Diseases of Male Genital Organs-1 PDF

Diseases of male genital organs-1 BY DR. HUSAMELDIN OMER MOHAMED OMER  Diseases of the penis Common congenital anomalies:  Hypospedius: presence of the urethral orifice on the ventral surface of the penis.  Epispadius: presence of the urethral orifice on the do...

Diseases of male genital organs-1 BY DR. HUSAMELDIN OMER MOHAMED OMER  Diseases of the penis Common congenital anomalies:  Hypospedius: presence of the urethral orifice on the ventral surface of the penis.  Epispadius: presence of the urethral orifice on the dorsal surface of the penis.  Phymosis: small orifice in the prepuce, which may be congenital or acquired due to infection. Inflammations: of the penis ❖ Non-specific inflammation. ❖ Specific inflammations: syphilis, gonorrhea, herpes, and granuloma inguinale. Tumors of the penis ❖ Benign: Condyloma acuminatum. ❖ Malignant: Carcinoma in situ (Bowen disease). Squamous cell carcinoma. Condyloma acuminatum (anal wart)  Benign papillomatous squamous tumor with a fibrovascular core that caused by human papillomavirus (HPV) infection (sexually transmitted disease).  Almost both sexes are affected equally and it mainly appears at the third decade of life. In females it may involve vulva, vagina or uterine cervix but in both sexes the most common site is the anal canal and perianal skin.  Giant condyloma acuminatum shows features of deep growth, local destruction and may become malignant. Gross appearance: Sessile or pedunculated masses. They are usually multiple, pink in colour and can be painful.In penis they involve mainly the cronal sulcus. Microscopic: Stromal papillae. Covered by stratified squamous epithelium with prominent hyperkeratosis. Vacuolation of surface epithelial cells is common.  Condyloma acuminatum, microscopic (low & high power)  Condyloma acuminatum, macroscopic (penis & anal canal) Carcinoma in situ (Bowen disease):  Bowen's disease is a very early form of skin cancer that affects the squamous cells, which are in the outer layer of skin. The main sign is a red, scaly patch on the skin.  It may occur in the genital regions in both males and females. It usually over the age of 35 years.  In males penis it is solitary or multiple plaques over the penile shaft. Microscopically there is marked epithelial atypia with loss of surface maturation. Squamous cell carcinoma: – More than 95% of all penile cancers And it occurs between ages of 40-70 and the median age 58 years – Potential causes (risk factors): Smegma accumulation under the prepuce in noncircumcised individuals. HPV infection. – Gross appearance: ulcer or exophytic growth. – Microscopic: well differentiated to poorly differentiated. Squamous cell carcinoma of the penis Diseases of testis & epididymis Cryptorchidism: failure of descent to scrotum. Occurs in 1% of boys. The testis is present along the normal path of descent from the abdominal cavity to the inguinal canal. Most cases are unilateral. Microscopic: atrophic changes may occur in the testes early at 2 years.  Clinical significance: Prevalence of inguinal hernia, Sterility due to atrophy, Neoplasms.  Treatment: surgical orchidopexy before age of 2. Testicular atrophy: Secondary to or due to: Cryptorchidism. Klinefelter syndrome (47 XXY chromosome) Vascular disease. Inflammation. Hypopituitarism. Elevated serum female sex hormones. Radiation. Morphology of testicular atrophy: Sertoli cell only lining of the seminiferous tubules. Decreased germ cell production (germ cell aplasia). Thickening and hyalinization of tubular basement membrane. Interstitial fibrosis. Bilateral testicular atrophy leads to infertility or the clinical state that is called azoospermia.  