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December 07
TUMORS
Benign Tumor
Condyloma Acuminatum
x Condyloma acuminatum is a benign tumor caused by
human papillomavirus (HPV).
x HPV type 6 and, less frequently, type 11 have been clearly
associated with condylomata acuminata.
Malignant Tumors
CONGENITAL ANOMALIES
Phimosis
x When the orifice of the prepuce is too small to permit its
normal retraction
INFLAMMATIONS
x Balanoposthitis refers to infection of the glans and prepuce Bowenoid papulosis
caused by a wide variety of organisms x Occurs in younger, sexually active adults.
x differs from Bowen disease by the presence of multiple
(rather than solitary) pigmented (reddish brown) papular
lesions.
Cuties ☺ 1 of 6
Pathology – Male Genital Tract by Dr Cruz Page 2 of 6
Tuberculosis
x almost invariably begins in the epididymis and may spread
to the testis.
x In many of these cases, there is associated tuberculous
prostatitis and seminal vesiculitis, and it is believed that
epididymitis usually represents a secondary spread from
these other involvements of the genital tract.
Syphilis
x The testis and epididymis are affected in both acquired and
congenital syphilis, but almost invariably, the testis is
involved first by the infection.
x In many cases, the orchitis is not accompanied by
epididymitis.
x The morphologic pattern of the reaction takes two forms:
the production of gummas or a diffuse interstitial
inflammation characterized by edema and lymphocytic
and plasma cell infiltration with the characteristic
hallmark of all syphilitic infections (i.e., obliterative
endarteritis with perivascular cuffing of lymphocytes and
plasma cells).
VASCULAR DISTURBANCES
Torsion
x Twisting of the spermatic cord may cut off the venous
drainage and the arterial supply to the testis.
x There are two types of testicular torsion.
1. Neonatal torsion
2. Adult torsion Spermatocytic Seminoma
x an uncommon tumor, representing 1% to 2% of all
testicular germ cell neoplasms.
x Affected individuals are generally over the age of 65 years
x slow-growing tumor that rarely if ever produces metastases;
hence, the prognosis is excellent
x Grossly, spermatocytic seminoma tends to be larger than
classic seminoma and presents with a pale gray, soft, cut
surface sometimes with mucoid cysts
x three cell populations, all intermixed:
1. medium-sized cells (15 to 18 µm), which are the most
numerous, containing a round nucleus and
SPERMATIC CORD AND PARATESTICULAR TUMORS eosinophilic cytoplasm;
2. smaller cells (6 to 8 µm), with a narrow rim of
Lipomas eosinophilic cytoplasm resembling secondary
x common lesions involving the proximal spermatic cord spermatocytes; and
x often identified at the time of inguinal hernia repair. 3. scattered giant cells (50 to 100 µm), either
uninucleate or multinucleate. In some intermediate-
Adenomatoid tumor sized cells, chromatin is similar to that seen in the
x most common benign paratesticular tumor meiotic phase of non-neoplastic spermatocytes
x usually small nodules that typically occur near the upper
pole of the epididymis. Embryonal Carcinoma
x occur mostly in the 20- to 30-year age group .
@@ The most common malignant paratesticular tumors located x more aggressive than seminomas.
at the distal end of the spermatic cord are x Grossly, the tumor is smaller than seminoma and usually
rhabdomyosarcomas in children and liposarcomas in does not replace the entire testis. On cut surfaces, the
adults. mass is often variegated, poorly demarcated at the
margins, and punctuated by foci of hemorrhage or
TESTICULAR TUMORS necrosis
x Histologically, the cells grow in alveolar or tubular patterns,
Germ Cell Tumors sometimes with papillary convolutions More
undifferentiated lesions may present sheets of cells. The
Seminoma neoplastic cells have an epithelial appearance and are
x most common type of germinal tumor (50%) and the type large and anaplastic. Mitotic figures and tumor giant
most likely to produce a uniform population of cells. cells are frequent.
x almost never occur in infants; they peak in the thirties
x produce bulky masses, sometimes 10 times the size of the
normal testis
x has a homogeneous, gray-white, lobulated cut surface,
usually devoid of hemorrhage or necrosis
x Microscopically, the typical seminoma presents sheets of
uniform cells divided into poorly demarcated lobules by
delicate septa of fibrous tissue
Pathology – Male Genital Tract by Dr Cruz Page 4 of 6
Choriocarcinoma
Tumors of Sex Cord-Gonadal Stroma
x highly malignant that is composed of both cytotrophoblastic
and syncytiotrophoblastic cells. Leydig (Interstitial) Cell Tumors
x In its "pure" form, choriocarcinoma is rare, constituting x They arise at any age, although most of the reported cases
fewer than 1% of all germ cell tumors. As will be have been noted between 20 and 60 years of age.
emphasized later, foci of choriocarcinoma are much x most common presenting feature is testicular swelling, but
more common in mixed patterns. in some patients, gynecomastia may be the first
x Typically, these tumors are small, rarely larger than 5 cm in symptom.
diameter.
x In children, hormonal effects, manifested primarily as
x Hemorrhage and necrosis are extremely common sexual precocity, are the dominating features
x they may elaborate androgens or combinations of
androgens and estrogens, and some have also
elaborated corticosteroids
x circumscribed nodules, usually less than 5 cm in diameter.
