MALE REPRODUCTIVE SYSTEM PATHOLOGY

MALE REPRODUCTIVE SYSTEM PATHOLOGY --- PENIS### Malformations Hypospadias Urethral opening on the ventral (underside) of penis Occurs in 1 in 300 male births Can cause urinary obstruction and increased UTI risk Associated with inguinal hernia and undescended testis Epispadias Urethral opening on the dorsal (top) side of penis Less common than hypospadias --- Inflammatory Lesions Balanitis — inflammation of the glans penis Balanoposthitis — inflammation of the glans AND prepuce (foreskin) Caused by: Candida albicans, anaerobic bacteria, Gardnerella, pyogenic bacteria Most common in uncircumcised males with poor hygiene Smegma (dead skin, sweat, debris buildup) acts as the irritant Phimosis — foreskin cannot retract over the glans Can be congenital Most cases are acquired from scarring after balanoposthitis --- Neoplasms Risk Factors for Squamous Cell Carcinoma (SCC) Uncircumcised males over 40 Poor hygiene (smegma exposure) Smoking HPV infection, especially types 16 and 18 More common in developing countries Bowen Disease (SCC in situ) Solitary plaque on the shaft of the penis Malignant cells throughout epidermis but NO stromal invasion Progresses to invasive SCC in about 10% of cases Invasive SCC Gray, crusted, papular lesion — most commonly on glans or prepuce Becomes indurated and ulcerated with irregular margins Histology: keratinizing squamous cell carcinoma Prognosis depends on stage Verrucous Carcinoma Variant of SCC with papillary architecture No cytologic atypia, pushing (not infiltrating) margins Locally invasive but does NOT metastasize --- SCROTUM, TESTIS, AND EPIDIDYMIS### Cryptorchidism (Undescended Testis)- Incomplete descent of testis from abdomen to scrotum Present in about 1% of 1-year-old males Leads to tubular atrophy and sterility (bilateral or unilateral) 3 to 5 times higher risk of testicular cancer Microscopic atrophy starts by age 5-6; hyalinization by puberty Treatment: Orchiopexy (surgical fixation) reduces risk of sterility and cancer --- Inflammatory Lesions Nonspecific Epididymitis and Orchitis Usually spreads from a urinary tract infection via vas deferens or lymphatics Testis is swollen and tender Histology: neutrophilic inflammatory infiltrate Mumps Orchitis Complicates mumps in about 20% of adult males (rare in children) Testes are edematous and congested Lymphoplasmacytic infiltrate Severe cases: necrosis, tubular atrophy, fibrosis, sterility Testicular Tuberculosis Most common cause of granulomatous orchitis Begins as epididymitis, then spreads to testis Histology: granulomatous inflammation with caseous necrosis --- Vascular Disturbances — Testicular TorsionTwisting of the spermatic cord obstructs venous drainage while arteries remain open, causing venous infarction. Two types: Type When Key Feature --- --- --- Neonatal In utero or shortly after birth No anatomic defect Adult Adolescence Bell clapper abnormality — testis has increased mobility Adult torsion: sudden onset of testicular pain, may wake patient from sleep UROLOGIC EMERGENCY — must untwist within 6 hours to save the testis Contralateral testis is surgically fixed (orchiopexy) to prevent same occurrence --- Testicular Neoplasms Epidemiology 6 per 100,000 males; more common in whites Brothers of affected males have 8 to 10 times higher risk Cryptorchidism increases risk 3 to 5 fold Virtually all germ cell tumors carry isochromosome i(12p) In post-pubertal males: 95% of testicular tumors are germ cell tumors and ALL are malignant Sex cord-stromal tumors (Sertoli/Leydig) are uncommon and usually benign --- Tumor Summary Table Tumor Peak Age Key Morphology Marker --- --- --- --- Seminoma 40-50 Sheets of uniform cells, clear cytoplasm, lymphocytes in stroma hCG elevated in 10% Embryonal Carcinoma 20-30 Poorly differentiated, pleomorphic, cords/sheets/papillary Negative (pure) Yolk Sac Tumor 3 years Endothelium-like cuboidal/columnar cells AFP elevated in 90% Choriocarcinoma 20-30 Cytotrophoblast + syncytiotrophoblast, no villi hCG elevated in 100% Teratoma All ages All 3 germ layers, variable differentiation Negative (pure) Mixed Tumor 15-30 Variable; commonly teratoma + embryonal carcinoma hCG + AFP in 90% --- Tumor Markers hCG — always elevated in choriocarcinoma; mildly elevated in others with syncytiotrophoblastic cells AFP — elevated indicates yolk sac tumor component LDH — correlates with tumor burden Clinical Features Present as painless, non-translucent testicular mass Standard treatment: radical orchiectomy (no biopsy — risk of tumor spillage) Seminomas: spread late, mainly to iliac and para-aortic lymph nodes Nonseminomatous: spread earlier, liver and lungs via hematogenous route --- PROSTATE### Prostatitis — 4 Categories Type Frequency Cause --- --- --- Acute bacterial 2-5% Common UTI organisms Chronic bacterial 2-5% Common uropathogens Chronic nonbacterial (pelvic pain syndrome) 90-95% No pathogen identified Asymptomatic inflammatory Unknown Leukocytes in secretions, no symptoms Granulomatous Prostatitis