1. Male Genital Tract
• Penis: Congenital, Inflammation,
Tumors
• Testis/Epididymis: Congenital,
Regressive, Inflammation,
Vascular diseases, Tumors
• Prostate: Inflammation, Benign
Enlargement, Malignancy

2. Male Genital Tract
(short version)
•Testis/Epididymis:
–Congenital
–Regressive
–Inflammation
–Vascular diseases
–Tumors

3. Male Genital Tract
(short version)
•Testis/Epididymis:
–Congenital: Cryptorchidism 1%
–Regressive: Atrophy
–Inflammation: Mumps, GC,
Chlamydia, E. Coli, Pseudomonas,
TB
–Vascular diseases: Torsion
–Tumors: Benign/Malig, Germ
Cell/non-Germ Cell

4. Cryptorchidism
• 1% of all births
• 25% bilateral
• Associated with significantly increased
incidence of germ cell tumors

5. Male Genital Tract
(short version)
•Testis/Epididymis:
–Congenital: Cryptorchidism 1%
–Regressive: Atrophy
–Inflammation: Mumps, GC,
Chlamydia, E. Coli, Pseudomonas,
TB
–Vascular diseases: Torsion
–Tumors: Benign/Malig, Germ
Cell/non-Germ Cell

6. Testicular Atrophy
• atherosclerotic narrowing of the blood supply in old age
• the end stage of an inflammatory orchitis, whatever the
etiologic agent
• cryptorchidism
• hypopituitarism
• generalized malnutrition or cachexia
• irradiation
• prolonged administration of female sex hormones, as in
treatment of patients with carcinoma of the prostate; and
cirrhosis

8. Male Genital Tract
(short version)
•Testis/Epididymis:
–Congenital: Cryptorchidism 1%
–Regressive: Atrophy
–Inflammation: Mumps, GC,
Chlamydia, E. Coli, Pseudomonas,
TB
–Vascular diseases: Torsion
–Tumors: Benign/Malig, Germ
Cell/non-Germ Cell

10. Male Genital Tract
(short version)
•Testis/Epididymis:
–Congenital: Cryptorchidism 1%
–Regressive: Atrophy
–Inflammation: Mumps, TB, GC,
Chlamydia, E. Coli, Pseudomonas
–Vascular diseases: Torsion
–Tumors: Benign/Malig, Germ
Cell/non-Germ Cell

12. Male Genital Tract
(short version)
•Testis/Epididymis:
–Congenital: Cryptorchidism 1%
–Regressive: Atrophy
–Inflammation: Mumps, GC,
Chlamydia, E. Coli, Pseudomonas,
TB
–Vascular diseases: Torsion
–Tumors: Benign/Malig, Germ
Cell/non-Germ Cell

13. Testicular TUMORS
• GERM CELL (malig.)
• NON-GERM (benign)
• CELL, i.e., “sex cord”
– SEMINOMA
– EMBRYONAL
– CHORIOCARCINOMA
– YOLK SAC
– TERATOMA
–MIXED!!!!!,
60%
– LEYDIG
– SERTOLI

14. Seminoma
(look for germ
cells and
lymphs)

15. Embryonal Carcinoma,
Formerly called “adeno”carcinoma,
so look for “glands” and AFP!!!)

16. CHORIOCARCINOMA
look for “trophoblast”, and HCG!!

17. YOLK SAC TUMOR,
aka “endodermal sinus tumor”
Schiller-Duvall Body

18. TERATOMA
MALIGNANT TERATOMA
TERATOCARCINOMA
neural tissue
retina
muscle bundles
islands of cartilage
clusters of squamous epithelium
structures reminiscent of thyroid gland
bronchial or bronchiolar epithelium
bits of intestinal wall or brain substance

19. SEX Cord Tumors
•Leydig,
tumor cells look
like Leydig cells
•Sertoli ,
tumor cells look
like sertoli cells

20. STAGING
• Stage I: Tumor confined to the testis,
epididymis, or spermatic cord
• Stage II: Distant spread confined to
retroperitoneal nodes below the
diaphragm
• Stage III: Metastases outside the
retroperitoneal nodes or above the
diaphragm

21. PROSTATE
•INFLAMMATIONS
•BENIGN ENLARGEMENT
•MALIGNANT TUMORS

22. CZ = CENTRAL
TZ =
TRANSITIONAL
PZ = PERIPHAL

23. PROSTATE
•INFLAMMATIONS
•BENIGN ENLARGEMENT
•MALIGNANT TUMORS

24. PROSTATITIS
• ACUTE, usually same as
Urinary Tract Pathogens
• CHRONIC, usually A-bacterial,
but also often recurrent or
persistent from acute
• GRANULOMATOUS, non-TB or
TB

28. “BENIGN” Enlargement
• BPH
• BPH
• Glandular and Stromal Hyperplasia
• “Nodular” Hyperplasia
• Associated with old age
• Associated with urinary obstruction,
frequency, bladder hypertrophy and bladder
trabeculations
• By itself, it is NOT premalignant, however….

30. P.I.N.

31. NUCLEOLI, NUCLEOLI, NUCLEOLI

32. PERINEURAL INVASION

34. BIOLOGIC BEHAVIOR
• NORMAL PROSTATE 
• HYPERPLASIA 
• P.I.N. (Prostatic Intraepithelial Neoplasia),
is like “dysplasia leading to
adenocarcinoma-in situ 
• INFILTRATION of “stroma” 
• CAPSULE 
• LYMPH NODES 
• DISTANT, especially BONE 

35. GRADING
• GLEASON SCORE = Predominant
pattern (1-5) + Secondary pattern (1-
5)
• Best Score = 2, Worst Score = 10

36. STAGING
TNM

37. TID-BITS
• Prostate is #1 most common malignancy in
men but NOT #1 killer. WHY?
• 80% over 80
• Every elderly male presenting with
widespread bone metastases is carcinoma
of the prostate until proven otherwise
• PSA (Prostate Specific Antigen) has been
controversial as a screening test but is
GREAT for follow up of a known prostate
cancer