Testicular atrophy Atrophic testis Normal testis Inflammations of testes: Non specific epididymo-orchitis: Causative organisms: Gram negative organisms in pediatric patients. Chlamydia and Gonococci in men younger than 35 y. E. coli and pseudomonas in older men. There is congestion, edema and neutrophilic infiltration. Specific inflammations: ❑ Gonorrhea: ❖Retrograde inflammation from urethra. ❖There is congestion, edema, neutrophilic infiltration and suppuration. ❑ Mumps: ❖Common in children, but may occur in adults. ❖Occurs about 1 week after the onset of parotitis. ❖May cause sterility, if fibrosis occurs in both testes. ❑ Tuberculosis: ❖Inflammation begins in the epididymis. ❖There is granulomatous inflammation associated with caseous necrosis. ❑ Syphilis: ❖Inflammation begins as orchitis. ❖Occurs in congenital and acquired syphilis. ❖May produce diffuse or gummatous nodules. ❑ Granulomatous noninfectious orchitis: – Uncommon cause of unilateral testicular enlargement. – Occurs in middle aged men. – It has possible auto-immune origin. – There is sudden onset of a mass with or without pain. – Microscopically the lesion resembles tuberculosis but it is diffuse throughout the testis without caseous necrosis. Vascular disturbances of testis (torsion):  Occurs due to twisting of the spermatic cord.  Typically seen in adolescence. However, neonatal torsion is well known and it may occur either in utero or shortly after birth  Presents as sudden onset of testicular pain.  It is due to increased mobility of the testis.  It must be untwisted before 6 hours, otherwise necrosis will occur. Testicular torsion Cystic or semi-cystic disorders of tunica and spermatic cord ❑ Hydrocele: Abnormal accumulation of serous fluid in tunica vaginalis due to local injury as inflammation, tumors, or may be idiopathic. ❑ Spermatocele: Presence of serous fluid and sperms in tunica vaginalis due to dilatation of epididymal tubules. ❑ Hematocele: Blood in the tunica vaginalis. – Due to: ▪ Trauma, ▪ Tumor, ▪ Torsion, or blood disease. ❑ Varicocele: ▪ Dilatation of veins of pampiniform plexus. ▪ It may be idiopathic or due to obstruction of venous drainage. Hydrocele Testicular tumors: A) Germ cell tumors:  Seminoma (classic type).  Spermatocytic seminoma (nonclassical).  Embryonal carcinoma.  Yolk-sac (endodermal sinus) tumor.  Choriocarcinoma.  Teratoma. B) Sex-cord stromal tumor:  Leydig cell tumor.  Sertoli cell tumor. Predisposing factors for germ cell tumors: ❖ Cryptorchidism. ❖ Genetic factors. ❖ Testicular dysgenesis, e.g. Klinefelter syndrome. ❖ Cytogenetic abnormalities involving chromosome 12. According to the WHO classification, germ cell tumors of the testis are divided into two main groups: A) Germ cell neoplasia in situ (GCNIS) tumors: seminoma, and non-seminoma (NSGCT). The latter encompasses teratoma (postpubertal type), embryonal carcinoma, choriocarcinoma, yolk sac tumors (YSTs). B) non-GCNIS tumors include spermatocytic tumors, YST prepubertal type, teratoma (prepubertal type). Neoplasia in situ means dysplastic changes beyond the basement membrane Seminoma Classic type (95%) and nonclassical (5%) A) Classical type The commonest tumor of testis. Peak incidence: 30s. May metastasize. Gross appearance: Round tumor. Firm in consistency. Homogeneous. Lobulated. Tunica albugenia usually remains intact. Microscopic appearance: Large polyhedral cells. Abundant clear cytoplasm. Large nuclei containing prominent nucleoli. Fibrous stroma infiltrated by lymphocytes. B) Spermatocytic nonclassical seminoma 5%: Occurs in older patients. No tendency to metastasize. The neoplastic cells resemble 2ry spermatocyte. Has better prognosis than classic type. Seminoma Embryonal carcinoma:  Peak incidence between 20-30 years.  It is more aggressive than seminoma. Morphology:  Primitive cells forming irregular sheets, tubules, alveoli and papillary structures. 90% of cases have elevated α-fetoprotein (AFP) and human chorionic gonadotropin (HCG) in the blood. Yolk-sac tumor:  Mainly occurs in children less than 4 years.  May occur in adults.  Composed of cuboidal cells arranged in a reticular pattern.  Structures resemble primitive glomeruli are seen in 50% of cases.  The patients have elevated (AFP). Choriocarcinoma: – Rare as a pure form tumor (