Atlas of Male Reproductive Pathology Current Histopathology Consultant Editor Professor G. Austin Gresham, TO, SeD, MO, FRC Path. Professor of Morbid Anatomy and Histology, University of Cambridge Volume Ten @CS &u[S&~ MALE REPRODUCTIVE PATHOLOGY BY I. D. ANSELL Consultant Histopathologist Department of Pathology City Hospital Nottingham l\+I.TP PRESS LIl\+I.ITED ~. "-\i.l,''''~ a member of the KLUWER ACADEMIC PUBLISHERS GROUP . , LANCASTER / BOSTON / THE HAGUE / DORDRECHT Published by MTP Press Limited Falcon House Queen Square Lancaster, England Copyright© 19851. D. Ansell Softcover reprint of the hardcover 1st edition 1985 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, ortransmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission from the publishers. British Library Cataloguing in Publication Data Ansell, I. D. Atlas of male reproductive pathology.-(Current histopathology; v. 10) 1. Generative organs, Male-Diseases I. Title II. Series 612'.61 RC875 ISBN-13: 978-94-010-8654-7 e-ISBN-13: 978-94-009-4868-6 DOl: 10.1007/978-94-009-4868-6 Published in the USA by MTP Press Adivision of Kluwer Boston Inc 190 Old Derby Street Hingham, MA 02043, USA Library of Congress Cataloging in Publication Data Ansell, I. D. (Ian David)' 1938- Atlas of male reproductive pathology. (Current histopathology; v. 10) Includes bibliographies and index. 1. Generative organs, Male-Diseases-Atlases. 2. Generative organs, Male-Biopsy-Atlases. 3. Histology, Pathological-Atlases. I. Title. II. Title: Male reproductive pathology. III. Series. [DNLM: 1. Genital Diseases, Male-pathology atlases. Wl CU788JBA v. 10/ WJ 17 A618al RC877 .A57 1985 616.6'5 85-2475 ISBN-13: 978-94-010-8654-7 Photoset and printed by Redwood Burn Limited Trowbridge, Wiltshire Bound by Butler and Tanner Limited, Frome and London Contents Consultant editor's note 7 Preface 9 Acknowledgements 10 Introduction 11 1 Testis-embryology and normal structure 13 2 Testis - developmental abnormalities 17 3 Testicular biopsy 21 4 Testis - germ cell tumours - general considerations 25 5 Testis-seminoma 29 6 Testis - non-seminomatous germ cell tumours-1 33 7 Testis-non-seminomatous germ cell tumours-2 37 8 Testis-non-germ-cell tumours 41 9 Testis - inflammatory conditions 45 10 Epididymis 49 11 Vas and seminal vesicles 53 12 Prostate-normal and hyperplasia 57 13 Prostate - carcinoma 61 14 Prostate-rarer tumours 65 15 Prostate - inflammatory conditions 69 16 Penis, urethra and scrotum - benign conditions 73 17 Penis, urethra and scrotum - malignant conditions 77 Index 81 Current Histopathology Series Already published in this series: Volume 1 Atlas of Lymph Node Pathology Volume 2 Atlas of Renal Pathology Volume 3 Atlas of Pulmonary Pathology Volume 4 Atlas of Liver Pathology Volume 5 Atlas of Gynaecological Pathology Volume 6 Atlas of Gastrointestinal Pathology Volume 7 Atlas of Breast Pathology Volume 8 Atlas of Oral Pathology Volume 9 Atlas of Skeletal Muscle Pathology Other volumes currently scheduled in this series include the following titles: Atlas of Articular Pathology Atlas of Cardiovascular Pathology Atlas of General Cytology Atlas of Connective Tissue Pathology Atlas of Neuropathology Atlas of Ophthalmic Pathology Atlas of Skin Pathology Atlas of Toxicology Consultant Editor's Note At the present time books on morbid anatomy and niques which should be within the compass of the histology can be divided into two broad groups: exten worker in a unit with reasonable facilities. sive textbooks often written primarily for students and (3) New types of material. e.g. those derived from monographs on research topics. endoscopic biopsy should be covered fully. This takes no account of the fact that the vast majority (4) There should be an adequate number of illus of pathologists are involved in an essentially practical trations on each subject to demonstrate the vari field of general Diagnostic Pathology providing an im ation in appearance that is encountered. portant service to their clinical colleagues. Many of (5) Colour illustrations should be used wherever they these pathologists are expected to cover a broad range aid recognition. of disciplines and even those who remain solely within The present concept stemmed from this definition but it the field of histopathology usually have single and sole was immediately realized that these aims could only be responsibility within the hospital for all this work. They achieved within the compass of a series. of which this may often have no chance to direct discussion on prob volume is one. Since histopathology is. by its very lem cases with colleagues in the same department. In nature. systemized. the individual volumes deal with the field of histopathology. no less than in other medical one system or where this appears more appropriate fields. there have been extensive and recent advances. with a single organ. not only in new histochemical techniques but also in the This atlas provides a modern account of the pathology type of specimen provided by new surgical procedures. of the male reproductive organs. It aims to provide an There is a great need for the provision of appropriate account of biopsy interpretation of specimens common information for this group. This need has been defined in ly encountered by the practising histopathologist. This the following terms. aim has been most satisfactorily achieved and has pro (1) It should be aimed at the general clinical patholo vided another useful bench manual in this series. gist or histopathologist with existing practical Experienced histopathologists and those in training will training. but should also have value for the trainee find it a valuable addition to the library in the reporting pathologist. room. (2) It should concentrate on the practical aspects of G. Austin Gresham histopathology taking account of the new tech- Cambridge Preface This atlas deals with conditions commonly encountered in the male genital tract. Whilst the majority of illustra tions are photomicrographs, photographs of macro scopic specimens are also used to illustrate important features in distinguishing different pathological con ditions. Special emphasis is placed on the small biopsy specimens