They have a distinctive golden brown, homogeneous cut
surface.
x Histologically, tumorous Leydig cells usually are remarkably
similar to their normal forebears in that they are large
and round or polygonal, and they have an abundant
granular eosinophilic cytoplasm with a round central
nucleus. Cell boundaries are often indistinct.
Teratoma x rod-shaped crystalloids of Reinke occur in about 25% of the
x refers to a group of complex tumors having various cellular tumors
or organoid components reminiscent of normal
derivatives from more than one germ layer. Sertoli Cell Tumors (Androblastoma)
x may occur at any age x may be composed entirely of Sertoli cells or may have a
x Pure forms of teratoma are fairly common in infants and component of granulosa cells.
children, second only in frequency to yolk sac tumors. x Some induce endocrinologic changes. Either estrogens or
x In adults, pure teratomas are rare, constituting 2% to 3% of androgens may be elaborated but only infrequently in
germ cell tumors. As with embryonal carcinomas, their sufficient quantity to cause precocious masculinization
frequency in combination with other histologic types is or feminization.
about 45%. x appear as firm, small nodules with a homogeneous gray-
x Grossly, teratomas are usually large, ranging from 5 to 10 white to yellow cut surface.
cm in diameter. x Histologically, the tumor cells are arranged in distinctive
x gross appearance is heterogeneous, with solid, sometimes trabeculae with a tendency to form cordlike structures
cartilaginous and cystic areas resembling immature seminiferous tubules.
x Hemorrhage and necrosis usually indicate admixture with
embryonal carcinoma, choriocarcinoma, or both Gonadoblastoma
x composed of a heterogeneous, helter-skelter collection of x rare neoplasms containing a mixture of germ cells and
differentiated cells or organoid structures, such as neural gonadal stromal elements
tissue, muscle bundles, islands of cartilage, clusters of
squamous epithelium, structures reminiscent of thyroid Testicular Lymphoma
gland, bronchial or bronchiolar epithelium, and bits of x Although not primarily a tumor of the testis, testicular
intestinal wall or brain substance, all embedded in a lymphoma is included here because affected patients
fibrous or myxoid stroma present with only a testicular mass
x Elements may be mature (resembling various tissues within x Lymphomas account for 5% of testicular neoplasms and
the adult) or immature (sharing histologic features with constitute the most common form of testicular neoplasm
fetal or embryonal tissue). in men over the age of 60.
Pathology – Male Genital Tract by Dr Cruz Page 5 of 6
x The histologic type in almost all cases is the diffuse large Chronic bacterial prostatitis
cell lymphoma x difficult to diagnose and treat
x The prognosis is extremely poor x common clinical setting is recurrent urinary tract infections
(cystitis, urethritis) caused by the same organism.
Miscellaneous Lesions of the Tunica Vaginalis
Chronic abacterial prostatitis
Hydrocele x Clinically, it is indistinguishable from chronic bacterial
x Clear serous fluid may accumulate from neighboring prostatitis.
infections or tumors, often spontaneously and without x no history, however, of recurrent urinary tract infection
apparent cause x Expressed prostatic secretions contain more than 10
leukocytes per high-power field, but bacterial cultures are
Hematocele uniformly negative.
x presence of blood in the tunica vaginalis.
x It is an uncommon condition that is usually encountered Granulomatous prostatitis
only when there has been either direct trauma to the
testis or torsion of the testis with hemorrhagic suffusion Nodular Hyperplasia (Benign Prostatic Hyperplasia)
into the surrounding tunica vaginalis or in hemorrhagic x extremely common disorder in men over age 50.
diseases associated with widespread bleeding diatheses. x characterized by hyperplasia of prostatic stromal and
epithelial cells, resulting in the formation of large, fairly
Chylocele discrete nodules in the periurethral region of the
x refers to the accumulation of lymph in the tunica and is prostate.
almost always found in patients with elephantiasis who x Histologic evidence of nodular hyperplasia can be seen in
have widespread, severe lymphatic obstruction. approximately 20% of men 40 years of age, a figure that
increases to 70% by age 60 and to 90% by age 70.
Spermatocele
x refer to a small cystic accumulation of semen in dilated
efferent ducts or ducts of the rete testis
Varicocele
x dilated vein in the spermatic cord
TUMORS
Prostate Adenocarcinoma
x extremely common disorder in men over age 50.
INFLAMMATIONS x "prostate cancer" and "prostate adenocarcinoma," when
used without qualifications, refer to the common or
Acute bacterial prostatitis acinar variant of prostate cancer.
x typically results from bacteria that cause urinary tract
infections.
x most cases are caused by various strains of E. coli, other
Gram-negative rods, enterococci, and staphylococci.
x The organisms become implanted in the prostate, usually
by intraprostatic reflux of urine from the posterior urethra
or from the urinary bladder, but occasionally, they seed
the prostate by the lymphohematogenous routes from
distant foci of infection.
x The diagnosis can be established by urine culture and
clinical features
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