DISEASE OF THE PENIS, SCROTUM AND TESTIS

Introduction

The penis is the male reproductive organ that is responsible for delivering semen during sexual intercourse. It is typically cylindrical in shape and composed of three main parts: the root, the shaft, and the glans. The root of the penis is the base of the organ, while the shaft is the long, cylindrical middle portion. The glans is the rounded tip of the penis that is covered by the foreskin in uncircumcised males.

The scrotum is the sac of skin that hangs beneath the penis and contains the testes. It is typically divided into two compartments, each of which houses one of the testes. The scrotum is responsible for regulating the temperature of the testes, which is important for proper sperm production and function.

The testes, also known as testicles, are the male reproductive glands that produce sperm and testosterone. They are oval-shaped and about the size of a small egg. The testes are located in the scrotum and are connected to the rest of the reproductive system by the vas deferens. Within the testes, there are tiny tubes called seminiferous tubules that produce sperm, while other cells in the testes produce testosterone. The testes also contain Leydig cells, which produce additional hormones that are important for male development and function.

There are many diseases that can affect the penis, scrotum, and testis. Here are a few examples:

• Erectile dysfunction (ED): This is a common condition in which a man has difficulty achieving or maintaining an erection. It can be caused by a variety of factors, including psychological issues, nerve damage, or underlying health conditions.
• Peyronie’s disease: This is a condition in which scar tissue forms in the penis, causing it to curve or bend abnormally. It can make erections painful or difficult, and can be treated with medication or surgery.
• Testicular cancer: This is a relatively rare but serious form of cancer that can affect one or both testicles. It typically causes a lump or swelling in the testicle, and may also cause pain or discomfort.
• Epididymitis: This is an inflammation of the epididymis, which is a small tube that carries sperm from the testicle to the vas deferens. It can cause pain and swelling in the scrotum, and may be caused by a bacterial infection.
• Balanitis: This is an inflammation of the glans (head) of the penis. It can be caused by a variety of factors, including infection, irritation, or poor hygiene.

It’s important to seek medical attention if you experience any symptoms or discomfort in the penis, scrotum, or testis. Your healthcare provider can diagnose and treat any underlying conditions and provide guidance on how to maintain good genital health.

 

1) Condyloma acuminatum is a sexually transmitted disease caused by the human papillomavirus (HPV). The pathologic features of condyloma acuminatum include multiple exophytic, papillary lesions that can be sessile or pedunculated. The surface of these lesions can be hyperkeratotic, with central umbilication, and have a cauliflower-like appearance. On microscopic examination, the lesions show acanthosis (thickening of the epidermis), papillomatosis (projection of the epidermis into finger-like structures), and koilocytosis (vacuolization of the squamous cells).

2) Giant condyloma (also known as Buschke-Lowenstein tumor) is a rare, locally aggressive form of condyloma acuminatum. The pathologic features of giant condyloma include a large, exophytic, cauliflower-like mass that can extend into the subcutaneous tissue. The lesion is characterized by a proliferation of squamous epithelium with hyperkeratosis, acanthosis, papillomatosis, and koilocytosis. The stroma may show a mixed inflammatory infiltrate, including neutrophils, lymphocytes, and plasma cells.

3) Bowen’s disease (also known as squamous cell carcinoma in situ) is a premalignant, noninvasive form of squamous cell carcinoma. The pathologic features of Bowen’s disease include a well-demarcated, erythematous plaque with a scaly surface. On microscopic examination, there is full-thickness atypia of the epidermis, with marked dyskeratosis (abnormal keratinization), pleomorphism (variation in cell size and shape), and mitotic activity.

4) Bowenoid papulosis is a rare, sexually transmitted disease caused by HPV. The pathologic features of Bowenoid papulosis are similar to those of Bowen’s disease, but the lesions are usually multiple and small. The affected skin shows full-thickness atypia, dyskeratosis, and pleomorphism. The risk of progression to invasive squamous cell carcinoma is low, but long-term follow-up is recommended.

5) Erythroplasia of Queyrat is a premalignant, in situ carcinoma of the mucosal or cutaneous squamous epithelium, typically occurring on the glans penis or inner foreskin in men. The pathologic features of erythroplasia of Queyrat include an erythematous plaque with a velvety surface. On microscopic examination, there is full-thickness atypia of the epithelium, with marked dyskeratosis, pleomorphism, and mitotic activity. The risk of progression to invasive squamous cell carcinoma is high, and treatment is recommended.

 

Cryptorchidism, also known as undescended testis, is a condition in which one or both testicles fail to descend from the abdomen into the scrotum during fetal development. Here’s a breakdown of the etiology, pathology, and complications associated with cryptorchidism:

a) Etiology: The exact cause of cryptorchidism is not known. However, it is believed to be a combination of genetic and environmental factors. Risk factors for cryptorchidism include premature birth, low birth weight, maternal smoking during pregnancy, and exposure to certain chemicals.

 

b) Pathology: In normal development, the testicles form in the abdomen and then descend into the scrotum before birth. In cryptorchidism, one or both testicles fail to descend, either partially or completely, into the scrotum. This may occur at any point in fetal development, and can result in the testis being located in the abdomen, inguinal canal, or anywhere along the path between the abdomen and scrotum.

 

c) Complications: If left untreated, cryptorchidism can result in a number of complications. These include:

• Infertility: Undescended testicles may not function properly, leading to a decrease in sperm production and fertility.
• Testicular cancer: Men with a history of cryptorchidism have an increased risk of developing testicular cancer.
• Torsion: The testicle may twist on itself, cutting off its blood supply and leading to a medical emergency.
• Inguinal hernia: An inguinal hernia can occur when a portion of the intestine pushes through a weak spot in the abdominal muscles into the inguinal canal, where the undescended testicle may be located.
• Psychological issues: Boys and men with cryptorchidism may experience body image issues and low self-esteem due to the appearance of their genitals.

 

Testicular tumors are classified into two main groups, based on their histological characteristics: germ cell tumors (GCTs) and non-germ cell tumors.

GCTs can be further divided into several subtypes, which are defined by the type of cells that the tumor is composed of. Each of these subtypes has distinct characteristics, including specific tumor markers that can be used for diagnosis and treatment. The five main subtypes of GCTs are:

1. Seminoma: This is the most common type of GCT, accounting for about 50% of cases. Seminomas are composed of cells that resemble the germ cells in the seminiferous tubules of the testes. The tumor marker for seminoma is elevated levels of serum lactate dehydrogenase (LDH) and placental alkaline phosphatase (PLAP).
2. Embryonal carcinoma: This type of GCT is composed of primitive germ cells and can be aggressive. The tumor marker for embryonal carcinoma is elevated levels of alpha-fetoprotein (AFP).
3. Teratoma: This type of GCT is composed of cells from all three germ layers (ectoderm, mesoderm, and endoderm). The tumor marker for teratoma is not well-defined, but elevated levels of beta-human chorionic gonadotropin (β-hCG) may be seen in some cases.
4. Yolk sac tumor: This is a rare type of GCT that is composed of cells that resemble the yolk sac of the embryo. The tumor marker for yolk sac tumor is elevated levels of AFP.
5. Choriocarcinoma: This is a rare and aggressive type of GCT that is composed of cells that produce human chorionic gonadotropin (hCG). The tumor marker for choriocarcinoma is elevated levels of hCG.

It is important to note that tumor markers are not always specific to one type of tumor and can be elevated in other conditions as well. A combination of tumor markers, imaging studies, and biopsy results are usually used to make an accurate diagnosis and determine the best treatment approach.