obtained from prostate and testis in modern urological practice and the importance of clinico pathological co-operation in pathological practice is stressed. Recent advances in our knowledge of testicu lar tumours are discussed and illustrated. The text is not entirely descriptive and attempts to give an intellectual framework around which histopathological diagnosis in this field can be practised. A modest number of references are included; they have not been singled out as representing milestones in the development of our knowledge of these conditions - the choice has rather more centred upon recent reports from which a litera ture search can be mounted if required. The atlas in no way pretends to be an encyclopaedic reference of con ditions of the male genital tract but attempts to provide an up-to-date comprehensive discussion of the histo pathology of this system. Acknowledgements I am most grateful to Mr Keith Gordon for developing all the photomicrographs and to Mr Geoff Gilbert and his staff in the Audio-Visual Department of the City Hospital who took the majority of the macroscopic illustrations. I must particularly thank my secretary, Mrs Dorothy Clay ton, for typing and retyping my draft chapters and for deciphering my hieroglyphics. Introduction At first glance urological pathology is not obviously a ated by the general surgeon with an interest in urology subject in which there have been great advances in of 30 years ago. Prostates are now resected transure recent years. Electron microscopy and immunological thrally in the vast majority of instances and the material techniques have not revolutionized our concepts of dis sent for examination is accordingly that much more diffi ease in this area, as has occurred in renal glomerular dis cult to orientate and indeed to diagnose. Biopsy tech ease or in tumours of the Iymphoreticular system. niques are also widely employed - for example needle However, there have been great changes in urological biopsy of abnormal areas within the prostate and tes practice over the last 20-30 years. Urology as a disci ticular biopsy in the investigation of infertility - and pline is no longer practised only in the larger cities and although these specimens are not as small as those most District General Hospitals are likely to have a urolo obtained by such techniques as bronchoscopy and gist trained in a centre where specialized histopathologi endoscopy they can certainly pose their own difficulties cal advice was available. Such urologists are well in interpretation. The discovery of marker substances, acquainted with many of the entities described and dis both within tumours themselves and in serum, has com cussed in this book and will expect the local histopath pletely revolutionized our thoughts on the classification ologist to be able to recognize them when he and indeed the treatment of testicular tumours and tech encounters them in his clinical practice. Modern urologi niques to apply this knowledge to diagnostic histopath cal practice produces a completely different spectrum ology are now available to all departments. of pathological specimens compared to those gener- 1 Testis - Embryology and Normal Structure The testes ar~ the prim~ry generative organs of the Embryology male and are situated outside the peritoneal cavity in the T~e t~stes develop from the medial aspect of the uroge scrotum. There IS now good evidence that the lower nital ridge on the dorsum of the coelomic cavity of the tempera.ture in this site is required for effective sperma early embryo in the region of the mesonephros (Plate togenesIs. The organ has two essential functions the production of spermatozoa and the production of ~ale ~ .2). The primordial germ cells migrate from their origin In the yolk sac along the midline to reach this area and sex hormones. then move laterally to the genital ridge, ventromedial to Spermatozoa are produced in the 600 or so coiled the mesonephros. Proliferation of coelomic epithelium seminiferou~ t~bules within the main body of the testis; of the gonadal primordium forms the cortex whilst the these lie within the separate fibrous compartments medulla is derived from multiplication of the mesenchy formed by extensions of fibrous tissue from the external malcells.below thiS. The medullary cells form solid epi ~oat, th~ tunica albugi.nea, inwards and posteriorly to the thelial primary sex cords into Which, in the male, the fibrous tissue at the hilum, the mediastinum testis (Plate g~rm ce!ls rr:'igrate. The medullary mesenchymal cells 1.1). As the tubules approach the hilum they straighten differentiate Into the supporting cells of the tubules, the out to become the tubuli recti which then anastomose Sertoll cells, and the hormone-producing interstitial cells freely within the mediastinum as the rete testis. From betw~en them, the Leydig cells. The medial portions of the rete testis a dozen or so ductuli efferentes pass into the primary sex cords develop into the rete testis which the head of the epididymis (situated posterior to the then links up with mesonephric tubules which form the bo~y of the testis) and then fuse to form the single epididymis. The vas is derived from the mesonephric or cOiled ductus deferens which passes downwards to Wolffian duct. The cells of the cortex form the cellular form the tail of the epididymis. The duct then passes cov~ring ~f the testis, the tunica vaginal is, and the con upwards again outside the testis as the vas deferens ~ectlve tissue b~tween. cortex and medulla develops within the spermatic cord on its way to the seminal vesi Int? the dense ~Ibrous t~ssue of the tunica albuginea. cle. Further description of the epididymis and vas will be ThiS embryological origin of the testis from upper found in Chapters 10 and 11. Mesonephric tubule Head of epididymis Testicular artery Vas deferens o;;-:;;:::=::r'l-l---+-+'-Mesoneph ri c (Wolffian duct) Ductuli efferentes Tunica albuginea Tubu I i recti Ductus epididymis Septa -----l~~~~ .......,..-ffi~--#-- Rete testis in mediastin urn I COELOMIC I CAVITY Seminiferous _---l~ I tubule I I Tail of epididymis Plate 1.1 Structure of the testis Plate 1.2 Embryogenesis of the testis