Cryptorchid testis from a 17-year-old. Postpubertalseminiferous tubules are lined by Sertoli cells. The tubule at the right also has primary spermatocytes. Tubules at bottom left are lined by immature Sertoli cells and are persistent immature tubules.
Atrophy is a regressive change affecting scrotal testis It is the end stage of an inflammatory orchitis.
Hyalinisation of seminiferous tubules is seen.
(A) Normal testis shows tubules with active spermatogenesis. (B) testicular atrophy in cryptochordism- tubules show sertoli cells but no spermatogenesis, there is thickening of basement membranes and apparent increase in interstitial leydig cells.
(A)Spermatic cord torsion for 5.5 hours in a 14-year-old. Testis biopsy shows marked interstitial hemorrhage but no necrosis of germinal cells. (B) Active granulation tissue at the periphery of an infarct of approximately 3 months' duration in a 17-year-old.
(A) Testis with uniform, tan parenchyma. (B) Mixed inflammatory cell infiltrate contains lymphocytes, plasmacytes, and histiocytes and involves tubules and interstitium
This is acute epididymitis caused by gonnococcal infection- the epididymis is replaced by an abscess,. Normal testis is seen on the right.
This is gross diagram of adenomatoidtumor consists of a white, circumscribed nodule (bisected) attached to the epididymis.
This typical adenomatoidtumor consists of tubules of cells that often have large cytoplasmic vacuoles.
Urethra and male genital system
URETHRA AND MALE
GENITAL SYSTEM (PENIS
ANATOMY OF URETHRA
• In males – Urethra is 20 cm in length
– three named regions
– Prostatic urethra
• Passes through the prostate gland
– Membranous urethra
• Through the urogenital diaphragm
– Spongy (penile) urethra
• Passes through the length of the penis
URETHRA IN FEMALES
_4 cm in length
BOUND BY CONNECTIVE TISSUE TO ANTERIOR
WALL OF VAGINA
URETHRAL ORIFICE EXITS BODY BETWEEN
VAGINAL ORIFICE AND CLITORIS
Epithelium of urethra
At the proximal end (near the bladder)
Stratified and pseudostratified columnar – mid
urethra (in males)
Stratified squamous epithelium
At the distal end (near the urethral opening)
Gonococcal urethritis( N.gonococcus)
Nongonococcal urethritisE.coli/ other enteric bacteria
Urethritis is often accompanied by cystitis in women and prostatitis in
Symptoms: local pain, fever, itching and frequency.
Reiters syndrome: clinical triad of arthritis, conjunctivitis and
Morphology: changes are typical of inflammation.
TUMOR AND TUMOR-LIKE CONDITIONS
Present as a small, red ,painful mass about the
external urethral meatus.
It may be covered with intact mucosa but is
extremely friable and bleeds to slightest trauma.
Histologic examination- inflamed granulation
tissue, polyp can be seen.
Benign epithelial tumors includes
Squamous and urothelial papilloma
Inverted urothelial papilloma
Nephrogenic adenomas and polyp
Dysuria and hematuria
Polyps are lined by prostatic-type epithelium , may be solitary or
characterised by a papillary or filiform fibrovascular core
covered by glandular epithelium.
The luminal layer is columnar whereas the basal layer is cuboidal or
Polyps may also contain acini some with corpora amylacea.
Majority of these polyps stain strongly for PSA and PSAP
using IHC techniques.
Histogenesis of these benign polyps is unclear but
Activation of embryonic nests
Overgrowth of the urothelium by proliferating prostatic
CONGENITAL POSTERIOR URETHRAL POLYP /
Seen in young boys who present with mild symptoms of
bladder outlet obstruction and hematuria.
Located in the area of verumontanum.
Histologically, they are characterised by congested or
edematous fibrovascular stroma lined by transitional
CARCINOMA OF URETHRA
Male urethral cancer
Prostatic and membranous urethra: tumors arising are
usually transitional type and most commonly associated with
These do not express PSA or PSAP antigens and are not
Bulbous and membranous urethra: tumors are mostly
squamous type and rarely associated with vesical neoplasm.
Female urethral cancer
Proximal two-thirds of female urethra: tumors arising
are transitional cell type and associated often with vesical
Distal one-third of urethra: are usually squamous cell
Adenocarcinomas of urethra
These are rare tumors and arise from the periurethral
glands or through metaplasia of the surface urothelium.
Penis - formed of three cylindrical masses of erectile tissue enclosed in separate fibrous coverings - held together by a covering
Root at base of penis, divides into crura which are attached to
the pelvic bones
Glans is at the tip of the penis and is the most sensitive part for
most men - covered by prepuce or foreskin which may be
removed by a surgical procedure called circumcision
smegma - secretion that can accumulate under foreskin of penis
Corona (crown) - ridge between glans and foreskin
Frenulum - connects glans to shaft on underside of penis
Two "corpora cavernosa"
One "corpus spongiosum" which lies ventrally in the
penis and houses the spongy urethra. Expands at
the end of the penis into the "glans penis.
