Anatomy

The testes are suspended in the scrotum by the spermatic cords, the left testis hanging somewhat lower (Figure 32.1). The average size is 4-5 cm in length, 2.5 cm in breadth, and 3 cm in the antero-posterior diameter. Weight varies from 10.5 to 14 g. Within the scrotum the testis is covered on its anterior, medial and lateral surfaces by tunica vaginalis, the remnant of a developmental connection with the peritoneal cavity. Each testis is covered by a tough fibrous coat, the tunica albuginea. The substance of the testis is subdivided by septa which run inwards from the tunica albuginea. The glandular structure consists of numerous lobules (~ 400) contained in one of the intervals between the fibrous septa. They consist of from one to four seminiferous tubules, between which lie the interstitial or Leydig cells, responsible for the production of testosterone. In the apices of the lobules, the tubules become less convoluted and unite together

Figure 32.1. Anatomy of the testis, epididymis and spermatic cord. Reproduced from Hermanek P, Hutter RVP, Sobin LH, Wagner G, Wittekind Ch (eds.). TNM Atlas: illustrated guide to the TNM/pTNM classification of malignant tumours, 4th edition. SpringerVerlag: Berlin and Heidelberg, 1997.

to form twenty to thirty larger ducts (tubuli recti). The tubuli recti enter the fibrous tissue of the mediastinum forming a close network of anastomosing tubes (rete testis). The rete testis perforate the tunica albuginea, and carry the seminal fluid from the testis to the epididymis.

The epididymis lies on the posterior surface of the testis. It consists of a central portion or body, an upper enlarged extremity (the head), and a lower pointed end (the tail), which is continuous with the ductus (vas) deferens. The head is intimately connected with the upper end of the testis by means of the efferent ductules of the gland; the tail is connected with the lower end by cellular tissue, and a reflection of the tunica vaginalis. The epididymis is connected to the back of the testis by a fold of the serous membrane. On the upper extremity of the testis, just beneath the head of the epididymis, is a minute oval, sessile body, the appendix of the testis (hydatid of Morgagni). It is the remnant of the upper end of the Mullerian duct. On the head of the epididymis is a second small stalked appendage (appendix epididymis) usually regarded as a detached efferent duct.

Figure 32.2. Testis - regional lymph nodes. The regional lymph nodes are the abdominal para-aortic (periaortic), preaortic, interaortocaval, precaval, paracaval, retrocaval and retroaortic nodes. Nodes along the spermatic vein should be considered regional. Laterality does not affect the N classification. The intrapelvic nodes and the inguinal nodes are considered regional after scrotal or ingiuinal surgery. Reproduced from Hermanek P, Hutter RVP, Sobin LH, Wagner G, Wittekind Ch (eds.). TNM Atlas: illustrated guide to the TNM/pTNM classification of malignant tumours, 4th edition. Springer-Verlag: Berlin and Heidelberg, 1997.

Figure 32.2. Testis - regional lymph nodes. The regional lymph nodes are the abdominal para-aortic (periaortic), preaortic, interaortocaval, precaval, paracaval, retrocaval and retroaortic nodes. Nodes along the spermatic vein should be considered regional. Laterality does not affect the N classification. The intrapelvic nodes and the inguinal nodes are considered regional after scrotal or ingiuinal surgery. Reproduced from Hermanek P, Hutter RVP, Sobin LH, Wagner G, Wittekind Ch (eds.). TNM Atlas: illustrated guide to the TNM/pTNM classification of malignant tumours, 4th edition. Springer-Verlag: Berlin and Heidelberg, 1997.

The vas deferens consists of a muscular tube, formed of three layers, which connects the tail of the epididymis to the ejaculatory duct at the prostate. The vas passes up in the spermatic cord through the superficial inguinal ring, inguinal canal and deep ring to reach the posterior surface of the bladder. At the ejaculatory duct it is joined by the duct from the seminal vesicles. The vas is lined by a tall columnar epithelium.

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