Male Genital System(Part-I)

Dr. Babai Halder

MALE GENITAL(REPRODUCTIVE) ORGANS

External Genital Organs

1. Penis

2. Scrotum

Internal Genital Organs

1. Testis

2. Epididymis

3. Vas Deferens

4. Accessory Glandsa. Seminal Vesicles

b. Prostate Gland

c. Bulbourethral Glands

External Genital Organs

Penis

Scrotum

Penis

It contains spongy tissue that becomes turgid and erect when filled with blood.

• Erectile Tissues– Corpus spongiosum – is the

mass of spongy tissue whichsurrounds urethra and involves in erection by allowing rushing of blood into it

– Corpus cavernosa – is one of a pair of songe-like regions of erectile tissue which contains most of the blood in the penis during penile erection

Cont...

• Urethra – a tube within the penis that conveys semen out of the body during ejaculation.

• Glans – the rounded, highly sensitive head of the penis.

• Prepuce – a fold of skin, covering the head of the penis.

Cont...

Scrotum

A pouch of skin formed from the lower part of the abdominal wall.

The scrotum keeps the testes at a temperature slightly cooler than body temperature.

Testis

Epididymis

Vas Deferens

Internal Genital Organs

Seminal Vesicles

Prostate Gland

Bulbourethral Glands

Testis (plural testes)

The testes are the two-oval shaped male organs that produce sperm and hormone testosterone.

*Testosterone- the primary male sex hormone

Cont…

Each testis is made of tightly coiled structures called seminiferous tubules.

Among tubules are cells that produce testosterone.

Epididymis

The epididymis is a tightly coiled tubes against the testicles.

It acts as maturation and storage place for sperm. Adult human testicle with

epididymis:

A. Head of epididymis,

B. Body of epididymis,

C. Tail of epididymis, and

D. Vas deferens

Vas Deferens (Ductus Deferens)

The vas deferens is a thin tube that starts from the epididymis to the urethra in the penis.

They transport sperm from the epididymis in anticipation of ejaculation.

a. Seminal Vesicles

b. Prostate Gland

c. Bulbourethral Glands

These glands produce nourishing fluids for the sperms that enter the urethra.

Accessory glands

Seminal Vesicles

The Seminal Vesicles are sac-like structures attached to the vas deferens at one side of the bladder.

They produce a sticky yellowish fluid that contains fructose.

Prostate Gland

The Prostate Gland surrounds the ejaculatory ducts at the base of the urethra, just below the bladder.

The Prostate Gland is responsible for making the production of semen, a liquid mixture of sperm cells, prostate fluid and seminal fluid.

• The prostate can be divided into several(4) biologicallydistinct regions- peripheral, central, transitional and theregion of anterior fibromascular stroma. Of which the mostimportant are the peripheral and transition zones.

• The types of proliferative lesions are different in eachregion.

• Most hyperplastic lesions arise in the inner transitionzone, while most carcinomas (70% to 80%) arise in theperipheral zones.

• It also divided into 5 lobes anatomically- anterior(TZ),posterior(PZ), Right & Left lateral(All Zones) & Median(CZ).

• The normal prostate contains glands with two cell layers, aflat basal cell layer and an overlying columnar secretory celllayer. In between glands there is abundant fibromascularstroma.

Bulbourethral Glands (Cowper’s gland)

The Bulbourethral Glands are two small glands located on the sides of the urethra just below the prostate gland.

These glands produce a clear, slippery fluid that empties directly into the urethra.

COMMON PATHOLOGICAL CONDITIONS IN MALE GENITAL SYSTEMS

• 1. Congenital anomalies- Cryptorchidism,hypoand epispadias.

• 2. Inflammatory conditions- TB, filarial infections

• 3. Vascular- Varicocele, torsion of testis, hematocele

• 4. Tumors of testis and epididymis.

• 5. Tumors of prostate gland.

