OVER VIEW OF THE ANATOMY AND HISTOLOGY OF THE

MALE GENITAL TRACT

BY DR B. A. ABIMIKU, FMCPath

TOPICS
. TESTIS/ADNEXA – Rete testis, Epididymis, Vas deferens, Testicular
Appendages

. PENIS /SCROTUM

. PROSTATE and SEMINAL VESICLE

EMBRYOLOGY (GENERAL)

By 6th week of development in both sexes, the primordial germ cell have
migrated from their extra embryonic location to genital ridge

Surrounded by sex cords to form a pair of primitive gonads

UP to this time, developing gonad is bipotential

Development into an ovary or a testis is determined by the coordinated

action of a sequence of genes

Ovarian development when no Y chromosome is not present or to testicular

development if Y chromosome is present.

The ovarian pathway is followed unless a gene on the short arm of the Y
(Testis-determined factor TDF), acts as a switch – diverting development into
male pathway. (The search for major Testis-determined gene is a current
problem in medical genetics)

In the presence of Y chromosome, the medullary tissue forms typical testes

with seminiferous tubules and Leydig cells under the influence of HCG from
the placenta. The spermatogonia derived from the primordial germ cells by
200 or more successive mitosis forms the walls of the seminiferous sertoli
cells

If no Y chromosome is present, the gonad forms the ovary

The cortex develops; the medulla regresses and oogonia begin to develop
within the follicles.

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The oogonia are derived from the primitive germ cells by a series of about 30
mitoses.

By end of 3rd month, the oogonia enter meiosis 1, but this process is arrested
at a stage (Dictyotene)- where the cell remains until ovulation occurs many
years later. Many of the oogonia degenerate before birth leaving only about
400 to mature into ova during the 30 years or so of sexual maturity of the
females.

While the primordial germ cells are migrating to the genital ridges,
thickenings in the ridges form

i. Developing genetic ducts

ii. The mesonephric duct (wolffian duct)

iii. Paramesonephric duct (mullerian duct)

In male, the Leydig cells of the fetal testes produce Androgen, stimulating
mesonephric ducts to form the male genital tract, while sertoli cells produce
a hormone that suppresses formation of paramesonephric duct.

In the female (or embryo with no gonad), the mesonephric ducts develop
into the female duct system.

Therefore in early embryo, the external genitalia consists of

(i) Genital tubercle giving Glans clitoris and Glans penis

(ii) Paired labioscrotal swellings giving labia majora and scrotum

(iii) Paired urethral folds giving labia minora and corpus spongiosum

At this stage, male external genitalia develop under the influence of

Androgens. In the absence of a testis, female external genitalia are formed
regardless of whether an ovary is present.

SUMMARY OF EMBRYOLOGY

PHENOTYPIC DIFFERENTIATION

i. XX genotype drives ovarian differentiation

ii. XY genotype drives Testicular differentiation

iii. Mesonephric (Wolffian) duct forms male external duct

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iv. Paramesonephric (Mullerian) duct form female genital duct

v. Testis drives development of male external genital.

GONADAL DEVELOPMENT

1. Two Xs required for ovarian development

2. Ovary requires for development of female secondary sexual characteristic

3. X and Y requires for testicular development

4. Testis forms testosterone and Mulleria Inhibiting substance – suppresses

paramesonephric duct development

5. Testosterone metabolite derives prostatic and external genitalia in male

direction

6. Gonads come from three rudiments:

(i) Primordial germ cells from yolk sac become gametogenic

(spermatogonia and oogonic)

(ii) Genital ridge mesenchyme forms CT BV, interstitial tissue, ovarian

stroma.

(iii) Coelomic epithelium forms supportive cells (sertoli cells in male and
follicular epithelium in female)

- Primitive sex cords contain gametogenic cells and supportive cells.

In male, cortical cords degenerate and medullary cords persist to form the
seminiferous tubules.

In female, cortical cords persist to form follicles while medullary cords

degenerate.

FATE OF MESONEPHRIC DUCT (WOLFFIAN)

i. Forms in both sexes

ii. All males are wolves, men are hairy like wolves

iii. Development is testosterone dependant

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iv. In males- forms efferent ductules, epididymis, ductus deferens and
seminal vesicles

In female, degenerate but sometimes form cysts in mesovarium, broad

ligament and wall of upper vagina (GARTNER’s DUCT/ Cyst)

v. Abnormalities – Infertility or two uteruses

FATE OF PARAMESONEPHRIC DUCT (MULLERIAN)

i. Development suppressed by mullerian luhibiting substance from testis

ii. Forms uterine tubes, uterus cervix and upper vagina in females

iii. Mostly degenerate in males but vestigial structures as Appendix testes

and prostatic urtricle.

