pathology of male genital system jan laco, m.d., ph.d
TRANSCRIPT
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Pathology of Male Genital Pathology of Male Genital SystemSystem
Jan Laco, M.D., Ph.D.
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SummarySummary
1. Penis and scrotum
2. Testis and epididymis
3. Prostate
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1. Penis and scrotum1. Penis and scrotum
a. malformations
b. inflammatory lesions
c. neoplasms
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1a. malformations1a. malformations
Hypospadias + epispadias
= abnormal location of distal urethral orifice
+ outer genital anomaliesepispadias + urinary bladder exstrophycomplications: obstruction
infections
infertility
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1a. malformations1a. malformations
Phimosis
= stenosis of prepuce (+ acquired)
smegma infection, urinary retention
Paraphimosis
= stenotic prepuce in coronal sulcus
penis congestion, infarction
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1b. inflammatory lesions1b. inflammatory lesions
glans penis – balanitisprepuce – posthitiscavernitis gangrene of penisSTD – syphilis, gonorrhea, HSV, Candidapurulent ulcerations scarring
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1c. neoplasms1c. neoplasms
benign x malignant
epithelial x mesenchymal
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Benign neoplasmsBenign neoplasms
Condyloma acuminatum (venereal wart)HPV 6, 11 - STDcoronal sulcusG: multiple papillomas, mm – cmM: hyperplasia, akanthosis, parakeratosiskoilocytes – perinuclear halo
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Malignant neoplasms – Malignant neoplasms – carcinoma in situ 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
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Malignant neoplasms - Malignant neoplasms - carcinomacarcinoma
penis > scrotum Africa, America, Asia > 40 years glans penis, prepuce exophytic x endophytic squamous cell Ca locally aggressive, LN metastases 5-year survival: 70%
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SummarySummary
1. Penis and scrotum
2. Testis and epididymis
3. Prostate
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2. Testis and epididymis2. Testis and epididymis
a. congenital anomalies
b. regressive changes and scrotal enlargement
c. inflammatory lesions
d. neoplasms
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2a. Congenital anomalies – 2a. Congenital anomalies – failure of descentfailure of descent
retroperitoneum inguinal canal scrotum
spontanneous descent until 1st yearadults = cryptorchidism prevalence: 0,3 - 0,8%idiopathic
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2a. Congenital anomalies – 2a. Congenital anomalies – failure of descent failure of descent
unilateral x bilateral (25%)M: tubular atrophy + hyperplasia of Leydig + changes in contralateral testis
– blastoma in situ !!!infertility 30 - 50x risk of germ cell tumor !!! orchiopexy < 2 years
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2b. Regressive changes2b. Regressive changes
torsion infarction necrosis acute urological emergency + shock
atrophy – senium– vascular– hormonal
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2b. Scrotal enlargement2b. Scrotal enlargement
hydrocele = serous fluid in t. vaginalis
+ inflammation, tumorhematocele = blood in t. vaginalis
+ torsion, injury
varicocele = varices plexus pampiniformis
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2c. Inflammatory lesions2c. Inflammatory lesions
epididymis > testis+ urinary tract and prostate infectionchildren: Gramm- bacteriaadults: N. gonorrhoe, Ch. trachomatisold: E. coli. Pseudomonas spp.epididymis = epididymitistestis = orchitis
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2c. Inflammatory lesions2c. Inflammatory lesions
suppurative e.: abscesses scarring
chronic form infertility
non-suppurative o.: mumps
adults (20%)
infertility ? TBC e.: solitary hematogennous metastasis
+ prostate + seminal vesicles
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2d. Testicular neoplasms2d. Testicular neoplasms
1. germ cell 2. stromal – Sertoli and Leydig cells 3. combination (1. + 2.) - gonadoblastoma 4. other – malignant lymphoma, … 5. secondary – ALL, Ca prostate, Ca GIT, lungs incidence 2-3 / 100 000 males
!!! most common male tumors in 3rd and 4th decades !!!
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1. Germ cell tumors1. Germ cell tumors
seminoma x non-seminomasseminoma: atypic germ cellnon-seminomas: totipotential cell
somatic and/or extraembryonic lines
90% testicular tumorsmalignant
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SeminomaSeminoma
most common malignant40 yearsG: solid, homogennous, grey-whiteintratesticular spreadM: polygonal cells + clear cytoplasm
fibrous septa + lymphocytes
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Non-seminomasNon-seminomas
embryonal carcinoma (ECa)
yolk sac tumor (YST)
choriocarcinoma (ChCa)
teratomas (T)
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Embryonal carcinomaEmbryonal carcinoma
malignant20 – 30 yearsG: small, grey-white
+ hemorrhages, necrosisM: solid, trabecular, papillary, glandular
irregular large cells
hCG
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Yolk sac tumor Yolk sac tumor
malignantchildrenG: large, solid, yellow-whiteM: polygonal cells + loose stroma
Schiller – Duvall bodies
AFP
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ChoriocarcinomaChoriocarcinoma
malignanttrophoblastG: irregular mass, hemorrhages, necrosisM: irregular cells
hCG
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TeratomasTeratomas
somatic cell lineschildren, youngdifferentiated mature – cystic
puberty – benign
> puberty – uncertaindifferentiated immature – uncertain
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Mixed germ cell tumorsMixed germ cell tumors
(ECa + YST + T + ChCa) + seminomateratocarcinoma: T + ECaextensive sampling
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Clinical featuresClinical features
cryptorchidism: riskunilateralmetastases
– LN – paraaortic
- seminoma
- blood – lungs, liver, brain, bones
- non - seminomas
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2. Stromal tumors2. Stromal tumors
Sertoli + Leydig cellsandrogens + estrogensuncommonadults90% benign
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SummarySummary
1. Penis and scrotum
2. Testis and epididymis
3. Prostate
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3. Prostate3. Prostate
a. inflammatory lesions
b. nodular hyperplasia
c. neoplasms
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3a. inflammations - 3a. inflammations - prostatitisprostatitis
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
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3b. Nodular hyperplasia3b. 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 !!!
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3c. Neoplasms - 3c. Neoplasms - adenocarcinomaadenocarcinoma
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 !!!
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3c. Neoplasms - 3c. Neoplasms - adenocarcinomaadenocarcinoma
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. 10-40%