1. Pathology of Male Genital System
Jan Laco, M.D., Ph.D.

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 – perinuclear halo

9. Malignant neoplasms – carcinoma in situ
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
Africa, America, Asia
> 40 years
glans penis, prepuce
exophytic x endophytic
squamous cell Ca
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%
idiopathic

14. 2a. Congenital anomalies – failure of descent
unilateral x bilateral (25%)
M: tubular atrophy + hyperplasia of Leydig
+ changes in contralateral testis
– blastoma in situ !!!
infertility
x  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
varicocele = varices plexus pampiniformis

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

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

19. 2d. Testicular neoplasms
1. germ cell
2. stromal – Sertoli and Leydig cells
3. combination ( ) - gonadoblastoma
4. other – malignant lymphoma, …
5. secondary – ALL, Ca prostate, Ca GIT, lungs
incidence 2-3 / males
!!! most common male tumors in 3rd and 4th decades !!!

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

21. Seminoma most common malignant 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 cells
 hCG

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, necrosis
M: irregular cells
 hCG

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

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

28. Clinical features cryptorchidism:  risk unilateral metastases
– LN – 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 p. – E. coli, Gramm-, N. gonorrhoe
from urethra, urinary bladder, cystoscopy
G: enlargement, edema, abscesses, necrosis
M: neutrophiles in glands
chronic p. – bacterial x abacterial
TBC p. – solitary hematogennous metastasis
 spread to urinary tract

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

34. 3c. Neoplasms - adenocarcinoma
very common
ethiology:  age, androgens
late dg. – dysuria, hematuria, metastasis
per rectum + 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:
– glandular differentiation + growth structure
10-year survival: early dg. 90% x late dg %