Diseases of Male Genital Organs - Part 1

Diseases of Male Genital Organs-1

• This presentation covers diseases of the male genital organs, beginning with the penis.

Diseases of the Penis

• Common Congenital Anomalies:

  • Hypospadias: The urethral opening is on the ventral surface of the penis.
  • Epispadias: The urethral opening is on the dorsal surface of the penis.
  • Phymosis: A small opening in the foreskin (prepuce), potentially congenital or acquired due to infection.

• Inflammations:

  • Non-specific inflammation: A general inflammation.
  • Specific inflammations: Syphilis, gonorrhea, herpes, and granuloma inguinale.

• Tumors:

  • Benign: Condyloma acuminatum.
  • Malignant: Carcinoma in situ (Bowen disease), Squamous cell carcinoma.

Condyloma Acuminatum (Anal Wart)

• Description: A benign papillomatous squamous tumor, with a fibrovascular core, caused by HPV infection (sexually transmitted).
• Prevalence: Equally affects both sexes, primarily appearing in the third decade of life.
• Site: Most commonly located in the anal canal and perianal skin, but can also affect the vulva, vagina, or uterine cervix in females.
• Progression: Giant condylomata can exhibit deep growth, local destruction, and potential malignant transformation.
  • Gross Appearance: Sessile or pedunculated masses, usually multiple, pink in color; can be painful. Primarily involves the coronal sulcus of the penis.
  • Microscopic Appearance: Stromal papillae covered by stratified squamous epithelium with prominent hyperkeratosis; vacuolation of surface epithelial cells is common.

Carcinoma in Situ (Bowen Disease)

• Description: An early form of skin cancer affecting the squamous cells of the skin's outer layer.
• Presentation: Manifests as a red, scaly patch on the skin.
• Prevalence & Location: Affects both sexes in the genital regions; typically develops after age 35.
• Penile presentation: In males, it typically manifests as solitary or multiple plaques on the penile shaft.
• Microscopic Findings: Marked epithelial atypia and loss of surface maturation.

Squamous Cell Carcinoma

• Prevalence: Constitutes over 95% of penile cancers, occurring between ages 40-70 with a median age of 58.
• Potential Causes (Risk Factors): Smegma accumulation (in non-circumcised individuals) and HPV infection.
• Gross Appearance: Ulcerative or exophytic growth.
• Microscopic Appearance: Ranges from well-differentiated to poorly differentiated.

Diseases of Testes & Epididymis

• Cryptorchidism: Failure of the testes to descend into the scrotum.

  • Prevalence: Occurs in approximately 1% of boys.
  • Anatomy: The testes are typically located along the normal path of descent from the abdominal cavity to the inguinal canal.
  • Unilateral Presentation: Most cases are unilateral.
  • Microscopic Findings: Atrophic changes can appear in the testes from approximately age 2 onward.

• Clinical Significance: Associated with inguinal hernia, infertility due to atrophy, and the risk of neoplasms.

• Treatment: Surgical orchidopexy (corrective surgery) before the age of 2.

Testicular Atrophy

• Causes: Secondary to Cryptorchidism, Klinefelter syndrome (47XXY), Vascular disease, Inflammation, Hypopituitarism, Elevated serum female sex hormones, or Radiation.

• Morphology:

  • Sertoli cell only lining of the seminiferous tubules.
  • Decreased germ cell production (germ cell aplasia).
  • Thickening and hyalinization of tubular basement membrane.
  • Interstitial fibrosis.

• Outcomes: Bilateral atrophy leads to infertility and azoospermia.

Inflammations of Testes

• Non-specific epididymitis-orchitis:

  • Causative organisms: Gram-negative organisms (pediatric patients), Chlamydia and Gonorrhea (younger than 35), E. coli and Pseudomonas (older men).
  • Clinical Presentation: Congestion, edema, neutrophilic infiltration.