DEVELOPMENT OF UROGENITAL SINUS

i. Cloaca is separated into rectum and Urogenital Sinus

ii. Urogenital sinus forms bladder, urethra and prostate in males

iii. Lower vagina part is from Urogenital Sinus together with upper part from
Paramesonephric duct – fuse to form vagina and cervix

EXTERNAL GENITALIA is made up of 3 parts;

i. Genital Tubercle: It consist of Glans clitoris in females and Glans penis in

males

ii. Labioscrotal swelling: This is made up of labia majora in females and

scrotum in males

iii. Urogenital fold: This is made up of labia minora in famales and corpus
spongiosus.

1. TRUE HERMOPHRODITE- Have both male and female sex organs (Testes
and ovaries)

2. PSEUDO HERMOPHRODITE- Mixed up of sex organs- common

TESTIS

Two functions are;

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(i) Produce the male gamete or spermatozoa

(ii) Produce male sexual hormone, testosterone – stimulate male sexual

organs

The growth and development of the human testis can be divided into 3 major
phases;

(i) Static from birth to age of 4 years

(ii) Growth from 4 to 10 years

(iii) Developmental (maturation) from age of 10 years to puberty.

GROSS

The normal Adult is a paired organ that lies within the scrotum, suspended
by spermatial cord

Average weight 15 -19g with right being heavier than the left

HISTOLOGY

Covered by a capsule and has three layers;

(i) Outer serosa (tumica vaginalis) covered by flattered layer of mesothelial

cells

(ii) Tunica albuginea

(iii) Tunica vasculosa

The posterior portion of the capsule called the mediastinum contains BV,
lymph vessels, nerves and a portion of the rete testis.

The parenchyma is divided into approximately 250 lobules with each

containing up to 4 seminiferous tubules.

A good Testicular biopsy should have 3-5 lobules with a portion of the septa

The seminiferous tubules are bound by a limiting membrane made up of

basal laminal and alternating layer of myloid cells and collagen fibres. These
tubules contain germ cells in various stages of development and sertoli cells.

At birth, the seminiferous tubules are compactly filled with small

undifferentiated cuboidal cells. Leydis cells are seen in newborn because of
influence of maternal hormones but disappear to appear later.

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Increase in tubules and cell size are gradual until 10years when definite
spout is noted.

-Coincides with appearance of gonadotrophins and 17-ketosteroids in urine.

Mitotic figures appear in tubular cells

Leydig cells reappear

At 11, mitotic activity is increased, primary and secondary spermatocytes

appear.

At 12, spermatids are numerous with appearance of spermatozoa.

The number of maturing tubules with active spermatogenesis increases

gradually until adult stage is reached.

Because of the great variation in the age at which puberty normally occurs,
the age of the individual cannot be determined by histological study of the
testis after the 12th year.

The maturation of sperm cells take up to 70 days and follow the following
steps:

(1) Spermatogonium (Types A & B) where A has round nucleus ,fine Xmatin,
1-2 nucleoli and B has round nuclei, Xmatin granules of various sizes, one
nucleolus

(2) Primary spermatocyte

(i) Preleptotene – small size, fine xmatin

(ii) Leptotene

(iii) Zygotene

(iv) Pachytene

(v) Diplotene – Biggest size, coarse Xmatin

(3) Secondary spermatocyte – Smaller, enters 2nd meiotic division

immediately, so hardly found in sections

(4) Spermatids

(5) Mature spermatozoon – 60 um long, actively motile, has head, neck and
tail

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All progeny of a spermatogonium are held together by a narrow cytoplasmic
bridge.

The maturation proceeds in an orderly overlapping pattern along the length

of the tubules.

Therefore, not all stages are seen on cross section of the tubules.

Spermatogenesis is regulated by FSH

Methods have been proposed for quantitative assessment of germ cell

elements and the relationship of spermatogenesis to seminal fluid sperm
density.

The one proposed by Johnson et al applies a score of 1-10 for each tubule
cross section examined.

10 – Complete spermatogenesis and perfect tubule

9 – Many spermatozoa present but disorganized spermatogenesis

8 – Only a few spermatozoa present

7 – No spermatozoa but many spermatids

6 – Few spermatid

5 – No spermatozoa or spermatids but mant spermatocyte

4 – Only few spermatocyte

3 – Only spermatogonia

2 – No germ cell

1 – No ferm cell or sertolic cell

In normal adult testis, mean score count should be at least 8 with 60% or
more of the tubules scoring 10.

The second method seeks to establish the germ cell – sertoli cell ratio by
counting at least 30 tubules cross sections. The ratio is constant at 13:1.
Average of 13 sertoli cells per tubules section is normal.

