The document discusses testicular biopsy and interpretation. It provides details on:
- The structure and layers of the normal testis
- The cells present within the seminiferous tubules including Sertoli cells, spermatogonia, and spermatocytes
- Indications for testicular biopsy including male infertility and controversial role in testicular cancer
- Techniques for testicular biopsy including open surgical and percutaneous methods
- Patterns seen in infertile males such as maturation arrest, Sertoli cell only syndrome, and hypospermatogenesis
Lab Diagnosis of Chronic lymphoproliferative disorders (CLPD);Flowcytometric...Dr Siddartha
Lab Diagnosis of Chronic lymphoproliferative disorders (CLPD);Flowcytometric Evaluation
Basavatarakam Indo-American Cancer Hospital and Research Institute
Lab Diagnosis of Chronic lymphoproliferative disorders (CLPD);Flowcytometric...Dr Siddartha
Lab Diagnosis of Chronic lymphoproliferative disorders (CLPD);Flowcytometric Evaluation
Basavatarakam Indo-American Cancer Hospital and Research Institute
This is a presentation on the topic of cytology of the breast, prepared by Dr Ashish Jawarkar, he is MD in pathology and a teacher at Parul institute of Medical sciences and research Vadodara.
Histopathological Grossing of Kidney Tumors with the common gross differentials encountered,
reference - TATA memorial grossing techniques , Rosai and ackerman surgical pathology , Fletcher , Springer histopathology Specimen
Fluid cytology in serous cavity effusionstashagarwal
The intrathoracic and intraperitoneal organs are covered by a single layer of mesothelial cells, which is continuous with the lining of the thoracic and peritoneal cavities. The potential space between the two layers of epithelium contains a small amount of lubricating fluid.
Serous fluid lies between the membranes lining the body cavities(parietal) and those covering the organs within the cavities(visceral).
Production and reabsorption are normally at a constant rate. They are influenced by
Changes in osmotic and hydrostatic pressure in the blood.
Concentration of chemical constituents in the plasma
Permeability of blood vessels and membranes.
An accumulation of fluid, called an effusion, results from an imbalance of fluid production and reabsorption. This fluid accumulation in the pleural, pericardial, and peritoneal cavities is known as serous effusion.
technique of preparing imprint smear# comparision with frozen sections# application and its role in thyroid ,paathyroid,breast,skin,head and neck and mucinous tumors# advantages and limitations
Atlas on bethesda system for reporting cervical cytologyAshish Jawarkar
This is an atlas with more nearly 100 images, authentic taken from NCI web atlas. Useful to understand and report pap smears. The subject has been presented in a way which will help students reproduce in exams.
This is a presentation on the topic of cytology of the breast, prepared by Dr Ashish Jawarkar, he is MD in pathology and a teacher at Parul institute of Medical sciences and research Vadodara.
Histopathological Grossing of Kidney Tumors with the common gross differentials encountered,
reference - TATA memorial grossing techniques , Rosai and ackerman surgical pathology , Fletcher , Springer histopathology Specimen
Fluid cytology in serous cavity effusionstashagarwal
The intrathoracic and intraperitoneal organs are covered by a single layer of mesothelial cells, which is continuous with the lining of the thoracic and peritoneal cavities. The potential space between the two layers of epithelium contains a small amount of lubricating fluid.
Serous fluid lies between the membranes lining the body cavities(parietal) and those covering the organs within the cavities(visceral).
Production and reabsorption are normally at a constant rate. They are influenced by
Changes in osmotic and hydrostatic pressure in the blood.
Concentration of chemical constituents in the plasma
Permeability of blood vessels and membranes.
An accumulation of fluid, called an effusion, results from an imbalance of fluid production and reabsorption. This fluid accumulation in the pleural, pericardial, and peritoneal cavities is known as serous effusion.
technique of preparing imprint smear# comparision with frozen sections# application and its role in thyroid ,paathyroid,breast,skin,head and neck and mucinous tumors# advantages and limitations
Atlas on bethesda system for reporting cervical cytologyAshish Jawarkar
This is an atlas with more nearly 100 images, authentic taken from NCI web atlas. Useful to understand and report pap smears. The subject has been presented in a way which will help students reproduce in exams.
Male Infertility Review 2011 By Paul J. Turek MD FACS, FRSM, Director of The ...The Turek Clinics
Lecture written and presented by Paul J. Turek MD FACS, FRSM. Dr. Turek is the Director of the The Turek Clinic in San Francisco and Former Professor and Endowed Chair at the University of California San Francisco (UCSF).
