The Male Genital system

Contents

Penis

Testis

Prostate

Penis

MalformationInflamatory LesionNeoplasms

Hypospadias (commener)

Inflamation

Here is a squamous cell carcinoma of the head of the penis. Note the uncircumcised state, which increases the risk for such carcinomas. The neoplasm is reddish-tan with an ulcerated surface.

This is a squamous cell carcinoma of the penis (penectomy specimen) that is a larger reddish brown fungating mass.

Testis

Here is a normal testis and adjacent structures. Identify the body of the testis, epididymis, and spermatic cord.

Here is a large hydrocele of the testis. Such hydroceles are fairly common. Clear fluid accumulates in a sac of tunica vaginalis lined by a serosa with a variety of inflammatory and neoplastic conditions. A hydrocele must be distinguished from a true testicular mass, and transillumination may help, because the hydrocele will transilluminate but a testicular mass will be opaque.

On the left is a normal testis. On the right is a testis that has undergone atrophy. Bilateral atrophy may occur with a variety of conditions including chronic alcoholism, hypopituitarism, atherosclerosis, chemotherapy or radiation, and severe prolonged illness. A cryptorchid testis will also be atrophic. Inflammation may lead to atrophy. Mumps, the most common cause for orchitis, usually has a patchy pattern of involvement that does not lead to sterility.

Malignancy????? Righ testis??

This is the microscopic appearance of normal testis. The seminiferous tubules have numerous germ cells. Sertoli cells are inconspicuous. Small dark oblong spermatozoa are seen in the center of the tubules.

Pink Leyding cells are seen here in the interstitium.

There is focal atrophy of tubules seen here to the upper right. The most common reason for this is probably childhood infection with the mumps virus, which produces a patchy orchitis. However, it is unusual for this infection to cause enough atrophy to significantly affect the sperm count.

Atrophic testis is demonstrated here. Note the marked loss of germ cells with remaining tall pink Sertoli cells, peritubular fibrosis, and interstitial fibrosis. If generalized, this is a cause for infertility. About half the time when infertility occurs in couples wanting children, the cause is a problem in the male genital system.

This testis has undergone infarction following testicular torsion. Torsion is an uncommon condition, but a medical emergency. It occurs when twisting of the spermatic cord cuts off the venous drainage, leading to hemorrhagic infarction. Greater mobility from incomplete descent or lack of a scrotal ligament predisposes to this condition. Immediate treatment by surgically untwisting and suturing the cord in place to prevent future torsion will prevent infarction.

Testicular TUMORSGERM CELL (malig.)

SEMINOMA EMBRYONAL CHORIOCARCINOMA YOLK SAC TERATOMA

MIXED!!!!!, 40%

NON-GERM (benign)CELL, i.e., “sex cord”

LEYDIG SERTOLI

Germ cell neoplasms are the most common types of testicular neoplasm.

They are most common in the 15 to 34 age group.

They often have several histologic components: seminoma, embryonal carcinoma, teratoma, choriocarcinoma.

The one that is most likely to be of one histologic type is seminoma

SEMINOMA

The mass lesion seen here in the testis is a seminoma.

Here is another seminoma of the testis. A small rim of remaining normal testis appears at the far right. The tumor is composed of lobulated soft tan to brown tissue.

Here is a seminoma that is larger yet. Normal testis appears to the left of the mass, and the spermatic cord extends to the left of that. The size of this neoplasm demonstrates the factors of fear and denial that occur in many patients, delaying detection and therapy.

Normal testis appears at the left, and seminoma is present at the right. Note the difference in size and staining quality of the neoplastic nests of cells compared to normal germ cells.

This is the histologic pattern of the typical seminoma. Lobules of neoplasitic cells (distinct border) have an intervening stroma with characteristic lymphoid infiltrates. The seminoma cells are large with vesicular nuclei, and pale watery cytoplasm.

(look for germ cells and lymphs)

embryonal carcinoma

Here is an embryonal carcinoma of the testis. There is a rim of normal testis superiorly. The tumor is ill defind invasive much more variegated than the seminoma, with red to tan to brown areas, including prominent hemorrhage and necrosis.

Here is an even larger testicular neoplasm. It is composed mostly of embryonal carcinoma, but there are scattered firmer white areas that histologically are teratoma. Thus, this testicular neoplasm is mixed embryonal carcinoma plus teratoma (sometimes called teratocarcinoma). Embryonal carcinoma is more aggressive than seminoma. The alpha- fetoprotein is often elevated.

