1. Male genital system

2. MALE GENITAL SYSTEM
PENIS
SCROTUM, TESTIS, & EPIDIDYMIS
PROSTATE

3. PENIS
MALFORMATIONS
INFLAMMATORY LESIONS
NEOPLASMS

4. 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)

5. Hypospadias (ventral)

6. Epispadias (dorsal)
Epispadias

7. 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

8. 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

9. 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

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

11. 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

12. Squamous Cell Carcinoma

15. 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

16. 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

17. 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

18. Hydrocele

19. LESIONS OF THE TESTES
CONGENITAL
INFLAMMATORY
NEOPLASTIC

20. 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

21. Atrophic testes secondary to cryporchidism

22. 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

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

24. 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

25. 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

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

27. 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

28. 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

29. 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

30. 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.

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

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

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

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

35. Dermoid Cyst
Dermoid cyst.

36. Immature Teratoma With Embryonal Carcinoma

37. 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

38. Thank You