Male Reproductive Pathology: Comprehensive OmpathStudy

Male Reproductive System Pathology Comprehensive overview of male reproductive system pathologies, covering congenital malformations, inflammatory conditions, and neoplasms of the penis, testis, epididymis, and prostate — including hypospadias, squamous cell carcinoma of the penis, cryptorchidism, testicular torsion, germ cell tumours, prostatitis, benign prostatic hyperplasia (BPH), and prostate carcinoma. Key Points Hypospadias is the most common penile malformation, characterized by a ventral urethral opening, and is associated with increased UTI risk. Squamous cell carcinoma is the predominant penile neoplasm, with risk factors including poor hygiene, smoking, and HPV infection. Cryptorchidism significantly increases the risk of both sterility and testicular cancer, even in the contralateral descended testis. Testicular torsion is a urologic emergency caused by twisting of the spermatic cord, requiring prompt surgical intervention to prevent venous infarction. Germ cell tumors account for 95% of postpubertal testicular neoplasms, often presenting as painless masses, and are frequently associated with the molecular marker isochromosome i(12p). Benign Prostatic Hyperplasia (BPH) is an androgen-dependent proliferation of prostatic tissue in the transitional zone, causing obstructive and irritative urinary symptoms in many older men. Prostate carcinoma is the most common cancer in men, typically arising in the outer peripheral zone, and is graded by the Gleason system. Tumor markers like hCG, AFP, and LDH are crucial for the diagnosis and monitoring of testicular germ cell tumors. Detailed Notes Congenital Malformations Most penile malformations involve abnormal positioning of the distal urethral orifice. Hypospadias Urethral opening on the ventral (underside) of the penis. Most common penile malformation — 1 in 300 live male births. Constricted orifice → urinary obstruction + increased UTI risk. Associated with inguinal hernia and cryptorchidism. Epispadias Urethral opening on the dorsal (top) of the penis. Less common than hypospadias. Severe cases associated with bladder exstrophy. Inflammatory Lesions (Penis) Balanitis — inflammation of the glans penis. Balanoposthitis — inflammation of the glans AND prepuce (foreskin). Organisms: Candida albicans , anaerobic bacteria, Gardnerella , pyogenic bacteria. Most common in uncircumcised males with poor hygiene. Smegma (dead skin, sweat, debris) acts as the local irritant. Phimosis Foreskin cannot retract over the glans. Can be congenital; most cases acquired from scarring after balanoposthitis. Perpetuates smegma accumulation, recurrent infection, and increased SCC risk. Neoplasms of the Penis Over 95% of penile neoplasms arise from squamous epithelium. More common in developing countries. Most cases occur in uncircumcised males over 40 years. Risk factors for squamous cell carcinoma (SCC) Uncircumcised males over 40. Poor hygiene — smegma exposure. Smoking. HPV infection, especially types 16 and 18. Bowen disease — SCC in situ Solitary plaque on the shaft of the penis in older uncircumcised males. Histology: malignant cells throughout the epidermis — no stromal invasion. Progresses to invasive SCC in ~10% of cases. Invasive squamous cell carcinoma Gray, crusted, papular lesion — most commonly on the glans or prepuce. Infiltration produces an indurated, ulcerated lesion with irregular margins. Histology: typical keratinizing SCC. Prognosis is stage-dependent. Verrucous carcinoma Variant of SCC with papillary architecture and virtually no cytologic atypia. Rounded, pushing deep margins. Locally invasive — does not metastasize. Cryptorchidism Failure of complete testicular descent from the abdomen into the scrotum. Present in ~1% of 1-year-old males. Both bilateral and unilateral forms are associated with tubular atrophy and sterility. Microscopic tubular atrophy evident by age 5–6 years; hyalinization by puberty. Foci of intratubular germ cell neoplasia develop within atrophic tubules — precursors to germ cell tumours. Carries 3–5 fold increased risk of testicular cancer; history of cryptorchidism found in ~10% of all testicular cancer cases. Contralateral descended testis also carries increased cancer risk. Treatment: orchiopexy — reduces risk of both sterility and malignancy. Note: similar atrophic changes occur with chronic ischemia, trauma, irradiation, chemotherapy, and elevated estrogen states (e.g. cirrhosis) — but these do not produce intratubular germ cell neoplasia. Inflammatory Lesions (Testis/Epididymis) Nonspecific epididymitis and orchitis Spreads from UTI via vas deferens or spermatic cord lymphatics. Testis: swollen and tender. Histology: predominantly neutrophilic inflammatory infiltrate. Mumps orchitis Complicates mumps in ~20% of infected adult males; rare in children. Testis: oedematous and congested. Histology: lymphoplasmacytic infiltrate. Severe cases → necrosis, tubular atrophy, fibrosis, and sterility. Tuberculous epididymo-orchitis Mos