Pathology of Male Reproductive System 3

Pathology of Male Reproductive System 3

Professor dr Ali Hassan Altimimi
Professor of pathology& histology MSc, PHD, MD(UK)

Epididymitis and Orchitis
- nonspecific infections of the contents of the scrotum are usually complications of the urinary tract infection, instrumentation, or prostate surgery
- gonorrhea - the infection often spreads to the epididymis, less often the testis
- mumps - orchitis is common in adolescents and adults
- may cause atrophy of the germinal epithelium and infertility; the Leydig cells are spared
- TB can cause granulomas involving the epididymis
- syphilis can have gummas involving the testis; may spread to the epididymis

Torsion of the Spermatic Cord
- twisting of the spermatic cord is likely to result in venous infarction and gangrene in a few hours; quite common in children and adolescents
- the involved testis is painful and elevated, ususallt twisted 540
- the underlying problem may be abnormal fixation of the testis or cryptochidism
- unilateral spermatic cord torsion can somehow damage the opposite testis
- a person can also suffer los of one testis by catching it in a hernia
Germ Cell Tumors
- cancer of the germinal epithelium
- among the commonest solid tumors of young men
- over 95% of these tumors are malignant germ cell tumors
- current thinking is that these cancers emphasize their common origin from germ cells:
- seminoma (40%)
- embryonal cell carcinoma (25%)
- choriocarcinoma (2%)
- yolk sac carcinoma
- teratocarcinoma (25%)
- all present as painless, non-tender masses of the testis
- risk factors are poorly understood, they include cryptochidism and intersex malformations
- seminoma
- cancer that closely resembles young spermatocytes
- tumor cells have fried egg appearance; arranged in masses separated by fibrous septa with a lymphocytic infiltrate, may have syncytiotrophoblast and/or granuloma formation
- chorionic gonadotrophin is a tumor marker for the 50% or so of seminomas that contain syncytiotrophoblast
- typically metastasize to the retroperitoneal lymph nodes and then to the lungs
- good response to radiation; five-year survival rate of 95% or better
- embryonal cell carcinoma
- a very primitive cancer that arises in the testis
- grossly grayish-white masses with hemorrhage and necrosis
- teratoma + embryonal cell carcinoma = teratocarcinoma
- hCG and alpha-ferroprotein are tumor markers
- tumors with an embryonal cell carcinoma component metastasize to the retroperitoneum and everywhere else
- the response to newer chemotherapy protocols is very good, with around 85% apparent cures even when metastatic disease is widespread
- choriocarcinoma
- the bloodiest tumor; solid areas may be hard to find
- the malignant cells resemble placenta, and the pathologist must identify cytotrophoblast and syncytiotrophoblast
- HCG levels are very elevated
- until recently, choriocarcinoma arising in the testis was always lethal
- teratomas
- cystic teratoma of testis is rare and is mostly composed of skin, hair, sebaceous glands, teeth
- solid teratomas are of two types:
- mature solid teratoma is benign, usually occurs in children
- immature solid teratoma is malignant, usually contains embryonal cell carcinoma or sometimes squamous cell carcinoma
- a tumor of germ cell origin may be mixed with any other tumor of germ cell origin
- any tumor of germ cell origin may metastasize as another histologic type of germ cell tumor
- lymphoma arises in the testes of older men with some frequency
- adenomatoid tumor is a benign nubbin derived from mesothelium
- germ cell tumors can and do arise in the retroperitoneum, mediastinum, and pineal "because they are midline structures"

Stromal Tumors
- Leydig cell tumors - occur at any age, are usually benign, can produce precocious puberty or gynecomastia
- the gross and microscopic appearances aretypical for endocrine tumors