Pathology

1. Chapter 21
Male
Genital Tract
Diseases

3. Male Genital Tract
(long version)
• Seminiferous tubules 
• Straight Tubules 
• Rete Testis (mediast.) 
• Efferent Ductules 
• Epididymis 
• Vas deferens 
• Seminal Vesicles 
• Ejaculatory Ducts 
• Urethra: ProstaticSpongy

9. Efferent Ductules and Epididymis

15. LITTRÉ

16. Male Genital Tract
(short version)
• Penis: Congenital, Inflammation, Tumors
• Testis/Epididymis: Congenital,
Regressive, Inflammation, Vascular diseases,
Tumors
• Prostate: Inflammation, Benign
Enlargement, Malignancy

17. Penis: Congenital
•Hypospadias
•Epispadias
•Phimosis

21. Penis: Inflammation
“Balanoposthitis”
• Candida
• Anerobes
• Gardnerella
• Pyogenic
• Role of “smegma”

22. Penis: Neoplasia
•Benign : Condyloma Acuminata (caused
by HPV), aka venereal or genital “warts”
•Malignant: Squamous cell carcinoma

25. Koilocytosis

26. Penis: Malignancy
•In-situ = Bowen’s Disease
•Invasive = Infiltrating or invasive
SQUAMOUS Cell Carcinoma

27. BOWEN’s Disease = SQUAMOUS cell carcinoma-in-situ of
the skin of the penis

31. Male Genital Tract
(short version)
• Penis: Congenital, Inflammation, Tumors
• Testis/Epididymis: Congenital,
Regressive, Inflammation, Vascular
diseases, Tumors
• Prostate: Inflammation, Benign
Enlargement, Malignancy

32. Male Genital Tract
(short version)
•Testis/Epididymis:
–Congenital
–Regressive
–Inflammation
–Vascular diseases
–Tumors

33. 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

34. Cryptorchidism
• 1% of all births
• 25% bilateral
• Associated with significantly increased incidence of
germ cell tumors

35. 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

36. Testicular Atrophy
• atherosclerotic narrowing of the blood supply in old age
• the end stage of an inflammatory orchitis, whatever the etiologic
agent
• Cryptorchidism (undescended testes are sterile)
• hypopituitarism
• generalized malnutrition or cachexia
• irradiation
• prolonged administration of female sex hormones, as in
treatment of patients with carcinoma of the prostate; and cirrhosis

38. 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

40. 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

42. 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

43. Testicular TUMORS
• GERM CELL (malig.)
– SEMINOMA
– EMBRYONAL
– CHORIOCARCINOMA
– YOLK SAC
– TERATOMA
–MIXED!!!!!,
60%
• NON-GERM (benign)
• CELL, i.e., “sex cord”
– LEYDIG
– SERTOLI

44. Seminoma
(look for germ cells
and lymphs)

45. Embryonal Carcinoma,
Formerly called “adeno”carcinoma, so look
for “glands” and AFP!!!)

46. CHORIOCARCINOMA
look for “trophoblast”, and HCG!!

47. YOLK SAC TUMOR,
aka “endodermal sinus tumor”
Schiller-Duvall Body

48. TERATOMA
MALIGNANT TERATOMA
TERATOCARCINOMA
clusters of squamous epithelium, hair, skin glands
neural tissue
retina
muscle bundles
islands of cartilage
structures reminiscent of thyroid gland
bronchial or bronchiolar epithelium
bits of intestinal wall or brain substance

49. SEX Cord Tumors
•Leydig,
tumor cells look
like Leydig cells
•Sertoli ,
tumor cells look
like sertoli cells

50. 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

51. PROSTATE
•INFLAMMATIONS
•BENIGN ENLARGEMENT
•MALIGNANT TUMORS

52. CZ = CENTRAL
TZ = TRANSITIONAL
PZ = PERIPHAL

53. PROSTATE
•INFLAMMATIONS
•BENIGN ENLARGEMENT
•MALIGNANT TUMORS

54. 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

58. “BENIGN” Enlargement
• BPH (H= Hypertrophy)
• BPH (H= Hyperplasia)
• 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….

60. P.I.N.

61. NUCLEOLI, NUCLEOLI, NUCLEOLI

62. PERINEURAL INVASION

64. 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 

65. GRADING
• GLEASON SCORE = Predominant pattern
(1-5) + Secondary pattern (1-5)
• Best Score = 2, Worst Score = 10

66. STAGING
TNM

67. 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