Hypospadias

Abnormal urethral orifices involving the VENTRAL aspect of the penis

Congenital anomalies of Penis

Epispadias

Abnormal urethral orifices involving the DORSAL aspect of the penis

Phimosis

•Abnormally small orifice in the prepuce

•Prepuce can’t be retracted

INFLAMMATIONS

• can be specific or non-specific

• specific usually refers to sexually transmitted infections

Balanoposthisis

• Non-specific infection of the glans penis and prepuce

• Causative factors – Candida

– Anaerobes

– Gardnerella

– Pyogenic organisms

• Role of smegma (white exudates made of desquamated epithelial cells, sweat & debris) –chronic accumulation account for symptom

Tumors of penis

• Benign tumors(Condyloma Acuminata)

• Condyloma Accuminatum (genital warts) is sexually transmitted tumor caused by human papilloma virus (HPV type 6 and 11)

Gross: Thrives in any moist mucocutaneoussurface of the external genitalia.

Occurs as a papillary excrescence at coronal sulcus or inner surface of the prepuce.

• Histologically:

Papillae covered by-

Hyperplastic

Hyperkeratotic ( acanthosis)

Stratified squamous epithelium of orderly maturation sequence

Koilocytosis (vacuolation) of scattered superficial cell.

Condyloma Accuminatum

koilocytosis

Koilocytosis

• Carcinoma in Situ( CIS)- includes:

- Bowen disease-Seen in men over the age of 35 years. Strongly associated with HPV especially type 16.

In men it involves the skin of the shaft of the penis and scrotum.

Gross- solitary thickened gray white opaque lesion.

Erthroplasia of Queyrat- clinical variant of bowen disease presenting as multiple shiny red velvety plaque.

shiny red plaque

HistologyEpidermis shows proliferation with numerous

mitosis , markedly dysplastic cells with large hyperchromatic nuclei and lack of orderly maturation.

However, the dermal-epidermal border is sharply delineated by an intact basement membrane.

• Bowenoid papulosis

Occurs in sexually active adults of younger age group.

Presence of multiple reddish brown papular lesions.

Histologically similar to bowen disease and is also related to HPV 16

But virtually never develops into invasive carcinoma.

Feature Bowen’s Disease

(Carcinoma in situ )

Bowenoid

Papulosis

Age >30 yrs <30 yrs

lesions Solitary, Gray- white Multiple, reddish

brown

Behavior ↑risk of invasive

carcinoma (10% cases)

Never

Visceral

malignancies

↑risk of visceral

malignancies

No

Histology Carcinoma in situ

(HPV-16)

Same as Bowen’s

(HPV-16)

carcinoma in-situ

Hyperchromatic, dysplastic, dyskeratotic epithelial cells with scattered mitosis is seen.

Malignant cancer of penis

• Invasive carcinoma

• Age- 40 to 70yrs

• Almost exclusively seen in non-circumcised males (Possible carcinogens in smegma);

• Cause : HPV types 16 & 18;

• Cigarette smoking elevates the risk.

• Circumcision confers protection.

• Clinical featuresSlow growing locally invasive lesion, usually

non-painful unless there is secondary ulceration and infection.

Progressive growth Spreads to inguinal & iliac lymph nodes, Later by blood.

Prognosis: Overall 5-year survival rate is <50% (with positive nodes<30%).

• MorphologyUsually begins on the glans or inner surface of

prepuce near the coronal sulcus. Two macroscopic patterns :

1. Papillary lesion- simulate condyloma acuminata,produces a cauliflower-like fungating growth.

2. Flat lesions- areas of epithelial thickening along with graying and fissuring of the mucosal surface.

• Histology- Both types are squamous cell carcinomas with varying degrees of differentiation.

Majority of the usual SCC show infiltrating keratinization with moderate degrees of differentiation.

• Verrucous carcinoma- exophytic well differentiated variant of SCC that has low malignant potential.

• Other less common subtypes of penile SCC includes

Basaloid

Warty( condylomatus)

Sarcomatoid

Pseudohyperplastic

Pseudoglandular( adenoid)

Adenosquamous variants

Squamous Cell Carcinoma

This is carcinoma of penis. The glans penis is deformed by a firm , ulcerated and infiltrative mass.

Squamous cell carcinoma, usual type, moderately differentiated.

Squamous cell carcinoma, usual type, poorly differentiated.

SCC- Well to Moderately differentiated

Thank you!!!