This is the histologic pattern of embryonal carcinoma. Sheets of blue undifferentiated cells are trying to form primitive tubules. Indistincet cell border. Pure just 3%

TERATOMA

TERATOMAMALIGNANT TERATOMATERATOCARCINOMA

•neural tissue

•retina

•muscle bundles

•islands of cartilage

•clusters of squamous epithelium

•structures of thyroid gland

•bronchial or bronchiolar epithelium

•bits of intestinal wall or brain substance

A small testicular carcinoma is shown here. There is a mixture of bluish cartilage with red and white tumor tissue.

Here is a testicular neoplasm that is mostly teratoma, but embryonal carcinoma and seminoma were found microscopically. In contrast with the ovary, pure benign teratomas of the testis are very rare.

At the bottom is a focus of cartilage. Above this is a primitive mesenchymal stroma and to the left a focus of primitive cells most characteristic for embryonal carcinoma. This is embryonal carcinoma mixed with teratoma.

yolk sac tumor

An endodermal sinus tumor (yolk sac tumor) of the testis is shown composed of primitive germ cells that form glomeruloid or embryonal-like structures. These tumors are most frequent in children, but overall they are rare .microcysts

SEX Cord Tumors

Leydig,

tumor cells look like Leydig cells

Sertoli ,

tumor cells look like sertoli cells

Prostate

CZ = CENTRAL

TZ = TRANSITIONAL

PZ = PERIPHAL

INFLAMMATIONSBENIGN ENLARGEMENTMALIGNANT TUMORS

The normal histologic appearance of prostate glands and surrounding fibromuscular stroma is shown here at high magnification.

Note the well-differentiated glands with tall columnar epithelial lining cells. These cells do not have prominent nucleoli.

This is chronic prostatitis. Numerous small dark blue lymphocytes are seen in the stroma between the glands.

There may be a bacterial agent accompanying this inflammation, and cystitis or urethritis may also be present.

However, more commonly, chronic prostatitis is abacterial and there is no history of urinary tract infection. The serum prostate specific antigen may be slightly elevated.

BENIGN ENLARGEMENT

A normal prostate gland is about 3 to 4 cm in diameter. This prostate is enlarged due to prostatic hyperplasia, which appears nodular. Thus, this condition is termed either BPH (benign prostatic hyperplasia) or nodular prostatic hyperplasia.

Here is another example of benign prostatic hyperplasia. Nodules appear mainly in the lateral lobes. Such an enlarged prostate can obstruct urinary outflow from the bladder and lead to an obstructive uropathy.

A frequently performed operation for symptomatic nodular prostatic hyperplasia is a transurethral resection, which yields the small "chips" of rubbery prostatic tissue seen here.

The enlarged prostate gland seen here not only has enlarged lateral lobes, but also a greatly enlarged median lobe that obstructs the prostatic urethra. This led to obstruction with bladder hypertrophy, as evidenced by the prominent trabeculation of the bladder wall seen here from the mucosal surface. Obstruction with stasis also led to the formation of the yellow-brown calculus (stone).

Obstruction from nodular prostatic hyperplasia has led to prominent trabeculation seen on the mucosal surface of this bladder with hypertrophy. The stasis from obstruction predisposes to infection. The obstruction can also lead to bilateral hydroureter and hydronephrosis.

Microscopically, benign prostatic hyperplasia can involve both glands and stroma, though the former is usually more prominent. Here, a large hyperplastic nodule of glands is seen.

At higher magnification, the enlarged prostate has glandular hyperplasia. The glands are well-differentiated and still have some intervening stroma. The small laminated pink concretions within the glandular lumens are known as corpora amylacea.

MALIGNANT TUMORS

These sections through a prostate removed via radical prostatectomy reveal irregular yellowish nodules, mostly in the posterior portion (seen here superiorly). This proved to be prostatic adenocarcinoma. Prostate glands containing adenocarcinoma are not necessarily enlarged. Adenocarcinoma may also coexist with hyperplasia. However, prostatic hyperplasia is not a premalignant lesion. Staging of prostatic adenocarcinoma is based upon how extensive the tumor is.

At the right are normal prostatic glands containing scattered corpora amylacea. At the left is prostatic adenocarcinoma. Note how the glands of the carcinoma are small and crowded. Prostatic adenocarcinomas are given a histologic grade (Gleason's grading system is used most often, and includes a score of 1 to 5 for the most prominent component added to a score of 1 to 5 for the next most common pattern).

Prominent nucleoli are seen in the nuclei of this prostatic adenocarcinoma, which is a characteristic feature.

At high magnification, this poorly differentiated prostatic adenocarcinoma demonstrates cells with nucleoli and mitotic figures.

This adenocarcinoma of prostate is so poorly differentiated that no glandular structure is recognizable, only cells infiltrating in rows

By immunoperoxidase staining with antibody to prostate specific antigen (PSA), this adenocarcinoma of prostate shows positivity. PSA is better known as a serum test to detect males that may have prostate cancer.

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