Male genital tract 1

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This ppt part-1 of UG lectures on Male genital tract pathology for MBBS students.

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Male genital tract 1

  1. 1. Male Genital Tract Pathology- 1 Dr.CSBR.Prasad, M.D.
  2. 2. Testis CSBRP-Dec-2016
  3. 3. CONGENITAL ANOMALIES • Cryptorchidism (Undescended testes ) • Synorchism (Fused testes) CSBRP-Dec-2016
  4. 4. Cryptorchidism (Undescended testes) CSBRP-Dec-2016 • Frequency:1% (at the end of 1st year) • Bilateral in 25% • May be associated with: • GUT abnormalities – Hypospedias • Testicular descent: – Transabdominal phase • Müllerian-inhibiting substance – Inguinoscrotal phase • Androgen induced release of Calcitonin gene related peptide from genitofemoral nerve
  5. 5. Histology: • Arrest in maturation of germ cells • Hyalinization of basement membrane • Prominent Leydig cells • Paucity of germ cells is also seen in the contralateral descended testis CSBRP-Dec-2016 Cryptorchidism (Undescended testes)
  6. 6. Normal testis CSBRP-Dec-2016
  7. 7. The seminiferous tubules in this cryptorchid testis are completely atrophic. CSBRP-Dec-2016
  8. 8. Complications: – Sterility – Inguinal hernia – Testicular cancers – Prone for trauma (inguinal testis) Surgical correction: (Orchiopexy) – Before 2years of age – for fertility – Before 10yrs of age – for protection against cancer CSBRP-Dec-2016 Cryptorchidism (Undescended testis)
  9. 9. • When you are faced with intriguing intraabdominal / retroperitoneal tumor, always examine the scrotum / testis REMEMBER • Scrotum is 10th compartment of abdomen • Abdominal examination is never complete without scrotal examination CSBRP-Dec-2016 Pathology Pearls
  10. 10. Torsion - TestisTorsion - Testis  Twisting of spermatic cord with occlusion of veins and patent arterial supply – results in vascular engorgement and hemorrhagic infarction  Two types: neonatal, adult (seen in adolescents)  Anatomic defect: testis exhibits increased mobility (bell- clapper abnormality)  Should be untwisted within 6hrs to restore viability CSBRP-Dec-2016
  11. 11. Torsion - TestisTorsion - Testis CSBRP-Dec-2016
  12. 12. This testis has undergone infarction following testicular torsion. CSBRP-Dec-2016
  13. 13. Torsion of testis CSBRP-Dec-2016
  14. 14. Testicular torsion: In this case, the condition has proceeded to hemorrhagic infarction. Note the outlines of the tubules remaining, but there is loss of nuclear detail, and the interstitium is hemorrhagic. CSBRP-Dec-2016
  15. 15. Testicular atrophy  Atherosclerosis  Inflammatory lesions (Orchitis)  Cryptorchidism  Hypopituitarism  Malnutrition  Irradiation  Excessive Estrogens:  Antiandrogens in Tx of prostatic cancer  Cirrhosis of liver CSBRP-Dec-2016
  16. 16. Note that the testis on the left is small and pale white while the opposite testis appears normal. The left testis did not descend into the scrotum during development, but remained in the abdomen, a condition called a cryptorchid testis. CSBRP-Dec-2016
  17. 17. On the left is a normal testis. On the right is a testis that has undergone atrophy. CSBRP-Dec-2016
  18. 18. Here is another example of focal atrophy of seminiferous tubules along with a few residual normal tubules in which there is active spermatogenesis. There is focal atrophy of the testicular tubules seen here. The most common infectious cause for this finding is mumps orchitis. CSBRP-Dec-2016
  19. 19. HydroceleHydrocele • Accumulation of serous fluid in tunica vaginalis • No apparent cause • Mistaken for tumors • Transillumination is positive CSBRP-Dec-2016
  20. 20. Upon physical examination, the scrotum appears enlarged. This enlargement is not painful, and there is no firm mass palpable. The enlargement is due to a fluid collection around the testis known as a hydrocele. CSBRP-Dec-2016
  21. 21. One diagnostic technique to detect a hydrocele is transillumination of the fluid-filled space with a light applied to the scrotum. The fluid will transmit the light, while a solid mass will not. CSBRP-Dec-2016
  22. 22. There is scrotal enlargment with fluid density from a hydrocele on the right. A hydrocele is a painless collection of clear fluid around the testis. Hydroceles generally develop over years. CSBRP-Dec-2016
  23. 23. A large hydrocele of the testis.A large hydrocele of the testis. CSBRP-Dec-2016
  24. 24. CSBRP-Dec-2016
  25. 25. A cross section through a frozen hydrocele demonstrates the relationship of the fluid to the testis. The fluid in a hydrocele accumulates slowly but can produce a mass effect and discomfort. CSBRP-Dec-2016
  26. 26. Hematocele Chylocele Spermatocele Varicocele CSBRP-Dec-2016
  27. 27. VaricoceleVaricocele • Prominent dilation of the pampiniform plexus of veins posterior to the testis • The increased blood flow increases the temperature of testicular tubules, thus inhibiting spermatogenesis • One possible cause for infertility is a varicocele CSBRP-Dec-2016
  28. 28. Varicocele, a lesion that consists of a prominent dilation of the pampiniform plexus of veins posterior to the testis. CSBRP-Dec-2016
  29. 29. Acute LEFT varicocele RCC growing into renal vein causes obstruction to left testicular vein which drains into it, there by causing engorgement of left pampiniform plexus. CSBRP-Dec-2016 Pathology Pearls
  30. 30. Name some tumors that enter the major vessels and even reach right side of the heart? Renal cell carcinoma Hepatocellular carcinoma CSBRP-Dec-2016 Pathology Pearls
  31. 31. Calcinosis of scrotum CSBRP-Dec-2016
  32. 32. CSBRP-Dec-2016
  33. 33. CSBRP-Dec-2016
  34. 34. Granulomatous orchitis • Seen in middle aged men • Unilateral testicular enlargement • Usually tender • Granulomas confined to seminiferous tubules (cf: TB orchitis) – Probably autoimmune CSBRP-Dec-2016
  35. 35. CSBRP-Dec-2016
  36. 36. CSBRP-Dec-2016
  37. 37. Testicular Tuberculosis [Tuberculous Orchitis] CSBRP-Dec-2016
  38. 38. Tuberculosis almost invariably begins in the epididymis and may spread to the testis Syphilis, primarily involves the testis Pathology Pearls CSBRP-Dec-2016
  39. 39. CSBRP-Dec-2016
  40. 40. E N D CSBRP-Dec-2016
  41. 41. Contact: Dr.CSBR.Prasad, M.D., Professor of Pathology, Sri Devaraj Urs Medical College, Kolar-563101, Karnataka, INDIA. CSBRPRASAD@REDIFFMAIL.COM CSBRP-Dec-2016

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