruction). Elephantiasis : in filarial infection ( lymphatic obstruction).

Elephantiasis

Varicocele : Dilation of the pampiniform plexus Complication : infertility

Testicular torsion : hemorrhagic infarction Etiology : Trauma or tumor in the testis

Testis Spermatocele Dilated efferent duct of epididymus , containing sperm

Self assessment Premalignant lesion of Penis Causes of infertility Etiology of testicular atrophy.

Self assessment Cryptorchidism and clinical significance Carcinoma penis: Type: prognosis, microscopy

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