Male Genital Tract Pathology-1

Dr.CSBR.Prasad, M.D.

Testis

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CONGENITAL ANOMALIES

• Cryptorchidism (Undescended testes )

• Synorchism (Fused testes)

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Cryptorchidism

(Undescended testes)

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• 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

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

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Cryptorchidism

(Undescended testes)

Normal testis

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The seminiferous tubules in this cryptorchid testis are completely atrophic.

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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

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Cryptorchidism

(Undescended testis)

• 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

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Pathology Pearls

Torsion - 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

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This testis has undergone infarction following testicular torsion. CSBRP-July-2012

Torsion of testis

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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.

Testicular atrophy

• Atherosclerosis

• Inflammatory lesions (Orchitis)

• Cryptorchidism

• Hypopituitarism

• Malnutrition

• Irradiation

• Excessive Estrogens:

• Antiandrogens in Tx of prostatic cancer

• Cirrhosis of liver

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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.

On the left is a normal testis.

On the right is a testis that has undergone atrophy.

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.

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Hydrocele • Accumulation of serous fluid in tunica

vaginalis

• No apparent cause

• Mistaken for tumors

• Transillumination is positive

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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-July-2012

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.

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.

A large hydrocele of the testis.

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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.

Hematocele

Chylocele

Spermatocele

Varicocele

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Varicocele • 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

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Varicocele, a lesion that consists of a prominent dilation of the

pampiniform plexus of veins posterior to the testis. CSBRP-July-2012

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.

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Pathology Pearls

Name some tumors that enter the

major vessels and even reach right

side of the heart?

Renal cell carcinoma

Hepatocellular carcinoma

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Pathology Pearls

Calcinosis of scrotum

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Granulomatous orchitis

• Seen in middle aged men

• Unilateral testicular enlargement

• Usually tender

• Granulomas confined to seminiferous

tubules (cf: TB orchitis)

• Probably autoimmune

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Testicular Tuberculosis

[Tuberculous Orchitis]

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Tuberculosis almost invariably

begins in the epididymis and may

spread to the testis

Syphilis, primarily involves the testis

Pathology Pearls

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E N D

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Contact:

Dr.CSBR.Prasad, M.D.,

Associate Professor of Pathology,

Sri Devaraj Urs Medical College,

Kolar-563101,

Karnataka,

INDIA.

CSBRPRASAD@REDIFFMAIL.COM