Reproductive Ultrasonography in animalsSakina Rubab
This is a descriptive presentation on the ultrasonography of female reproductive system as well as male reproductive system too,focusing on disease diagnosis through ultrasonographic images and pregnancy diagnonsis.
Prof. Mridul Panditrao's Peri-operative Management of Jehovah's Witness Patient Prof. Mridul Panditrao
A case report of Emergency Peri-operative Mnagement of a Jehovah's Witness patient.
Because of their peculear religious belief, these patients do not accept Blood and It's products. This can pose serious problems to the Anesthesiologist.
1. Discuss normal vs. abnormal semen analysis
2. Evaluate different treatments of varicocele
3. Assess azoospermia and discuss micro dissection testicular sperm extraction
4. Diagnose Klinefelter syndrome and genetic abnormalities in men with infertility
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. INTRODUCTIONINTRODUCTION
Testis is the male gonad & measures 4 x 3Testis is the male gonad & measures 4 x 3
x2.5cms.x2.5cms.
It weighs 20 gms, Rt being heavier than left.It weighs 20 gms, Rt being heavier than left.
It comprises of 3 layers :T .vaginalisIt comprises of 3 layers :T .vaginalis
:T.albuginea:T.albuginea
:T.vasculosa:T.vasculosa..
3. HISTOLOGY OF NORMALHISTOLOGY OF NORMAL
TESTISTESTIS
It is made up of 250 lobules.It is made up of 250 lobules.
Each lobule consists of :4 seminiferous tubules&Each lobule consists of :4 seminiferous tubules&
connective tissue stroma with leydig cells.connective tissue stroma with leydig cells.
Seminiferous tubuleSeminiferous tubule forms the main structure.forms the main structure.
At birth the diameter is 60micron &150At birth the diameter is 60micron &150 inin adults.Theadults.The
limiting membrane is madelimiting membrane is made ofof the basal lamina&the basal lamina&
alternate layers of smooth muscle cells& collagen.alternate layers of smooth muscle cells& collagen.
The sertoli or the sustentacular cells lie with their nucleiThe sertoli or the sustentacular cells lie with their nuclei
mostly near the basement membraneof the ST.mostly near the basement membraneof the ST.
4. SERTOLI CELLS:SERTOLI CELLS: nuclear membrane isnuclear membrane is
distinct; chromatin is relatively pale;distinct; chromatin is relatively pale;
nucleolus is eosinophilic ,round or oval.nucleolus is eosinophilic ,round or oval.
Spermatogonia :Spermatogonia :most immature germ cell;most immature germ cell;
located basally in the ST;round to ovallocated basally in the ST;round to oval
nucleus with dense chromatin.nucleus with dense chromatin.
Primary spermatocytes:Primary spermatocytes:nucleus slightlynucleus slightly
large with dark aggregates of chromatin.large with dark aggregates of chromatin.
5. Sec. spermatocytes:Sec. spermatocytes:nucleus slightly elongatednucleus slightly elongated
characteristic of sperm head& tail is elaborated.characteristic of sperm head& tail is elaborated.
The normal maturation takes 70 days& finalThe normal maturation takes 70 days& final
maturation occurs in thematuration occurs in the epididymis.epididymis.
INTERSTITIUMINTERSTITIUM: contains blood vessels: contains blood vessels
&lymphatic vessels with testosterone secreting&lymphatic vessels with testosterone secreting
leydig cells.leydig cells.
Leydig cellsLeydig cells: round to oval nuclei with stainable: round to oval nuclei with stainable
lipid, contain eosinophilic Reinke crystals.lipid, contain eosinophilic Reinke crystals.
6. INDICATIONS OF BIOPSYINDICATIONS OF BIOPSY
1.1. Male infertility investigationsMale infertility investigations
2.2. Role in testicular cancers: controversialRole in testicular cancers: controversial
7. CAUSES OF INFERTILITYCAUSES OF INFERTILITY
PRE TESTICULAR:PRE TESTICULAR:
1.Hypogonadism:1.Hypogonadism:
prepubertal:prepubertal:craniopharyngoma ;hypogonadotropiccraniopharyngoma ;hypogonadotropic
enuchoidismenuchoidism
post pubertalpost pubertal :chromophobe adenoma:chromophobe adenoma
2.Estrogen excess2.Estrogen excess
3. Androgen excess3. Androgen excess
4. Hyperprolactinemia4. Hyperprolactinemia
5.Glucocorticoid excess5.Glucocorticoid excess
6.DM, hypo/hyper thyroidism6.DM, hypo/hyper thyroidism
8. TESTICULAR:TESTICULAR:
1.Diseases of spermatogenesis1.Diseases of spermatogenesis
2. Klinefelter syndrome2. Klinefelter syndrome
3.Cryptorchidism3.Cryptorchidism
4.Radiation &chemotherapy4.Radiation &chemotherapy
5.Mumps5.Mumps
6.Iatrogenic6.Iatrogenic
9. POST TESTICULARPOST TESTICULAR::
1. Anomalies of excretory ducts & accessory1. Anomalies of excretory ducts & accessory
glandsglands
2. Impaired sperm motility2. Impaired sperm motility
11. HISTORYHISTORY
h/osurgery in genital area,mumps,STD.h/osurgery in genital area,mumps,STD.
