Spectrum of Histomorphology in "Vanished Testicular Remnants": Are Germ Cells Present?
Tatjana Antic, Elizabeth Hyjek, Jerome B Taxy. The University of Chicago, IL
Background: The clinical rationale for orchiectomy in orchiopexy-resistant cryptorchidism is the risk for testicular malignancy posed by the presence of germ cells (GC) within seminiferous tubules (ST). In about 5% of undescended testicles, the scrotum is clinically empty, the “vanished” gonad presumably representing an in utero “vascular accident”. The “vanished testicular remnants” (VTR) are often removed without orchiopexy. This study evaluates the histomorphologic spectrum in VTR.
Design: Scrotal explorations in twenty nine patients (30 testicles) with VTR were recovered from the surgical pathology files (2004-2008). Seven fetal autopsy testicles, eight castrate and two undescended testicles were used for histological and immunohistochemical comparison. H&E slides and a panel of immunostains were evaluated: SOX-9, inhibin, WT1, OCT 3/4, PLAP and CD117.
Results: In the thirty VTRs, the ages ranged from 11 months to 13 years (mean 4.5 years). Routine histology showed no STs in 18 (60%) VTRs which were characterized by combination of fibrosis (18), calcifications (16) and hemosiderin deposits (9). The twelve testicles (40%) with STs had no GC, being entirely lined by Sertoli cells (SC), immunoreactive for SOX-9, inhibin and WT1 and negative for OCT 3/4, PLAP and CD117. No Leydig cells were present. An epididymis and vas deferens were present in 22 and 23 VRTs respectively. The control fetal testicles showed STs with both GC and SC. The GC were positive for OCT 3/4, PLAP and CD117 and negative for SOX9, inhibin and WT1. The control castrate testicles (age range from 47 to 82, mean 71 years) and one cryptorchid testis (age 26 years) showed atrophic STs with histologically recognizable GC and SC. The GC were negative for OCT 3/4, PLAP, CD117, SOX9, inhibin and WT1. One cryptorchid testis (age 15 years) was negative for GC.
Conclusions: The histomorphology of VTR ranges from fibrosis only to ST without GC. This contrasts with fetal testes which do exhibit GCs; and cryptorchid testes which have variable GC presence. The reason(s) for GC absence in VTR is not certain, however, these gonads would not seem to be potential neoplastic sources.
Category: Genitourinary (including renal tumors)
Tuesday, March 1, 2011 1:00 PM
Poster Session IV # 87, Tuesday Afternoon