Cryptorchidism (Undescended testes)• Frequency:1% (at the end of 1st year)• Bilateral in 25%• May be associated with: • GUT abnormalities – Hypospedias• Testicular descent: – Transabdominal phase • Müllerian-inhibiting substance – Inguinoscrotal phase • Androgen induced release of Calcitonin gene related peptide from genitofemoral nerve CSBRP-July-2012
Cryptorchidism (Undescended testes)Histology:• Arrest in maturation of germ cells• Hyalinization of basement membrane• Prominent Leydig cells• Paucity of germ cells is also seen in the contralateral descended testis CSBRP-July-2012
The seminiferous tubules in this cryptorchid testis are completely atrophic. CSBRP-July-2012
Cryptorchidism (Undescended testis)Complications: – Sterility – Inguinal hernia – Testicular cancers – Prone for trauma (inguinal testis)Surgical correction: (Orchiopexy) – Before 2years of age – for fertility – Before 10yrs of age – for protection against cancer CSBRP-July-2012
Pathology Pearls• When you are faced with intriguing intraabdominal / retroperitoneal tumor, always examine the scrotum / testis REMEMBER• Scrotum is 10th compartment of abdomen• Abdominal examination is never complete without scrotal examination CSBRP-July-2012
Torsion - testis•Twisting of spermatic cord with occlusion of veins andpatent arterial supply – results in vascular engorgement andhemorrhagic infarction•Two types: neonatal, adult (seen in adolescents)•Anatomic defect: testis exhibits increased mobility (bell-clapper abnormality)•Should be untwisted within 6hrs to restore viability CSBRP-July-2012
This testis has undergone infarction following testicular torsion. CSBRP-July-2012
Testicular torsion: In this case, the condition has proceeded tohemorrhagic infarction. Note the outlines of the tubules remaining, butthere is loss of nuclear detail, and the interstitium is hemorrhagic.
Testicular atrophy • Atherosclerosis • Inflammatory lesions (Orchitis) • Cryptorchidism • Hypopituitarism • Malnutrition • Irradiation • Excessive Estrogens: • Antiandrogens in Tx of prostatic cancer • Cirrhosis of liver CSBRP-July-2012
Note that the testis on the left is small and pale white while the opposite testis appearsnormal. The left testis did not descend into the scrotum during development, butremained in the abdomen, a condition called a cryptorchid testis.
On the left is a normal testis.On the right is a testis that has undergone atrophy.
Here is another example of focal atrophy of seminiferous tubules along with a few residualnormal tubules in which there is active spermatogenesis. There is focal atrophy of the testiculartubules seen here. The most common infectious cause for this finding is mumps orchitis. CSBRP-July-2012
Hydrocele• Accumulation of serous fluid in tunica vaginalis• No apparent cause• Mistaken for tumors• Transillumination is positive CSBRP-July-2012
Upon physical examination, the scrotum appears enlarged. This enlargement is notpainful, and there is no firm mass palpable. The enlargement is due to a fluid collectionaround the testis known as a hydrocele. CSBRP-July-2012
One diagnostic technique to detect a hydrocele is transillumination of thefluid-filled space with a light applied to the scrotum. The fluid willtransmit the light, while a solid mass will not.
There is scrotal enlargment with fluid density from a hydrocele on theright. A hydrocele is a painless collection of clear fluid around the testis.Hydroceles generally develop over years.
Varicocele• Prominent dilation of the pampiniform plexus of veins posterior to the testis• The increased blood flow increases the temperature of testicular tubules, thus inhibiting spermatogenesis• One possible cause for infertility is a varicocele CSBRP-July-2012
Varicocele, a lesion that consists of a prominent dilation of the CSBRP-July-2012 pampiniform plexus of veins posterior to the testis.
Pathology Pearls Acute LEFT varicoceleRCC growing into renal vein causes obstruction to left testicular vein which drains into it, there by causing engorgement of left pampiniform plexus. CSBRP-July-2012
Pathology PearlsName some tumors that enter themajor vessels and even reach right side of the heart? Renal cell carcinoma Hepatocellular carcinoma CSBRP-July-2012