Male genital part i

mgt 1 patho

1. Male Genital System(Part-I) Dr. Babai Halder

2. MALE GENITAL(REPRODUCTIVE) ORGANS External Genital Organs Penis Scrotum Internal Genital Organs Testis Epididymis Vas Deferens Accessory Glands Seminal Vesicles Prostate Gland Bulbourethral Glands

3. External Genital Organs Penis Scrotum

4. Penis It contains spongy tissue that becomes turgid and erect when filled with blood.

5. Erectile Tissues Corpus spongiosum – is the mass of spongy tissue which surrounds urethra and involves in erection by allowing rushing of blood into it  Corpus cavernosa – is one of a pair of songe -like regions of erectile tissue which contains most of the blood in the penis during penile erection Cont...

6. Urethra – a tube within the penis that conveys semen out of the body during ejaculation. Glans – the rounded, highly sensitive head of the penis. Prepuce – a fold of skin, covering the head of the penis. Cont...

7. Scrotum A pouch of skin formed from the lower part of the abdominal wall. The scrotum keeps the testes at a temperature slightly cooler than body temperature.

8. Testis Epididymis Vas Deferens Internal Genital Organs Seminal Vesicles Prostate Gland Bulbourethral Glands

9. Testis (plural testes ) The testes are the two-oval shaped male organs that produce sperm and hormone testosterone. * Testosterone - the primary male sex hormone

10. Cont … Each testis is made of tightly coiled structures called seminiferous tubules. Among tubules are cells that produce testosterone.

11. Epididymis The epididymis is a tightly coiled tubes against the testicles. It acts as maturation and storage place for sperm. Adult human testicle with epididymis: A. Head of epididymis, B. Body of epididymis, C. Tail of epididymis, and D. Vas deferens

12. Vas Deferens ( Ductus Deferens ) The vas deferens is a thin tube that starts from the epididymis to the urethra in the penis. They transport sperm from the epididymis in anticipation of ejaculation.

13. Seminal Vesicles Prostate Gland Bulbourethral Glands These glands produce nourishing fluids for the sperms that enter the urethra. Accessory glands

14. Seminal Vesicles The Seminal Vesicles are sac-like structures attached to the vas deferens at one side of the bladder. They produce a sticky yellowish fluid that contains fructose.

15. Prostate Gland The Prostate Gland surrounds the ejaculatory ducts at the base of the urethra, just below the bladder . The Prostate Gland is responsible for making the production of semen, a liquid mixture of sperm cells, prostate fluid and seminal fluid.

16. The prostate can be divided into several(4) biologically distinct regions- peripheral, central, transitional and the region of anterior fibromascular stroma . Of which the most important are the peripheral and transition zones . The types of proliferative lesions are different in each region. Most hyperplastic lesions arise in the inner transition zone , while most carcinomas (70% to 80%) arise in the peripheral zones. It also divided into 5 lobes anatomically- anterior(TZ), posterior(PZ), Right & Left lateral(All Zones) & Median(CZ). The normal prostate contains glands with two cell layers, a flat basal cell layer and an overlying columnar secretory cell layer . In between glands there is abundant fibromascular stroma .

17. Bulbourethral Glands (Cowper’s gland) The Bulbourethral Glands are two small glands located on the sides of the urethra just below the prostate gland. These glands produce a clear, slippery fluid that empties directly into the urethra.

18. COMMON PATHOLOGICAL CONDITIONS IN MALE GENITAL SYSTEMS 1. Congenital anomalies- Cryptorchidism,hypo and epispadias . 2. Inflammatory conditions- TB, filarial infections 3. Vascular- Varicocele , torsion of testis, hematocele 4. Tumors of testis and epididymis . 5. Tumors of prostate gland.

19. Hypospadias Abnormal urethral orifices involving the VENTRAL aspect of the penis Congenital anomalies of Penis

20. Epispadias Abnormal urethral orifices involving the DORSAL aspect of the penis

21. Phimosis Abnormally small orifice in the prepuce P repuce can’t be retracted

22. INFLAMMATIONS can be specific or non-specific specific usually refers to sexually transmitted infections

23. Balanoposthisis Non-specific infection of the glans penis and prepuce Causative factors Candida Anaerobes Gardnerella Pyogenic organisms Role of smegma (white exudates made of desquamated epithelial cells, sweat & debris) – chronic accumulation account for symptom

24. Tumors of penis Benign tumors( Condyloma Acuminata ) Condyloma Accuminatum (genital warts) is sexually transmitted tumor caused by human papilloma virus (HPV type 6 and 11) Gross: Thrives in any moist mucocutaneous surface of the external genitalia. Occurs as a papillary excrescence at coronal sulcus or inner surface of the prepuce.

25. Histologically : Papillae covered by- Hyperplastic Hyperkeratotic ( acanthosis ) Stratified squamous epithelium of orderly maturation sequence Koilocytosis (vacuolation) of scattered superficial cell.

26. Condyloma Accuminatum koilocytosis

27. Koilocytosis

28. Carcinoma in Situ( CIS)- includes: - Bowen disease- Seen in men 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 and scrotum. Gross- solitary thickened gray white opaque lesion. Erthroplasia of Queyrat - clinical variant of bowen disease presenting as multiple shiny red velvety plaque. shiny red plaque

29. Histology Epidermis shows proliferation with numerous mitosis , markedly dysplastic cells with large hyperchromatic nuclei and lack of orderly maturation. However, the dermal-epidermal border is sharply delineated by an intact basement membrane.

30. Bowenoid papulosis Occurs in sexually active adults of younger age group. Presence of multiple reddish brown papular lesions. Histologically similar to bowen disease and is also related to HPV 16 But virtually never develops into invasive carcinoma.

31. Feature Bowen’s Disease (Carcinoma in situ ) Bowenoid Papulosis Age >30 yrs <30 yrs lesions Solitary, Gray- white Multiple, reddish brown Behavior ↑risk of invasive carcinoma (10% cases) Never Visceral malignancies ↑risk of visceral malignancies No Histology Carcinoma in situ (HPV-16) Same as Bowen’s (HPV-16)

32. carcinoma in-situ Hyperchromatic , dysplastic, dyskeratotic epithelial cells with scattered mitosis is seen.

33. Malignant cancer of penis Invasive carcinoma 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.

34. Clinical features Slow growing locally invasive lesion, usually non-painful unless there is secondary ulceration and infection. Progressive growth Spreads to inguinal & iliac lymph nodes, Later by blood. Prognosis: Overall 5-year survival rate is <50% (with positive nodes<30%).

35. Morphology 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 growth. Flat lesions- areas of epithelial thickening along with graying and fissuring of the mucosal surface.

36. Histology- Both types are squamous cell carcinomas with varying degrees of differentiation. Majority of the usual SCC show infiltrating keratinization with moderate degrees of differentiation. Verrucous carcinoma- exophytic well differentiated variant of SCC that has low malignant potential.

37. Other less common subtypes of penile SCC includes Basaloid Warty( condylomatus ) Sarcomatoid Pseudohyperplastic Pseudoglandular ( adenoid) Adenosquamous variants

38. Squamous Cell Carcinoma This is carcinoma of penis. The glans penis is deformed by a firm , ulcerated and infiltrative mass.

39. Squamous cell carcinoma, usual type, moderately differentiated.

40. Squamous cell carcinoma, usual type, poorly differentiated.

41. SCC- Well to Moderately differentiated

42. Thank you!!!