Diseases of Male Genital Tract

Penile & Scrotal Path - Pointy & Pouchy Problems

• Penile Inflammatory Conditions:
  • Balanitis: Inflammation of glans.
  • Balanoposthitis: Inflammation of glans & prepuce.
  • Phimosis: Inability to retract prepuce. Paraphimosis: Retracted prepuce cannot be returned (⚠️ emergency).
• Penile Premalignant Lesions (Often HPV-related, esp. HPV 16):
  • Bowen's Disease: SCC in situ on shaft/scrotum; grey-white plaque.
  • Erythroplasia of Queyrat: SCC in situ on glans/prepuce; single/multiple red, velvety plaques.
  • Bowenoid Papulosis: Younger patients; multiple reddish-brown papules; rarely progresses to invasive SCC.
• Penile Malignant Tumors:
  • Squamous Cell Carcinoma (SCC): Most common (>95%). Risk factors: HPV (16, 18), phimosis, poor hygiene, smoking.
  • Verrucous Carcinoma (Buschke-Löwenstein tumor): Exophytic, locally invasive, low metastatic potential.
• Scrotal Conditions:
  • Hydrocele: Serous fluid in tunica vaginalis.
  • Varicocele: Dilated pampiniform plexus veins (📌 "bag of worms" feel).
  • Scrotal SCC: Associated with poor hygiene, chronic irritation (e.g., soot exposure in chimney sweeps).

⭐ Erythroplasia of Queyrat is a specific form of squamous cell carcinoma in situ occurring on the glans penis or prepuce, strongly associated with HPV infection.

Testicular Tumors - Germ Cell Jamboree

• 95% are Germ Cell Tumors (GCTs); peak incidence 15-35 years. Presents as painless testicular mass.
• Risk factors: Cryptorchidism, family history, Klinefelter syndrome, prior GCT.

Seminoma vs. NSGCT Overview

-   AFP: ↑ Yolk Sac Tumor (YST), Embryonal Ca.
-   hCG: ↑ Choriocarcinoma, Embryonal Ca, ~**10-15%** Seminomas.
-   LDH: Non-specific; tumor burden.
-   PLAP: Seminoma, Embryonal Ca.
-   OCT3/4: Seminoma, Embryonal Ca.

⭐ Seminomas are classically AFP negative; presence of AFP strongly suggests a non-seminomatous component or a mixed GCT.

Prostate Pathology - Gland Gone Wild

• Benign Prostatic Hyperplasia (BPH)

  • Common in older men; non-premalignant.
  • Zone: Transitional (periurethral) → LUTS (hesitancy, urgency).
  • Patho: ↑DHT → stromal & epithelial hyperplasia.
  • Histo: Nodular glandular & stromal proliferation.
  • Complications: Obstruction, UTI, bladder hypertrophy.
  • Rx: α1-blockers, 5α-reductase inhibitors, TURP.

• Prostatitis

  • Inflammation: Acute/Chronic bacterial (E. coli), CPPS (most common).
  • Symptoms: Dysuria, pelvic pain; fever (acute).

• Prostate Adenocarcinoma

  • Most common male cancer (excluding skin).
  • Zone: Peripheral (posterior) → DRE palpable.
  • Risk: Age, African-American, family Hx.
  • Screening: PSA (↑ > 4 ng/mL suspicious), DRE.
  • Histo: Infiltrative glands, prominent nucleoli, perineural invasion. Gleason score (prognostic).
  • Spread: Bone (osteoblastic 📌), obturator nodes.

  ⭐ Most prostate cancers are adenocarcinomas arising in the peripheral zone.

• Flowchart: Prostate Cancer Workup

High‑Yield Points - ⚡ Biggest Takeaways

• Cryptorchidism ↑ risk of seminoma & infertility.
• Testicular torsion: Acute hemorrhagic infarction from cord twisting; Bell-clapper deformity predisposes.
• BPH: Transitional zone origin, causes urinary obstruction; not premalignant.
• Prostate adenocarcinoma: Typically peripheral zone; Gleason score for prognosis.
• Seminoma: Most common germ cell tumor; radiosensitive, fried egg cells, ↑PLAP.
• Yolk Sac Tumor: Common in children <3 yrs; Schiller-Duval bodies, ↑AFP.
• Choriocarcinoma: Aggressive; early hematogenous spread, markedly ↑hCG.