B/ 90 Disease of the penis, scrotum and spermatic cord

Question 1

Diseases of the penis

Answer 1

Malformations, inflammatory lesions, neoplasms

Question 2

Malformations of the penis

Answer 2

Hypospadia: an abnormal opening of the urethra along the ventral aspect of the penis.
Epispadias: the urethral orifice located on the dorsal aspect of the penis.

Both of these malformations may lead to lower UTI.

Question 3

Inflammatory lesions of the penis

Answer 3

Balanitis - A local inflammation of the glans penis.

Balanoposthitis - Local inflammation of the glans penis and the prepuce overlying it. Both of which are a result of poor hygiene in uncircumcised males which leads to the formation of smegma: an accumulation of desquamated cells, sweat and debris. The penis is red and swollen, purulent discharge may be present.

Phimosis - inability of the prepuce to retract over the glans penis. Can be congenital or due to scarring from blanaoposthitis.

Paraphimosis - Compromised circulation to the glans due to retraction of a stenotic prepuce over the glans penis.

Fungus infection - Candida albicans. Erosive, painful, pruritic lesion of the glans penis, scrotum and adjacent areas.

Question 4

Risk factors for neoplasm of the penis

Answer 4

More than 95% is associated with squamous epithelium. Risk factors: poor hygiene, smoking, infection with HPC particularly serotypes 16 and 18. Carcinoma of the penis is generally preceded by intraepithelial neoplasia/ carcinoma in situ.

Question 5

Morphology of neoplasm of the penis

Answer 5

Gray, crusted, papular lesion. It can infiltrate the underlying CT to produce ulcerated skin lesions.

Question 6

Histology of neoplasm of the penis

Answer 6

Keratinizing squamous cell carcinoma with infiltrating margins.

Question 7

Verrucous carcinoma

Answer 7

A variation of keratinizing squamous cell carcinoma which is characterized by papillary architecture.

Question 8

Diseases of the scrotum

Answer 8

Neoplasms, hydrocele, hematocele, Chylocele, Elephantiasis, Epidermoid cyst

Question 9

Neoplasms of the scrotum

Answer 9

Squamous cell carcinoma is the most common. In general neoplasms of the scrotum are rare.

Question 10

Hydrocele

Answer 10

Accumulation of serous fluid within the tunica vaginalis. May be a response to local infection, tumors or it may be idiopathic.

Question 11

Hematocele

Answer 11

Accumulation of blood within the tunica vaginalis.

Question 12

Chylocele

Answer 12

Accumulation of lymph within the tunica vaginalis.

Question 13

Elephantiasis

Answer 13

An enlargement of the scrotum to a grotesque proportion. Can be the result of lymphatic obstruction - by filariasis for example.

Question 14

Epidermoid cyst

Answer 14

A closed sac under the skin containing keratin. May be associated with a swollen hair follicle and blocked sebaceous gland.

Question 15

Diseases of the spermatic cord

Answer 15

Spermatic cord torsion, Varicocele

Question 16

Spermatic cord torsion

Answer 16

Torsion of the testis within the tunical sac. The torsion produces venous and arterial ischemia unless it is rapidly corrected.

Question 17

Varicocele

Answer 17

Abnormal dilation of the veins of the pampiniform plexus. Probably occurs due to insufficiency of venous valves.
Microscopically: variable thickening of venous wall with fibrosis, decreased spermatogenesis in tubules with germ cell degeneration and increased amount of Leydig cells.