Epispadias & Hypospadias =Malformations of
the urethral groove:
Epispadias - opening on the Dorsal surface of penis
Hypospadias - More common(1 in male 300
births)- opening on ventral surface of penis
Complications: Urinary obstruction ↑ risk of
ascending UTI, can’t ejaculate properly
1. HYPOSPADIAS & EPISPADIAS
opening in the ventral
surface of penis
opening in the DORSAL
surface of penis
↑ risk of infection
can’t ejaculate properly
2. Phimosis =Abnormally narrow prepuce –
prevents normal retraction;
Results in Urinary obstruction, ↑ risk of
recurrent infections, ↑ risk of cancer.
3. Paraphimosis = forcible retraction of the
prepuce in cases of
severe congestion of the Glans,
acute urinary obstruction
1. Balanitis :
Inflammation of the Glans, Commonly caused by Phimosis.
2. Balanoposthitis :
Infection of the Glans and prepuce.
Both caused by-pyogenic bacteria including
gonococcus, anaerobic bacteria
Fungi – Candida (seen in diabetics)
Mycoplasma, Chlamydia, gardnerella
Most often consequence of poor local hygiene in uncircumcised males
& underlying systemic disorder such as Diabetes.
PENILE FIBROMATOSIS (PEYRONIE'S DISEASE)
Mostly affects men between ages 40-60.
A history of penile trauma and urethritis is present
in some instances, suggesting a sclerosing
inflammatory process in the genesis of the lesion.
It presents as an indurated plaque or indentation in
the corpora cavernosa.
30% of cases are associated with erectile
TUMORS OF PENIS
Condyloma Accuminatum (genital warts) =
Benign, HPV (types 6 & 11)
Gross: Occurs as a papillary excrescence at
coronal sulcus or inner surface of the prepuce.
Carcinoma in Situ( CIS)- includes:
- Bowen diseaseSeen in both men and women over the age of 35 years.
Strongly associated with HPV especially type 16.
In men it involves the skin of the shaft of the penis an
Gross- solitary thickened gray white opaque lesion.
Erthroplasia of Queyrat- clinical variant of bowen
disease presenting as a shiny red velvety plaque.
shiny red plaque
Epidermis shows proliferation with numerous
mitosis , markedly dysplastic cells with large
hyperchromatic nuclei and lack of orderly
However, the dermal-epidermal border is
sharply delineated by an intact basement
Occurs in sexually active adults
Presence of multiple reddish brown papular
Histologically similar to bowen disease and is
also related to HPV 16
But virtually never develops into invasive
(Carcinoma in situ )
Solitary, Gray- white
↑risk of invasive
carcinoma (10% cases)
↑risk of visceral
Carcinoma in situ
Same as Bowen’s
MALIGNANT CANCER OF PENIS
Age- 40 to 70yrs
Almost exclusively seen in non-circumcised
males (Possible carcinogens in smegma);
Cause : HPV types 16 & 18;
Cigarette smoking elevates the risk.
Circumcision confers protection.
Slow growing locally invasive lesion, usually
non-painful unless there is secondary ulceration
Progressive growth Spreads to inguinal & iliac
lymph nodes, Later by blood.
Prognosis: Overall 5-year survival rate is <50%
(with positive nodes<30%).
Usually begins on the glans or inner surface of
prepuce near the coronal sulcus.
Two macroscopic patterns :
Papillary lesion- simulate condyloma acuminata
, produces a cauliflower-like fungating.
Flat lesions- areas of epithelial thickening along
with graying and fissuring of the mucosal surface
Histology- Both types are squamous cell
carcinomas with varying degrees of differentiation.
Majority of the usual SCC show
infiltrating keratinization with moderate degrees of
Verrucous carcinoma- exophytic well differentiated
variant of SCC that has low malignant potential.
Other less common subtypes of penile SCC
ANATOMY OF THE TESTIS
Testis are paired oval structures about 4 cm in the
longest (vertical) diameter lying in the scrotal sac
Epididymis , mass formed by tortuous tubules lies on its
posterior border- It has a Head , Body and Tail
Tunica vaginalis – outermost layer ,closed sac covering
testis and epididymis , has visceral and parietal layers
Tunica albuginea- deep to tunica vaginalis formed by a
dense fibrous membrane
Substance of the testis divided into lobules
containing highly convoluted seminiferous tubules
involved in spermatozoa production
Each testis has about 200 lobules, one to three
seminiferous tubules in each lobule
Tubules enter the fibrous tissue in posterior part of
testis to form a network called rete testis
Tunica vasculosa lies deep to tunica albuginea,
layer of vascular tissue
Failure of descent of testis from the abdominal cavity through
the inguinal canal.
