Dyshormonal diseases of male genital organs

Pathology of the testicular tunics and spermatic cord

Diseases of the testicular tunics are quite common and have a diverse etiology.

Hydrocele (hydrocele testis) is an accumulation of fluid. The acquired form develops against the background of hypersecretion (e.g., in orchitis and epididymo-orchitis) or due to impaired outflow through the lymphatic and venous pathways of the spermatic cord. In uncomplicated cases, the tunica vaginalis remains smooth and shiny. When infection or a neoplastic process joins, it thickens and undergoes sclerosis, and hemorrhages are possible. The congenital form is associated with incomplete obliteration of the processus vaginalis of the peritoneum, which creates a potential hernia tract. If a congenital hydrocele does not regress by two years of age, surgical intervention is required.

Other lesions of the tunics include:

• Hematocele — an accumulation of blood, usually resulting from trauma or as a complication of hydrocele.
• Spermatocele — a cystic dilatation of the tubules of the rete testis or efferent ductules, the contents of which include spermatozoa.
• Cyst of the tunica albuginea (hydatid) — a rare pathology in men over 40 years of age, representing a cyst with clear or bloody fluid, lined by a single layer of epithelium.
• Fibrous pseudotumors — nodular or laminar proliferations of connective tissue forming as an outcome of trauma or orchitis.

Varicocele and the problem of infertility

A special place is occupied by varicocele — abnormal dilation of the veins of the spermatic cord. The overwhelming majority of cases (80%) are left-sided, which is explained by the anatomical specifics of the drainage of the left testicular vein into the left renal vein.

This disease is closely related to the development of male infertility. The pathogenesis of infertility in varicocele is due to two main factors: the development of tissue hypoxia and a local increase in scrotal temperature. These conditions prevent normal spermatogenesis.

Microscopic examination of a testicular biopsy reveals:

• Foci of desquamation of necrotic spermatogenic epithelium.
• Pronounced peritubular sclerosis.
• Testicular tissue atrophy of varying degrees of severity.

The main treatment method for this pathology is surgical ligation of the affected venous vessel.

Inflammatory diseases of the epididymis

Among diseases of the epididymis, inflammatory processes (epididymitis) predominate over neoplastic ones.

Ascending bacterial epididymitis can be acute or chronic. In young patients, the causative agents are most often Neisseria gonorrhoeae and Chlamydia trachomatis, whereas in elderly men, Escherichia coli predominates, which is usually associated with urinary tract infections. Morphologically, in the acute form, edema, hyperemia, and pronounced infiltration by polymorphonuclear leukocytes are observed in the wall and lumen of the epididymis. The chronic process is characterized by the formation of encapsulated abscesses, diffuse infiltration by macrophages, plasma cells, and lymphocytes, as well as the development of fibrosis with possible obliteration of the duct lumen.

Tuberculous epididymitis occurs as a result of retrograde dissemination of infection in urinary tract tuberculosis. Macroscopically, the epididymis is enlarged and firm, and the vas deferens thickens, sometimes acquiring a bead-like appearance. The microscopic picture is represented by classical epithelioid cell granulomas with areas of caseous necrosis in the center. Progression of the process threatens the development of specific epididymo-orchitis.

Also distinguished is sperm granuloma — an inflammatory reaction arising in response to the penetration of spermatozoa directly into the interstitial tissue of the epididymis.

Tumors of the epididymis and scrotum

The most significant among neoplasms of the epididymis is the adenomatoid tumor. This is a benign unilateral formation forming a rounded node 1–3 cm in diameter. On cross-section, the tissue is gray-yellow, shiny, with a soft or dense consistency. Microscopically, the tumor has a solid-glandular structure, where tubular areas alternate with solid fields. The cytoplasm of the cells is often vacuolated and oxyphilic, and the sclerotic stroma contains smooth muscle elements and lymphoid infiltrates.

As for scrotal pathologies, the predominant malignant tumor in this area is squamous cell carcinoma, the morphology of which is identical to epidermoid carcinoma of other locations. Basal cell carcinoma, Paget's disease, and various benign lesions such as condylomata acuminata, hamartomas, and cysts may also occur.

Class and exam questions

What else to study on this topic

• Morphological characteristics of benign prostatic hyperplasia (BPH).
• Proliferation of prostate acinar cells with atypia as a precancerous condition.
• Grading of prostate cancer according to the Gleason scale.
• Germ cell tumors of the testis and their age-related features (e.g., in children).
• Localization of early metastases in prostate cancer.

Other topics in the section "Chapter 18. Diseases of the Male Reproductive System"

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