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Male Genital Tract

Phatology of male genital tract

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15 views42 pages

Male Genital Tract

Phatology of male genital tract

Uploaded by

abcde777444
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Diseases of Male Genital

Tract
1. Cryptorchidism
- It is synonymous with undescended testis
- It is found in 1% of 1yr old boys
- This anomaly represents a complete or
incomplete failure of the intra-abdominal testes
to descend into the scrotal sac
- In most patients , the undescended testis is found
in the inguinal canal
- The condition is completely asymptomatic & it is
found by the patient or the examining physician
only when the scrotal sac is discovered not to
contain the testis
Moprphology
- Cryptorchidism is unilateral in most cases , but it
might be bilateral in 25% of cases
- Histologic changes begin as early as 2 years of
age
 These changes include arrest in development of
germ cells associated with marked hyalinization
& thickening of basement membrane of
semineferous tubules
Consquences
- Inguinal testis is exposed to trauma & crushing
against the ligaments & bones
- Bilateral cryptorchidism is associated with
sterility
- The undescended testis is at greater risk of
developing testicular cancer than is the
descended testis
2. Inflammation – Orchitis
- Inflammations are distinctly more common in the
epididymis than in the testis
- Gonorrhea & tuberculosis almost invariably arise
in the epididymis, where as syphilis affects the
testis first
Non specific Epididymitis & orchitis
- usually begin as a primary urinary tract infection
with secondary ascending infection of the testis
through the vas deferens or lymphatics of the
spermatic cord.
Causes
- Children – Gram negative rods
- Men < 35 – C. trachomatis, N. gonorrhea
- Men > 35 – E. coli, pseudomonas
Morphology
- The involved testis is typically swollen and tender
and contains a predominantly neutrophilic
inflammatory infiltrate
Specific Epididymitis & orchitis
- Gonorrhea
- Mumps
- Tuberculosis
- Syphilis
3. Torsion
- Twisting of the spermatic cord may cut off the
venous drainage & the arterial supply to the
testis.
 There are two types of torsion
 Neonatal torsion
 Adult torsion – it is seen in adolescence , presenting as
sudden onset testicular pain. Adult torsion results from
bilateral anatomic defect in which the testis has
increased mobility (Bell clapper abnormality)
- If the testis is explored in surgically & manually
untwisted 6 hrs after onset of torsion , there is a
good chance that the testis will remain viable.
Otherwise it will undergo infarction
- To prevent the catastrophic occurrence of
subsequent torsion in the contralateral testis, the
testis that is unaffected by torsion is surgically
fixed to the scrotum (orchiopexy)
4. Varicocele
- Varicosity of the pampiniform plexus of
veins around the spermatic cord.
- The increased blood flow increases the
temperature of testicular tubules, thus
inhibiting spermatogenesis.
 Primary varicocele - no obvious cause , more
common on the left side
 Secondary varicocele – the result of venous
obstruction eg renal carcinoma
5. Hydrocele
 An accumulation of serous fluid within the
tunica vaginalis of the testis.
 Congenital hydrocele - appeaing in the first
weeks of life, results from persistence of the
processes vaginalis (the channel b/n the
peritoneal cavity & the tunica).
 Secondary hydrocele – may be associated with
underlying lesion of testis or epididymis –
inflammation & neoplasia.
6. Testicular tumors
- Tumors of the testis are uncommon
- They are divided into two major categories- germ
cell tumors(95%) and non germinal tumors
arising from stroma and sex cord.
They are divided into two major categories
 Germ cell tumors (95%)
- Seminoma
- spermatocytic seminoma
- Yolk sac tumor
- Embryonal carcinoma
- Choriocarcinoma
- Teratoma
- Mixed tumors
 Non germinal tumors derived from stroma or sex
cord
- Leydig (interstitial) cell tumors
- Sertoli cell tumors
Pathway of spread
- Lymph nodes – Para-aortic, mediastenal,
supraclavicular lymph nodes
- Hematogenous dissemination- lungs, liver,
brain ,bone
 Seminoma tend to remain localized to the testis
for long time and metastasis typically involve
LNs where as NSGCT present with advanced
clinical disease, metastasize early by
hematogenous pathway.
 Seminomas are radiosensetive whereas NSGCT
are relatively radioresistent.

 In general NSGCT are more aggressive and have


poorer prognosis.
 GCT secrete polypeptide hormones and enzymes
that an be detected in the blood including AFP,
HCG, placental alkaline phosphatase, placental
lactogen and lactate dehydogenase.
7. Benign prostatic hyperplasia (BPH)
 It is extremely common disorder in men over age
50
 20% of men 40 yrs of age; 70% by age 60 ; 90%
by age 70.
 It is characterized by hyperplasia of prostatic
stromal & epithelial cells, resulting in the
formation of large discrete nodules in the
periurethral region of the prostate.
 When sufficiently large, the nodules compress &
narrow the urethral canal to cause partial or
sometimes complete obstruction of the urethra.
 In addition the urinary tract obstruction in BPH
is due to smooth muscle contraction of the
prostate mediated by alpa adrenoreceptor (hence
drugs that inhibit the receptor relief obstruction) .
Morphology
- The normal prostate weighs 20 to 30 gm, but
most prostates with nodular hyperplasia can
weigh from 50 to 100 gm.
- Nodular hyperplasia originates in inner aspect of
the prostate gland , in the transitional zone
 Microscopically, nodular prostatic hyperplasia
consists of nodules of glands and intervening
stroma. Most of the hyperplasia is contributed by
glandular proliferation, but the stroma is also
increased
Clinical course
- Symptoms of nodular hyperplasia are related to
two secondary effects
1. Compression of the urethra with difficulty in
urination
2. Retention of urine in the bladder with subsequent
distension of bladder with development of
cystitis & renal infection
- Patients experience frequency, nocturia, difficulty
in starting & stopping the stream of urine,
overflow dribbling & dysuria. Sudden acute
urinary retention occurs & persists until the
patient receives an emergency catheterization.
- In severe, prolonged cases, hydroureter with
hydronephrosis and renal failure can ensue.
8. Tumors of prostate
Adenocarcinoma
- It is the most common form of cancer in men &
the second leading cause of cancer death.
- It is typically disease of men over age of 50.
- Several risk factors such as age, race, family
history, hormonal levels & environmental
factors play role
 Androgens are believed to play role in
pathogenesis of prostate carcinoma. The tumor
cells carry androgen receptor & inhibition of
these tumors can be achieved with orchiectomy
 Morphology - In 70% of cases , carcinoma of
prostate arises in the peripheral zone of the
gland. The neoplastic tissue is gritty & firm
 Bone metastasis of prostatic carcinoma are
osteoblastic (affected bones include lumbar
spine, proximal femur)
 Microscopically, most lesions are
adenocarcinomas that produce well defined
glandular pattern.
 Clinical features
- Decreased urinary stream , urinary frequency,
back pain from metastasis to lumbar spine.
- On physical examination nodule felt on
digital rectal examination.

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