Causes: Most common idiopathic
about1% of males
right > left, 25% bilateral
When unilateral, may see atrophy in contralateral testis.
concomitant inguinal hernia
increased risk of testicular malignancy
Orchiopexy ( Placement in the scrotal sac)
May help prevent atrophy
May not decrease risk of malignancy.
Atrophic changes by 2 yrs of age;
Arrest in the development of germ cells
Hyalinization and thickening of seminiferous tubules &
Sparing Leydig cells which become prominent
With progressive tubular atrophy the testis becomes
small and firm in consistency.
Similar changes - contralateral descended testis
Atrophy is a regressive change affecting scrotal testis
It is the end stage of an inflammatory orchitis
Possible causative factors:
Atherosclerotic narrowing of the blood supply in old age
generalized malnutrition or cachexia
prolonged administration of female sex hormones, as in
treatment of patients with carcinoma of the prostate
Associated with decreased
fertility, hypospermatogenesis, maturation arrest and
sometimes vas deferens obstruction.
Hyalinization of seminiferous tubules & interstitial fibrosis
Sparing of Leydig cells.
•↑ in space
Twisting of the spermatic cord which typically cuts
off the venous drainage of the testis.
There is intense vascular engorgement which may
lead to hemorrhagic infarction
Bilateral anatomic defect where the testis has
increased mobility giving rise to “bell-clapper”
Neonatal torsion: occurs either in utero or just after
Adult torsion: typically seen in adolescence.
C/f- sudden onset tesicular pain, often without any
Testis should be surgically explored and
manually untwisted within 6 hours to maintain its
Contralateral un-affected one should surgically
( Orchiopexy )
Depends on the duration of the process.
Extravasation of blood into the interstitial tissue
Haemorrhagic testicular infarction
Late stages: marked enlargement of testis
sac of soft, necrotic, hemorrhagic tissue
1. Nonspecific Epididymitis & Orchitis
Infection reaches the epididymis and testis
from the urinary tract through either the vas
deferens or via lymphatics of spermatic cord.
children- Gram negative rods
15-35 year old (sexually active males)-Chlamydia
Older men- E. coli & Pseudomonas;
Early stage: Acute suppurative inflammation
characterised by congestion, edema and infiltration by
neutrophils, macrophages and lymphocytes.
Later stages: Fibrosis & hyalinization sterility
Leydig cells - not affected (normal sexual activity)
2. Granulomatous OrchitisAlso called “Autoimmune Orchitis”
Presents in middle age
Sudden onset of tender testicular mass;
fever may be seen
if painless and of insidious onset, may mimic
Histology: Granulomas within seminiferous
1. Gonorrheal Epididymo -OrchitisRetrograde infection from the posterior urethra to
prostate, seminal vesicles and then to epididymis
causing suppurative Epididymitis.
may lead to development of frank abcesses and
finally destruction of epididymis.
In untreated cases, spread to testis (suppurative
Mumps Orchitis1 week after onset of parotitis;
seen in postpubertal males
testicular involvement is rare in school aged
Orchitis is unilateral in 70% of cases.
Histology: Interstitial inflammation with mononuclear
Recovery is complete
3. Tuberculous Epididymo - OrchitisPrimarily Epididymitis, with secondary spread to
sinuses on the dorsal surface of the scrotum
4. Syphilitic OrchitisStarts in the testis
rarely spreading to epididymis
production of Gummas or
Diffuse interstitial inflammation with lympho plasmacytic
obliterative endarteritis with perivasular cuffing of
lymphocytes and plasma cells.
SPERMATIC CORD AND PARATESTICULAR
Lipoma of spermatic cord
common lesion affecting the proximal spermatic
usually diagnosed at the time of inguinal hernial
not a true neoplasm, rather represents
retroperitoneal adipose tissue that has been pulled
into the inguinal canal along with hernial sac
most common benign paratesticular tumor
involves the epididymis and also spermatic cord
presents as painless , firm, intrascrotal mass
typically , head of epididymis is affected
Gross : Well circumscribed , firm, white to tan nodule
, usually less than 2 cm.
characteristic solid to cystic tubules and cords of
cells lining the tubules are flattened to cuboidal
with a prominent intervening fibrous stroma.
the cellular vacuoles may yield a signet ringlike appearance
cytoplasm is typically abundant and
eosinophilic with vesicular nuclei.
IHC shows positivity for CK, EMA and Calretinin
Malignant paratesticular tumors
in children: Rhabdomyosarcoma
in adults: liposarcomas
located at the distal end of spermatic cord.
Robin – pathologic basis of disease.
Urinary MG WHO.