Male Genital Tract for NEET PG Pathology: Testicular Tumours and Markers, Cryptorchidism, Torsion, BPH, Prostate Cancer and Gleason, Penile Cancer

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🎯 Exam priority: Medium–high. Expect: seminoma vs non-seminoma and which markers they make, raised AFP with a "pure seminoma", cryptorchidism and cancer, torsion signs and the salvage window, epididymitis organisms by age, BPH zone, Gleason score and Grade Groups, osteoblastic metastases, and penile cancer precursors.

CBME mapping: PA 28.1–28.6. Tumour markers in general are in article 4; Klinefelter syndrome in article 8.

Testicular tumours and markers, scrotal lesions, prostate and penis. Drawn by TrackNation.

Testicular Tumours

• The commonest solid cancer in men aged 15–35; usually a painless scrotal mass. Most arise from primordial germ cells; the classification also lists intratubular germ cell neoplasia.

• Seminoma about 40%; non-seminoma about 60% (any non-seminoma element): embryonal carcinoma, yolk sac (endodermal sinus) tumour, choriocarcinoma, teratoma, and mixtures (teratocarcinoma = teratoma + embryonal carcinoma). Functional interstitial cell tumours are rare (< 5%); rhabdomyosarcoma occurs mainly in children.

• Markers — measure AFP, β-hCG and LDH before orchiectomy. Seminomas do not make AFP; β-hCG is raised in about 14% of stage I seminomas. AFP or β-hCG is raised in 40–60% of non-seminomas. A raised AFP with a "pure seminoma" on histology means a mixed (non-seminomatous) tumour unless something like liver disease explains it.

• Cryptorchidism (3% of term, 30% of preterm boys) raises testicular cancer risk 2.5–20 times — less if orchiopexy is done before age 10 — and cancer can also arise in the normally descended testis.

Scrotum: Acute and Painless

• Testicular torsion: tender, high-riding, horizontal testis; cremasteric reflex absent. The defect is usually bilateral. Salvage is 80–100% at 6–8 hours and near zero at 12 hours.

• Epididymitis: under 35 — N. gonorrhoeae or C. trachomatis; over 35 — gram-negative coliforms.

• Mumps orchitis: post-pubertal; atrophy of at least one testis in 60%.

• Painless masses: hydrocele (transilluminates), hernia, varicocele (up to 20% of men; left side; "bag of worms", bigger on standing and Valsalva), spermatocele. Testicular cancer is the most concerning cause.

Prostate

• Benign prostatic hyperplasia: non-malignant adenomatous overgrowth of the periurethral gland, causing bladder outlet obstruction. Autopsy prevalence 40–50% at 51–60 years and over 80% after 80. Treated with 5-alpha-reductase inhibitors, alpha-blockers or surgery.

• Prostate cancer: usually adenocarcinoma; prostatic intraepithelial neoplasia is a possible precursor. Risk: age, Black ancestry, BRCA1/2, Lynch syndrome. Cancer may feel stony hard and nodular on rectal examination; diagnosis by DRE or PSA, confirmed by biopsy.

• Gleason score: the most and next-most prevalent patterns are each graded 1–5 and added. ≤ 6 well, 7 moderately, 8–10 poorly differentiated. The WHO 2016 Grade Groups simplify this (table).

• Spread to bone gives osteoblastic metastases — pelvis, ribs, vertebrae.

Penis

• Virtually all penile cancers are squamous cell carcinomas (verrucous, warty and basaloid variants), mostly in uncircumcised men with poor hygiene; HPV 16 and 18 contribute.

• Precursors: erythroplasia of Queyrat, squamous carcinoma in situ (formerly Bowen disease) and bowenoid papulosis.

Traps the Examiner Sets

• Seminoma never makes AFP — a raised AFP means a non-seminoma element.

• BPH = periurethral (inner) gland; cancer = adenocarcinoma with osteoblastic bone metastases.

• Gleason 3 + 4 (Group 2) is not the same as 4 + 3 (Group 3).

• Torsion: absent cremasteric reflex; time is testis (near zero salvage by 12 hours).

Memory Hooks & Shortcuts

Shortcuts to lock in this article's numbers and lists. Each one only re-packages facts proven above.

• 🧠 Seminoma Says 'no' to AFP — markers

• 🧠 Time is Testis: 6 hours good, 12 hours gone — torsion

• 🧠 Under 35 = STI; over 35 = E. coli — epididymitis

• 🧠 Varicocele on the Left — 'bag of worms' — varicocele

• 🧠 BPH sits By the Pee-pipe (periurethral) — BPH zone

• 🧠 Prostate Paints bone white (osteoblastic) — prostate metastases

Rapid-Revision Cards

• Testis cancer age

  Commonest solid cancer in men 15–35.

