Quick Guide: Male Reproductive System OmpathStudy

--- MALE REPRODUCTIVE SYSTEM PATHOLOGY --- PENIS Malformations Hypospadias — urethral opening on the ventral (underside) of penis; 1 in 300 male births; risk of urinary obstruction & UTIs; associated with inguinal hernia and undescended testis. Epispadias — urethral opening on the dorsal (top) of penis; less common than hypospadias. --- Inflammatory Lesions Balanitis — inflammation of the glans penis only. Balanoposthitis — inflammation of glans AND prepuce. Caused by: Candida albicans , anaerobes, Gardnerella , pyogenic bacteria Risk factor: poor hygiene in uncircumcised males → smegma accumulation Phimosis — prepuce cannot be retracted over glans; congenital OR acquired (from balanoposthitis scarring). --- Penile Neoplasms 95% arise from squamous epithelium More common in developing countries, uncircumcised males 40 years Risk factors: poor hygiene (smegma), smoking, HPV types 16 & 18 Bowen Disease (SCC in situ) Solitary plaque on shaft Malignant cells throughout epidermis, no stromal invasion ~10% progress to invasive SCC Invasive SCC Gray, crusted, papular lesion on glans/prepuce Indurated, ulcerated, irregular margins Keratinizing squamous cell carcinoma histologically Verrucous Carcinoma (SCC variant) Papillary architecture, minimal cytologic atypia Locally invasive but does NOT metastasize --- SCROTUM, TESTIS & EPIDIDYMIS Cryptorchidism Incomplete testicular descent into scrotum Present in ~1% of 1-year-olds Tubular atrophy visible microscopically by age 5-6 years; hyalinization by puberty 3-5x increased risk of testicular cancer Increased cancer risk also in the contralateral descended testis Treatment: Orchiopexy — reduces sterility and cancer risk --- Inflammatory Lesions Nonspecific Epididymitis/Orchitis Ascending UTI via vas deferens or spermatic cord lymphatics Swollen, tender testis; neutrophilic infiltrate Mumps Orchitis Complicates ~20% of adult mumps infections (rare in children) Oedematous, congested testis; lymphoplasmacytic infiltrate Severe cases → necrosis, tubular atrophy, sterility Testicular Tuberculosis Starts as epididymitis → spreads to testis Granulomatous inflammation + caseous necrosis --- Testicular Torsion Twisting of spermatic cord → venous obstruction → venous infarction Arteries remain patent (thicker walls) Urologic emergency — viable if corrected within 6 hours Contralateral testis fixed surgically (orchiopexy) to prevent future torsion Type Timing Defect --- --- --- Neonatal In utero or shortly after birth None identified Adult Adolescence Bell-clapper abnormality (bilateral) --- Testicular Neoplasms ~6 per 100,000 males; more common in whites 95% of postpubertal testicular tumors = germ cell tumors, all malignant Sex cord-stromal tumors (Sertoli/Leydig) = uncommon, usually benign i(12p) — isochromosome 12p found in virtually all germ cell tumors Risk factors: cryptorchidism, family history (8-10x risk for brothers), intersex syndromes Presentation: Painless testicular mass, non-translucent (vs. hydrocele) Management: Radical orchiectomy (biopsy risks tumor spillage) --- Germ Cell Tumor Table Tumor Peak Age Key Morphology Markers --- --- --- --- Seminoma 40-50 Sheets of uniform polygonal cells, clear cytoplasm, lymphocytes in stroma hCG elevated in 10% Embryonal Carcinoma 20-30 Poorly differentiated pleomorphic cells; cords/sheets/papillary Negative (pure) Yolk Sac Tumor 3 years Poorly differentiated endothelium-like 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 Commonly teratoma + embryonal carcinoma hCG + AFP in 90% --- Tumor Markers hCG — always elevated in choriocarcinoma; elevated in 10% of seminomas AFP — elevated = yolk sac component present LDH — correlates with tumor burden Metastasis: Seminoma — spreads late; iliac and para-aortic lymph nodes Nonseminomatous — spreads early; liver and lungs (hematogenous) --- PROSTATE Prostatitis — 4 Categories Type Frequency Cause --- --- --- Acute bacterial 2-5% Common uropathogens Chronic bacterial 2-5% Common uropathogens Chronic nonbacterial (CPPS) 90-95% No pathogen identified Asymptomatic inflammatory Unknown Incidental leukocytes Acute bacterial: fever, chills, dysuria; tender boggy prostate on rectal exam; treat with antibiotics CPPS: no proven therapy Granulomatous prostatitis: BCG instillation (bladder cancer treatment) is most common cause — histologically identical to TB --- Benign Prostatic Hyperplasia (BPH) 90% of men by 8th decade; located in inner/transitional zone Gland typically weighs 60-100g; well-circumscribed nodules Pathogenesis: DHT (from testosterone via 5-alpha-reductase type 2) binds nuclear androgen receptors → promotes growth DHT is 10x more potent than testosterone Does not occur in castrated males or those with androgen insensitivity Clinical features (only ~10% symptomatic): Hesitancy, intermittent urinary stream Urgency, frequen