• Specific Inflammations:

  • Gonorrhea: Retrograde inflammation from the urethra, congestion, edema, neutrophilic infiltration, and suppuration.
  • Mumps: Common in children, but can affect adults; occurs about a week after parotitis onset, can cause sterility if fibrosis occurs in both testes.
  • Tuberculosis: Inflammation begins in the epididymis, characterized by granulomatous inflammation with caseous necrosis.
  • Syphilis: Inflammation begins as orchitis, affects both congenital and acquired syphilis; may manifest as diffuse or gummatous nodules.
  • Granulomatous non-infectious orchitis: Uncommon cause of unilateral testicular enlargement, occurs in middle-aged men, possible auto-immune origin, sudden onset of a mass and potential pain, microscopic findings resembling tuberculosis but without caseous necrosis.
  • Vascular disturbances (Torsion):
    • Due to torsion of the spermatic cord
    • Typically seen in adolescence or early in life.
    • Presents with sudden testicular pain.
    • Needs urgent treatment to untwist before 6 hours to prevent necrosis.

Cystic/Semi-Cystic Disorders

• Hydrocele: Abnormal accumulation of serous fluid in the tunica vaginalis (potentially due to local injury, inflammation, tumor, or idiopathic).
• Spermatocele: Presence of serous fluid and sperm in the tunica vaginalis, due to dilation of epididymal tubules.
• Hematocele: Blood within the tunica vaginalis, commonly due to trauma, tumor, or torsion.
• Varicocele: Dilated veins of the pampiniform plexus (potentially idiopathic or due to venous obstruction).

Testicular Tumors

• Germ Cell Tumors (A):

  • Seminoma (classic type), Spermatocytic seminoma (nonclassical), Embryonal carcinoma, Yolk-sac (endodermal sinus) tumor, Choriocarcinoma, Teratoma.

• Sex-Cord Stromal Tumors (B):

  • Leydig cell tumor, Sertoli cell tumor.

• Predisposing Factors for Germ Cell Tumors: Cryptorchidism, Genetic factors, Testicular dysgenesis (e.g., Klinefelter syndrome), Cytogenetic abnormalities (e.g., chromosome 12).

• WHO Classification:

  • Germ cell neoplasia in situ (GCNIS): Seminoma and non-seminoma tumors.
  • Non-GCNIS: Spermatocytic tumors, yolk-sac tumors (YST), prepubertal/postpubertal teratomas.

Seminoma

• A) Classical type:
  • Most common testicular tumor
  • Peak incidence in the 30s.
  • Has metastatic potential.
  • Gross appearance: Round, firm, homogeneous, lobulated, tunica albuginea usually intact.
  • Microscopic appearance: Large polyhedral cells with abundant clear cytoplasm, large nuclei with prominent nucleoli; fibrous stroma infiltrated by lymphocytes.
• B) Spermatocytic nonclassical seminoma:
  • Occurs in older patients.
  • Often does not metastasize.
  • Cells resemble secondary spermatocytes.
  • Has a better prognosis than the classical type.

Other Germ Cell Tumors

• Embryonal Carcinoma: More aggressive than seminomas, peak incidence in 20-30 years; primitive cells forming irregular sheets, tubules, and alveoli; elevated AFP and hCG.
• Yolk Sac Tumor: Mostly in <4-year-olds but can occur in adults; composed of cuboidal cells arranged reticular pattern; primitive glomeruli seen in ~50% and elevated AFP.
• Choriocarcinoma: Rare, occurring mainly in the 2nd and 3rd decades; composed of syncytiotrophoblastic and cytotrophoblastic cells; elevated HCG.
• Teratoma: Second most common germ cell tumor in pediatrics, after yolk sac tumors; composed of germ layers (ectoderm, mesoderm, endoderm). Prepubertal types are usually benign; postpubertal types are often malignant.

Sertoli Cell and Leydig Cell Tumors

• Sertoli Cell Tumor: Rare, benign; resembles testicular tubules; may secrete estrogen causing gynecomastia.
• Leydig Cell Tumor: 1-2% in adults, 3-6% in prepubertal; may secrete androgens in children but estrogens in adults.

This quiz covers various diseases affecting the male genital organs, specifically focusing on conditions related to the penis. You'll learn about congenital anomalies, inflammations, and tumors, along with detailed information on condyloma acuminatum. Test your knowledge on these important topics in male health.