The third method is by counting spermatids per tubules cross section. The
correlation with seminal fluid sperm count is excellent.

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Sertoli cells have the following features:

- Have a columnar shape

- Lies in between the tubule

-Have irregularly shaped nuclei that are folded with prominent nucleolus.

-Cytoplasm may contain Charcot-Bottcher crystalloids = bundles of filaments

-The intermediate filament of sertoli cells is VIMENTIN but can coexpress

keratin and desmin.

The interstitium cointains myoid cells and Leydig cells.

Leydig cells occur singly or in clusters and are associated with nerve
bundles, lipochrome pigment.

Reactive for inhibin and melan-A

Decrease with aging.

CRYPTORCHIDISM

-Undescended testis at time of birth

-One in 10 males has this problem at time of birth

-Present at inguinal or Abdomen

-Most will descend by 1year

-1 in 100 has permanent retention that needs correction.

-Cause unknown but role of testosterone under hypothalamus – pituitary axis

-Unilateral in 80%

-Repairs should be done before age of 5

-Complications include torsion and malignancy.

TESTICULAR ADNEXA

RETE TESTIS:

-Located at the hilum of the testis

-Has complex tubular structure

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-Receives the luminal contents of the seminiferous tubules

-Has three components – septal, mediastinal (tunical) and extratesticular

(bullae retis)

- Empties into ductuli efferentes

-Lined by pseudostratified ciliated and non-ciliated epithelium.

-Retes testis dysgenesis is the rule in cryptorchid testicles.

EPIDIDYMIS

-Tubular structure connecting the ductuli efferentes to the vas deferens

- Composed of 3 portions

. Head (caput)

. Body (corpus)

. Tail (caudal)

- Composed of tall columnar cells, basal cells and clear cells

- The cells feature varies sized intranuclear eosinoplulic PAS - +ve inclusion

- May also have bright eosionophilic intracytoplasmic granules and globules

VAS DEFFERENS

-30 – 40cm in length

-Tubular structure arising from the caudal portion of epididymis

-Emptying in the prostatic urethra at the level of verumontanum

-The distil end joins the excretory duct of seminal vesicle to form the
ejaculatory duct.

-Lined by pseudostratified ciliated columnar cells and basal cells.

-The muscle coat is made up of inner and outer longitudinal coats and a
middle oblique or circular zone.

TESTICULAR APPENDAGES

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1. Appendix testis or Hydatid of Morgagni

i. Remnant of the cranial portion of mullerian duct

ii. Round or oval, sessile or pedunculated structure.

iii. Attached to tunica albuginea at the upper pole of the testis.

2. Appendix Epididymis – Remnant of the cranial portion of the mesonephric

duct

3. Vas aberrans or Organ of Haller – Remnant of mesonephricn tubules

4. Paradidymis or Organ of Giraldes – Remnant of mesonephric tubules

PENIS

Gross:

Components: Corpus (shaft), Glans and Prepuce (foreskin)

Corpus – composed of corpora cavernosa (vascular spaces surrounded by

tunica albuginea) and corpus spongiosus where penile urethra runs.

-Covered by skin smooth muscle, DARTOS and elastic sheath (BUCK’s Fascia)

-The fascia separates the penis into dorsal and ventral portions

-Identified on CT and MRI techniques

Histology:

-Skin is made up of non keratinized stratified squamous epithelium, 5-6 cell

layers

-Becomes keratinized after circumcision

-The glans is separated from shaft by Balanopreputial sulcus in the dorsal

and lateral aspects and by frenulum in the ventral region

-Modified sebaceous glans known as Tyson glands are thought to be present

at the sulcus – site of production of smegma

URETHRA – Is divided into 3 portions:

. Prostatic (short segment)

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. Membranous (balbomembranous from lower pole of prostate to bulb of the
corpus spongiosum)

. Penile – pass through corpus spongiosum

The terminal enlarged portion of the penis is the fossa navicularis

- Penile urethra contains numerous Ig A +ve plasma cells – active site of

secretory Ig A mediated immune defense

Histology:

-Urethra lining is

i. Transitional type in proximal

ii. Stratified squamous in distal (fossa navicularis)

iii. stratified or pseudostratified columnar ciliated in the rest of the canal

Squamous metaplasia is common after oestrogen therapy.

-Glandular structures are

i. Intraepithelial glands or morgagni’s lacunae (one-layer cylindrical

intraepithelial glands)

ii. Littre’s glands (Tubuloacinar mucinous glands) present along the full
length of capus spangiosum

iii. Bulbourethral or cowper’s glands (mucous acinar) located deeply at the

level of the membranous urethra.