• Seminoma share

  About 40% of germ cell tumours.

• Non-seminomas

  Embryonal, yolk sac, choriocarcinoma, teratoma (60%).

• Seminoma and AFP

  Never; raised AFP = non-seminoma element.

• Seminoma and hCG

  Raised in ~14% (stage I).

• NSGCT markers

  AFP or β-hCG up in 40–60%.

• Markers before surgery

  AFP, β-hCG, LDH.

• Cryptorchidism

  3% term, 30% preterm; cancer 2.5–20×.

• Orchiopexy

  Before 10 years cuts cancer risk.

• Torsion

  No cremasteric reflex; ~0 salvage by 12 h.

• Epididymitis

  < 35 GC/chlamydia; > 35 coliforms.

• Mumps orchitis

  Atrophy in 60%.

• Varicocele

  Left; bag of worms; 20% of men.

• Hydrocele

  Transilluminates.

• BPH

  Periurethral; > 80% over 80.

• Prostate cancer type

  Adenocarcinoma; PIN precursor.

• Gleason

  Two commonest patterns (1–5) added.

• Grade Groups

  1 = 3+3; 2 = 3+4; 3 = 4+3; 4 = 8; 5 = 9–10.

• Prostate mets

  Osteoblastic: pelvis, ribs, spine.

• Penile cancer

  SCC; uncircumcised; HPV 16/18.

• Queyrat

  Erythroplasia: SCC in situ of glans.

Sources

Facts in this article were checked against these documents.

• MSD Manual Professional: Testicular Cancer; Prostate Cancer; Penile Cancer — Merck & Co. (MSD Manuals), reviewed 2025 (link)

• MSD Manual Professional: Benign Prostatic Hyperplasia; Prostatitis; Orchitis; Epididymitis; Testicular Torsion; Painless Scrotal Mass — Merck & Co. (MSD Manuals), reviewed 2025 (link)

• MSD Manual Professional: Cryptorchidism — Merck & Co. (MSD Manuals), reviewed 2025 (link)

• PDQ Testicular, Prostate and Penile Cancer Treatment (Health Professional Version) — US National Cancer Institute, 2025–26 (link)

• Competency Based Undergraduate Curriculum, Pathology (PA 28) — National Medical Commission, 2024

Test Yourself: Practice Questions

Twenty-eight questions in NEET PG style, most of them clinical vignettes.

Practice Questions (NEET PG pattern)

Original questions written in the style of the exam: +4 for a correct answer, −1 for a wrong one. Every answer was checked against the sources listed above. NEET PG papers are not published by NBEMS, so these are not past-paper questions.

Q1. A 25-year-old man notices a painless, firm testicular swelling. In his age group, this is most likely

• (a) a varicocele

• (b) a hydrocele

• (c) epididymitis

• (d) a testicular germ cell tumour

Q2. The commonest single type of testicular germ cell tumour is

• (a) choriocarcinoma

• (b) yolk sac tumour

• (c) seminoma (about 40%)

• (d) Leydig cell tumour

Q3. A man's orchiectomy specimen is reported as pure seminoma, but his serum AFP is clearly raised and his liver is normal. He should be managed as

• (a) a non-seminomatous (mixed) germ cell tumour

• (b) a lymphoma

• (c) a benign lesion

• (d) a pure seminoma

Q4. Which tumour marker is never produced by a pure seminoma?

• (a) alpha-fetoprotein

• (b) none of these is ever raised

• (c) beta-hCG

• (d) LDH

Q5. Before orchiectomy for a testicular mass, the serum markers to measure are

• (a) calcitonin and CEA

• (b) AFP, beta-hCG and LDH

• (c) PSA and CA-125

• (d) CEA and CA 19-9

Q6. A testicular tumour is composed of teratoma mixed with embryonal carcinoma. It is called

• (a) gonadoblastoma

• (b) polyembryoma only

• (c) seminoma

• (d) teratocarcinoma

Q7. Which of these is a non-seminomatous germ cell tumour?

• (a) yolk sac (endodermal sinus) tumour

• (b) spermatocytic tumour counted as seminoma

• (c) Leydig cell tumour

• (d) lymphoma

Q8. In men with non-seminomatous germ cell tumours, serum AFP is raised in about

• (a) 5%

• (b) never

• (c) 40–60%

• (d) 100%

Q9. A man had an undescended testis corrected at age 14. His risk of testicular cancer is

• (a) normal after surgery at any age

• (b) raised only for lymphoma

• (c) raised (2.5–20 times), including in the other testis

• (d) lower than average

Q10. Cryptorchidism is present in about what proportion of preterm boys?

