22 male

Male Genital Tract

• Penis: Congenital, Inflammation, Tumors

• Testis/Epididymis: Congenital, Regressive, Inflammation, Vascular diseases, Tumors

• Prostate: Inflammation, Benign Enlargement, Malignancy

Male Genital Tract(short version)

•Testis/Epididymis: –Congenital

–Regressive

–Inflammation

–Vascular diseases

–Tumors

Male Genital Tract(short version)

•Testis/Epididymis: –Congenital: Cryptorchidism 1%–Regressive: Atrophy–Inflammation: Mumps, GC,

Chlamydia, E. Coli, Pseudomonas, TB

–Vascular diseases: Torsion–Tumors: Benign/Malig, Germ

Cell/non-Germ Cell

Cryptorchidism• 1% of all births• 25% bilateral• Associated with significantly increased

incidence of germ cell tumors

Male Genital Tract(short version)

•Testis/Epididymis: –Congenital: Cryptorchidism 1%–Regressive: Atrophy–Inflammation: Mumps, GC,

Chlamydia, E. Coli, Pseudomonas, TB

–Vascular diseases: Torsion–Tumors: Benign/Malig, Germ

Cell/non-Germ Cell

Testicular Atrophy• atherosclerotic narrowing of the blood supply in old age

• the end stage of an inflammatory orchitis, whatever the etiologic agent

• cryptorchidism• hypopituitarism• generalized malnutrition or cachexia• irradiation• prolonged administration of female sex hormones, as in

treatment of patients with carcinoma of the prostate; and cirrhosis

Male Genital Tract(short version)

•Testis/Epididymis: –Congenital: Cryptorchidism 1%–Regressive: Atrophy–Inflammation: Mumps, GC,

Chlamydia, E. Coli, Pseudomonas, TB

–Vascular diseases: Torsion–Tumors: Benign/Malig, Germ

Cell/non-Germ Cell

Male Genital Tract(short version)

•Testis/Epididymis: –Congenital: Cryptorchidism 1%–Regressive: Atrophy–Inflammation: Mumps, TB, GC,

Chlamydia, E. Coli, Pseudomonas–Vascular diseases: Torsion–Tumors: Benign/Malig, Germ

Cell/non-Germ Cell

Male Genital Tract(short version)

•Testis/Epididymis: –Congenital: Cryptorchidism 1%–Regressive: Atrophy–Inflammation: Mumps, GC,

Chlamydia, E. Coli, Pseudomonas, TB

–Vascular diseases: Torsion–Tumors: Benign/Malig, Germ

Cell/non-Germ Cell

Testicular TUMORS• GERM CELL (malig.)

– SEMINOMA– EMBRYONAL– CHORIOCARCINOMA– YOLK SAC– TERATOMA

–MIXED!!!!!, 60%

• NON-GERM (benign)• CELL, i.e., “sex cord”

– LEYDIG– SERTOLI

Seminoma

(look for germ cells and

lymphs)

Embryonal Carcinoma,

Formerly called “adeno”carcinoma, so look for “glands” and AFP!!!)

CHORIOCARCINOMAlook for “trophoblast”, and HCG!!

YOLK SAC TUMOR, aka “endodermal sinus tumor”

Schiller-Duvall Body

TERATOMAMALIGNANT TERATOMA

TERATOCARCINOMAneural tissue

retina

muscle bundles

islands of cartilage

clusters of squamous epithelium

structures reminiscent of thyroid gland

bronchial or bronchiolar epithelium

bits of intestinal wall or brain substance

SEX Cord Tumors

•Leydig,

tumor cells look like Leydig cells

•Sertoli ,

tumor cells look like sertoli cells

STAGING• Stage I: Tumor confined to the testis,

epididymis, or spermatic cord

• Stage II: Distant spread confined to retroperitoneal nodes below the diaphragm

• Stage III: Metastases outside the retroperitoneal nodes or above the diaphragm

PROSTATE• INFLAMMATIONS

• BENIGN ENLARGEMENT

• MALIGNANT TUMORS

CZ = CENTRAL

TZ = TRANSITIONAL

PZ = PERIPHAL

PROSTATE• INFLAMMATIONS

• BENIGN ENLARGEMENT

• MALIGNANT TUMORS

PROSTATITIS• ACUTE, usually same as

Urinary Tract Pathogens

• CHRONIC, usually A-bacterial, but also often recurrent or persistent from acute

• GRANULOMATOUS, non-TB or TB

“BENIGN” Enlargement• BPH• BPH• Glandular and Stromal Hyperplasia• “Nodular” Hyperplasia• Associated with old age• Associated with urinary obstruction,

frequency, bladder hypertrophy and bladder trabeculations

• By itself, it is NOT premalignant, however….

P.I.N.

NUCLEOLI, NUCLEOLI, NUCLEOLINUCLEOLI, NUCLEOLI, NUCLEOLI

PERINEURAL INVASION

BIOLOGIC BEHAVIOR• NORMAL PROSTATE • HYPERPLASIA • P.I.N. (Prostatic Intraepithelial Neoplasia),

is like “dysplasia leading to adenocarcinoma-in situ

• INFILTRATION of “stroma” • CAPSULE • LYMPH NODES • DISTANT, especially BONE

GRADING• GLEASON SCORE = Predominant

pattern (1-5) + Secondary pattern (1-5)

• Best Score = 2, Worst Score = 10

STAGING

TNM

TID-BITS• Prostate is #1 most common malignancy in

men but NOT #1 killer. WHY?

• 80% over 80

• Every elderly male presenting with widespread bone metastases is carcinoma of the prostate until proven otherwise

• PSA (Prostate Specific Antigen) has been controversial as a screening test but is GREAT for follow up of a known prostate cancer