-Lymphatic drainage of penis is to the superficial and deed infuinal node

(sites for nodal metastases)

-Lymph vessels are centrally located – bilateral drainage

SCROTUM

Scrotal sac is seven-layer structure investing the testes, adnexa and distal
spermatic cord

-Epidermis

-Dermis

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-Tunica dartos (smooth muscle bundles)

-3 layers of Colle’s fascia (intercurral, cremasteric and infundibuliform)

-Pariental layer of tunica vaginalis – flattered layer of mesothelial cells

resting on Basement membrane

Scrotal lymphatics drain into the ipsilateral superficial inguinal lymph nodes.

PROSTATE

GROSS:

-Pear shaped glandular organ

-Measuring 2x3x4 cm

-Weighing 20g in normal adult

-Traditionally has been divided into 5 lobes, that is; Anterior, Middle,
Posterior and two lateral lobes.

-Realistic division is the inner (periurethral) zone and outer (cortical) zone

-Thus, correlates wall with physiological pathologic feature of the organ

- BPH arises from the inner zone while Adenocarcinoma from the peripheral
zone

- More recent division is into 4 regions is Peripheral, Central, Transitional and

Periurethral gland zones.

-Again BPH is from Transitional and Periurethral regions while cancer and
prostatitis are from peripheral region.

-The Prostate is enveloped by a fibromuscular layer known as a capsule even

though it is s not a true capsule.

-More evident along the base of the organ

-The prostate has two components – the Glandular and Stromal elements.
The glands are composed of ACINI and DUCTs.

ACINI – Large (primary, major excretory)

- Peripheral (secondary minor excretory)

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Both acini and ducts contain secretory cells, basal cells and Neuroendocrine
cells.

(a) The secretory cells secrete

i. Prostatic Acid Phosphotase (PAP)

ii. Prostatic-Specific Antigen (PSA)

iii. Keratin

iv. Vimentin

The first two are organ specific, hence can be used as a diagnostic tool; while
the last two are low molecular-weight

Normal prostatic secretion is neutral mucosubstance as opposed to those

secrete by cancer cells (mixture of acidic and neutral mucins) and
fibrinolysin that liquefies the semen.

(b) The basal cells secrete keratins 34 and is positive for antikeratin antibody
903 (use in differential diagnosis) between WD carcinoma (-ve) and benign
conditions.

Basal cells are equivalent to myoepithelial cells as in Breast hence can

undergo myepithelial metaplasia in sclerosing adenosis. It has strong
reaction for Androgen receptors

It can be viewed as multipotential cells that give rise to epithelial lineages in

normal and neoplastic prostate.

(c) The Neuroendocrine cells express

i. Chromagranin A & B

ii. Secretogranin II

iii. Peptide hormones such as Somato statin, Calcitonin and Bombesin.

iv. Coexpress PSA hence common origin with secretory cells

But negative for Androgen receptors

NB: The secretion of the prostate is the first fraction of the ejaculate

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The secretory ducts of the prostate are lined by simple columnar epithelium
that changes to Transitional epithelium near openings of the ducts into the
urethra.

Immunoreactive for PSA & PAP

Can undergo squamous metaplasia

The prostatic stroma contains large among of smooth muscle that squeeze
secretions when stimulated

Contain androgen receptor

-Xteristic feature of Prostate is presence of Corpora Amylacea in the

secretory alveoli. These are rounded eosinophilic bodies measuring 0.25 – 2
mm in diameter.

Appear at seven month of feotal development, increases in number with age.

May undergo calcification.

-Peripheral nerves are evenly distributed in the organ.

Site for cancer cells (perineural invasion)

The prostatic lymph vessels drain into pelvic lymph nodes, then to
retroperitoneal chain

SEMINAL VESICLES

- Developed from vas deferens

- Enlongated sacs (4 cm long and 2cm wide)

-Each consists of one coiling tube, 15cm long

the mucosa shows thin, branched, anastomosing folds.

-Epithelium lining ranges from columnar to pseudostratified columnar.

The muscularis consists of inner circular and outer longitudinal layers of

smooth muscle

-Thought to store sperm (hence the name)

The secretions consists of 60-70 % of the ejaculate

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Secretions are acidophilic with high content of FRUCTOSE – use as source of
energy by spermatozoa

Also secrete prostanglandins and flavins (yellow fluorescent pigment use in

Forensic medicine to detect semen stains)

Functions of seminal vesicles secretions include

i. Formation of sperm coagulum

ii. Regulation of sperm motility

iii. Suppression of immune function in the female genital tract

The secretion is the third fraction of ejaculate (spermatozoa are released

with the second fraction)

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