• (a) 3%

• (b) 0.3%

• (c) 70%

• (d) 30%

Q11. A boy has rapid-onset severe scrotal pain with vomiting; the testis is tender, elevated and horizontal and the cremasteric reflex is absent. The diagnosis and urgency are

• (a) mumps orchitis — supportive care

• (b) varicocele — elective

• (c) epididymitis — antibiotics

• (d) torsion — salvage falls to near zero by 12 hours

Q12. After fixing a torsed testis, the surgeon also fixes the other side because

• (a) the anatomical defect is usually bilateral

• (b) mumps is likely

• (c) the vas is absent

• (d) cancer is likely

Q13. A sexually active 24-year-old has acute epididymitis. The likely organisms are

• (a) E. coli and coliforms

• (b) Neisseria gonorrhoeae or Chlamydia trachomatis

• (c) Mycobacterium tuberculosis

• (d) mumps virus

Q14. A 65-year-old man has acute epididymitis without sexual risk factors. The likely organisms are

• (a) Treponema pallidum

• (b) gram-negative coliform bacilli

• (c) Chlamydia trachomatis

• (d) Candida

Q15. After mumps, a young man's testis shrinks. Testicular atrophy follows mumps orchitis in about

• (a) 1%

• (b) 60% (at least one testis)

• (c) 100%

• (d) never

Q16. A man has a left scrotal swelling that feels like a bag of worms and gets bigger on standing and straining. This is

• (a) a hydrocele

• (b) a varicocele

• (c) a spermatocele

• (d) a seminoma

Q17. A painless cystic scrotal swelling that lights up when a torch is held behind it is most likely

• (a) an incarcerated hernia

• (b) a varicocele

• (c) a hydrocele

• (d) a testicular tumour

Q18. Benign prostatic hyperplasia arises in the

• (a) peripheral zone only

• (b) periurethral prostate gland

• (c) seminal vesicles

• (d) bladder neck muscle only

Q19. On autopsy studies, the prevalence of BPH in men over 80 is

• (a) more than 80%

• (b) about 8%

• (c) about 50% only in Black men

• (d) about 20%

Q20. Besides alpha-blockers, a standard drug class for treating BPH is

• (a) corticosteroids

• (b) anticholinergics as first choice

• (c) loop diuretics

• (d) 5-alpha-reductase inhibitors

Q21. The commonest histological type of prostate cancer is

• (a) squamous cell carcinoma

• (b) transitional cell carcinoma

• (c) sarcoma

• (d) adenocarcinoma

Q22. A possible premalignant change in the prostate is

• (a) squamous metaplasia after infarct

• (b) prostatic intraepithelial neoplasia

• (c) nodular hyperplasia

• (d) corpora amylacea

Q23. A prostate biopsy shows a most prevalent pattern of grade 4 and a second pattern of grade 3. The Gleason score and Grade Group are

• (a) 4, Grade Group 1

• (b) 7 (4 + 3), Grade Group 3

• (c) 7 (3 + 4), Grade Group 2

• (d) 12, Grade Group 5

Q24. The lowest Gleason score usually reported on a biopsy, 3 + 3, corresponds to

• (a) Grade Group 5

• (b) poorly differentiated

• (c) Grade Group 1, well differentiated

• (d) Grade Group 3

Q25. An elderly man with back pain has sclerotic (dense) lesions in the pelvis and vertebrae on X-ray. The most likely primary is

• (a) renal cell carcinoma

• (b) multiple myeloma

• (c) prostate adenocarcinoma

• (d) thyroid follicular carcinoma

Q26. An inherited predisposition to prostate cancer is

• (a) HFE mutation

• (b) APC mutation only

• (c) factor V Leiden

• (d) BRCA2 mutation

Q27. An uncircumcised man with poor local hygiene develops penile cancer. The likely histology and viral co-factor are

• (a) adenocarcinoma — EBV

• (b) squamous cell carcinoma — HPV 16/18

• (c) basal cell carcinoma — HPV 6

• (d) melanoma — HHV-8

Q28. Squamous carcinoma in situ affecting the glans or inner prepuce is called

• (a) condyloma acuminatum

• (b) erythroplasia of Queyrat

• (c) lichen planus

• (d) balanitis xerotica only

Active Recall

From memory: classify testicular germ cell tumours and state which markers each makes; explain the raised-AFP 'pure seminoma'; give cryptorchidism's cancer risk; describe torsion, epididymitis by age and mumps orchitis; describe BPH; explain the Gleason score and Grade Groups and where prostate cancer spreads; and name penile cancer's type, risks and precursors.