Chapter 24: Male Genital Pathology

Male Genital Pathology begins by examining congenital penile malformations, specifically distinguishing between epispadias, where the urethral opening is on the dorsal surface, and hypospadias, where it appears on the ventral surface, both of which carry risks for infection and infertility. The discussion moves to inflammatory and neoplastic conditions of the penis, identifying balanitis, Peyronie disease, and Condyloma acuminatum caused by low-risk HPV, as well as Squamous Cell Carcinoma associated with high-risk HPV serotypes 16 and 18. Significant attention is given to hemodynamic and functional disorders such as priapism and the multifactorial causes of erectile dysfunction. The summary then shifts to scrotal and testicular pathology, differentiating between fluid collections like hydroceles, cysts like spermatoceles, and vascular dilations known as varicoceles. It outlines the age-dependent etiology of epididymitis, noting that pathogens like Neisseria gonorrhoeae and Chlamydia trachomatis typically affect men under the age of 35, while E. coli affects older populations. Critical testicular emergencies such as torsion and the oncological risks associated with cryptorchidism are thoroughly analyzed. A major portion of the chapter is dedicated to testicular cancer, detailing the use of serum markers like AFP, beta-hCG, and LDH for diagnosis and monitoring. It categorizes germ cell tumors into seminomas, which are generally radiosensitive and have a good prognosis, and non-seminomatous tumors including embryonal carcinoma, choriocarcinoma, and yolk sac tumors, which often display more aggressive behavior and specific histologic patterns like Schiller-Duval bodies. The text also covers sex cord-stromal tumors and identifies lymphoma as the most common testicular malignancy in men over the age of 60. Finally, the chapter contrasts disorders of the prostate, explaining how Benign Prostatic Hyperplasia (BPH) arises in the transition zone to cause urinary obstruction, whereas prostate adenocarcinoma typically develops in the peripheral zone, is graded via the Gleason system, and may present with osteoblastic bone metastases.