Atlas of Male Reproductive Pathology

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 &u[s&~ @CS 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-pathologyatlases. 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 histology can be divided into two broad groups: extensive textbooks often written primarily for students and monographs on research topics. This takes no account of the fact that the vast majority of pathologists are involved in an essentially practical field of general Diagnostic Pathology providing an important service to their clinical colleagues. Many of these pathologists are expected to cover a broad range of disciplines and even those who remain solely within the field of histopathology usually have single and sole responsibility within the hospital for all this work. They may often have no chance to direct discussion on problem cases with colleagues in the same department. In the field of histopathology. no less than in other medical fields. there have been extensive and recent advances. not only in new histochemical techniques but also in the type of specimen provided by new surgical procedures. There is a great need for the provision of appropriate information for this group. This need has been defined in the following terms. (1) It should be aimed at the general clinical pathologist or histopathologist with existing practical training. but should also have value for the trainee pathologist. (2) It should concentrate on the practical aspects of histopathology taking account of the new techniques which should be within the compass of the worker in a unit with reasonable facilities. (3) New types of material. e.g. those derived from endoscopic biopsy should be covered fully. (4) There should be an adequate number of illustrations on each subject to demonstrate the variation in appearance that is encountered. (5) Colour illustrations should be used wherever they aid recognition. The present concept stemmed from this definition but it was immediately realized that these aims could only be achieved within the compass of a series. of which this volume is one. Since histopathology is. by its very nature. systemized. the individual volumes deal with one system or where this appears more appropriate with a single organ. This atlas provides a modern account of the pathology of the male reproductive organs. It aims to provide an account of biopsy interpretation of specimens commonly encountered by the practising histopathologist. This aim has been most satisfactorily achieved and has provided another useful bench manual in this series. Experienced histopathologists and those in training will find it a valuable addition to the library in the reporting room. G. Austin Gresham Cambridge

Preface This atlas deals with conditions commonly encountered in the male genital tract. Whilst the majority of illustrations are photomicrographs, photographs of macroscopic specimens are also used to illustrate important features in distinguishing different pathological conditions. Special emphasis is placed on the small biopsy specimens obtained from prostate and testis in modern urological practice and the importance of clinicopathological co-operation in pathological practice is stressed. Recent advances in our knowledge of testicular 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 literature search can be mounted if required. The atlas in no way pretends to be an encyclopaedic reference of conditions of the male genital tract but attempts to provide an up-to-date comprehensive discussion of the histopathology 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 Clayton, for typing and retyping my draft chapters and for deciphering my hieroglyphics.

Introduction At first glance urological pathology is not obviously a subject in which there have been great advances in recent years. Electron microscopy and immunological techniques have not revolutionized our concepts of disease in this area, as has occurred in renal glomerular disease or in tumours of the Iymphoreticular system. However, there have been great changes in urological practice over the last 20-30 years. Urology as a discipline is no longer practised only in the larger cities and most District General Hospitals are likely to have a urologist trained in a centre where specialized histopathological advice was available. Such urologists are well acquainted with many of the entities described and discussed in this book and will expect the local histopathologist to be able to recognize them when he encounters them in his clinical practice. Modern urological practice produces a completely different spectrum of pathological specimens compared to those generated by the general surgeon with an interest in urology of 30 years ago. Prostates are now resected transurethrally in the vast majority of instances and the material sent for examination is accordingly that much more difficult to orientate and indeed to diagnose. Biopsy techniques are also widely employed - for example needle biopsy of abnormal areas within the prostate and testicular biopsy in the investigation of infertility - and although these specimens are not as small as those obtained by such techniques as bronchoscopy and endoscopy they can certainly pose their own difficulties in interpretation. The discovery of marker substances, both within tumours themselves and in serum, has completely revolutionized our thoughts on the classification and indeed the treatment of testicular tumours and techniques to apply this knowledge to diagnostic histopathology are now available to all departments.