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Category: Volume 08 Issue 07 July 2020
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Title: Clinical Significance of Histomorphological Changes in Prepubertal and Postpubertal Cryptorchid Testis

Authors: Mohammed Shakir Ali, Pairooz Ahmed Khan, Mary Mathew

 DOI: https://dx.doi.org/10.18535/jmscr/v8i7.37

Abstract

Introduction: Cryptorchidism i.e. undescended testis (UDT) is the most common disorder of male endocrine glands in children. At birth, approximately 4.5 % of the boys have undescended testis.

The exact cause is poorly understood. Congenital, hereditary or hormonal imbalance appears to be related to gonadal maldevelopment. Despite successful relocation of the testis, long term sequels of cryptorchidism may occur, including infertility, sub-fertility, injury,, and malignancy.

Purpose/Aim: To study gross and histopathological changes in prepubertal and postpubertal cryptorchid testes and correlate with clinical presentation and outcome.

Study Design: A total of 75 testicular specimens were evaluated in the current study. Participants were categorized into prepubertal and postpubertal groups. The patient’s clinical and surgical details were retrieved. Histopathological diagnosis, gross and microscopic features of testicular and paratesticular tissues were recorded. The diagnosis of testicular regression syndrome was made according to Susan E. S. et al.

Results: The median age at presentation is 2 years in prepubertal and 29 years in postpubertal subjects. Secondary testicular parenchymal changes comprising thick capsule, atrophic testicular architecture, hyalinised basement membrane, abundant extracellular matrix, interstitial calcification, inflammation, edema, and fibrosis are more common in postpubertal subjects compared to prepubertal group (excluding TRS) and are statistically significant.

Conclusion: In >60% of the cases, the diagnosis of the undescended testis is made on clinical grounds.Mean tubular diameter (MTD) and tubal fertility index (TFI) decreases with the duration of the undescended testis and are independent predictors of future fertility, the severity of architectural change and abnormal spermatogenesis.

Keywords: Testis, cryptorchidism, undescended testis, atrophic testis, prepubertal testis, postpubertal testis

References

  1. Iraj Rezvani. Cryptorchidism: A Pediatrician’s View. Pediatr Clin North Am. 1987; 34: 735-46.
  2. Jack S. Elder. Disorders and Anomalies of the Scrotal Contents. In: Nelson’s Text Book of Pediatrics, 18th ed. Philadelphia: Saunders. 2007: 2260-1.
  3. Susan E. Spires, C. Stephen Woolums, Andrew R. Pulito, Stephen M. Spires. Testicular Regression Syndrome: A Clinical and Pathologic Study of 11 Cases. Arch Pathol Lab Med. 2000; 124: 694–698.
  4. Govender, Y. Sing, R. Chetty. Sertoli cell nodules in the undescended testis: A histochemical, immunohistochemical, and ultrastructural study of hyaline deposits. J Clin Pathol. 2004; 57: 802-6.
  5. Manuel Nistal, Ricardo Paniagua, Maria Luisa Riestra, Miguel Reyes-Mugica, Mariana Morais Cajaiba. Bilateral Prepubertal Testicular Biopsies Predict Significance of Cryptorchidism associated Mixed Testicular Atrophy and Allow Assessment of Fertility. Am J SurgPathol. 2007; 31: 1269-76.
  6. Haluk Emir, BekirAyik, Mehmet E, Cenk Bu yukunal, NurDanismend, Sergulen D, YunusSoylet. Histological evaluation of the testicular nubbins in patients with nonpalpable testis: Assessment of etiology and surgical approach. PediatrSurg Int. 2007; 23: 41–4.
  7. Nistal M, Riestra M.L, Paniagua R. Correlation between testicular biopsies (prepubertal and postpubertal) and spermiogram in cryptorchid men. Hum Pathol. 2000; 31: 1022–30.
  8. Manuel Nistal, Marıa L.R, R. Paniagua. Focal Orchitis in Undescended Testes: Discussion of Pathogenetic Mechanisms of Tubular Atrophy. Arch Pathol Lab Med. 2002; 126: 64-9.
  9. Vijjan VK, Malik VK, Agarwal PN. The Role of Laparoscopy in the Localization and Management of Adult Impalpable Testes. JSLS 2004; 8: 43-46.
  10. John Radcliffe Hospital Cryptorchidism Study Group. Cryptorchidism: a prospective study of 7500 consecutive male births, 1984-8. Arch Dis Child. 1992; 67: 892-89.
  11. K. Thong, C. T. Lim and H. Fatimah. Undescended testes: incidence in 1,002 consecutive male infants and outcome at 1 year of age. Pediatr Surg Int. 1998; 13: 37-41.
  12. Scorer C.G. The descent of the testis. Arch Dis Child. 1964; 39: 605-9
  13. G. Scorer. The incidence of incomplete descent of the testicle at birth. Arch Dis Child. 1956; 31: 198-202.
  14. Cendron M, Schned A.R, Ellswort P.I. Histological evaluation of the testicular nubbin in the vanishing testis syndrome. J Urol. 1998; 160: 1161-3
  15. Francisco B. B, Fernando Alvariz. Clinical classification for undescended testis: Experience in 1010 orchidopexies. J Ped Surg. 1988; 23: 444-7.
  16. OzgurPirgon, Bumin Nuri Dundar. Vanishing Testes: A Literature Review. J Clin Res Pediatr Endocrinol. 2012; 4: 116-120.
  17. Tatjana A, Elizabeth M. Hyjek, Jerome B. Taxy. The Vanishing Testis: A Histomorphologic and Clinical Assessment. Am J Clin Pathol. 2011; 136: 872-80.
  18. Turek P.J, Ewalt D.H, Snyder H.M. The absent cryptorchid testis: surgical findings and their implications for diagnosis and etiology. J Urol. 1994; 151: 718-20.
  19. Mohammed Shakir Ali, Mary Mathew. Testicular Regression Syndrome: Useful diagnostic approach. IOSR-JDMS. 2018; 17: 07-10.
  20. Caroline F.S, Vanessa S.M, Tatiane da S.F, Carlos Alberto M.L. Quantitative Morphology Update: Image Analysis. Int. J. Morphol. 2013; 31: 23-30.

Corresponding Author

Dr Pairooz Ahmed Khan

Registrar, Department of Urology, Central Security Hospital, Riyadh, KSA