h/o viremia of recent onseth/o viremia of recent onset
h/ometabolicdisorder,DM,cirrhosis,uremia,h/ometabolicdisorder,DM,cirrhosis,uremia,
obesityobesity
h/o CT,RT,traumah/o CT,RT,trauma
Occupational historyOccupational history
12. SEMEN ANALYSISSEMEN ANALYSIS
Two examinations at leastTwo examinations at least
Abstinence for 2 days before examinationAbstinence for 2 days before examination
Examined within 2 hours of collectionExamined within 2 hours of collection
VOL : 1.5 - 5.0 mlVOL : 1.5 - 5.0 ml
COUNT : >50millionCOUNT : >50million
MOTILITY : >50%MOTILITY : >50%
MORPHOLOGY:head, acrosome, midMORPHOLOGY:head, acrosome, mid
piece , tailpiece , tail
13. CHEMICAL ANALYSIS:CHEMICAL ANALYSIS:
1.1. Fructose: obstructionFructose: obstruction
2.2. Alpha glucosidase:epidydmisAlpha glucosidase:epidydmis
3.3. CK activity: fertilizing potentialCK activity: fertilizing potential
14. Classification of infertility by semenClassification of infertility by semen
analysisanalysis
1.1. Absent ejaculationAbsent ejaculation
2.2. Azospermia:no living spermsAzospermia:no living sperms
ST sclerosisST sclerosis
germinal aplasiagerminal aplasia
maturation arrestmaturation arrest
duct obstructduct obstruct
endocrinalendocrinal
21. Adequacy of biopsy:Adequacy of biopsy:
gross: atleast 3mmsecgross: atleast 3mmsec
histo:3-5 lobules with septa ORhisto:3-5 lobules with septa OR
:100 profiles of ST:100 profiles of ST
23. HISTOLOGICAL PATTERNS OFHISTOLOGICAL PATTERNS OF
INFERTILE MALEINFERTILE MALE
Normal histologyNormal histology
Immature testis in adultImmature testis in adult
Sloughing of immature cellsSloughing of immature cells
HypospermatogenesisHypospermatogenesis
Maturation arrestMaturation arrest
Sertoli cell only syndromeSertoli cell only syndrome
Peritubular fibrosis & tubular hyalinizationPeritubular fibrosis & tubular hyalinization
24. NORMAL HISTOLOGYNORMAL HISTOLOGY
Ductal obstructionDuctal obstruction
VaricoceleVaricocele
ST hyper curvatureST hyper curvature
Branching of STBranching of ST
Isolated impaired sperm motilityIsolated impaired sperm motility
Sampling errorSampling error
Toxic, metabolic or infectious agentToxic, metabolic or infectious agent
Most commonly in azospermic males with obstr.ofMost commonly in azospermic males with obstr.of
excurrent ducts of testisexcurrent ducts of testis
25. IMMATURE TESTIS INADULTIMMATURE TESTIS INADULT
Histo. similar to prepubertal testisHisto. similar to prepubertal testis
No peritubular elastic fibresNo peritubular elastic fibres
Few spermatogoniaFew spermatogonia
Remaining intratubular cells are SertoliRemaining intratubular cells are Sertoli
cellscells
No mature leydig cellsNo mature leydig cells
27. Sloughing of Immature CellsSloughing of Immature Cells
In oligospermic menIn oligospermic men
Tubules normal or reduced in diameter withTubules normal or reduced in diameter with
central lumina obliterated and containingcentral lumina obliterated and containing
sloughed spermatogenic cellssloughed spermatogenic cells
Sloughed cells consist of spermatocytes withSloughed cells consist of spermatocytes with
mature elementsmature elements
Orderly pattern of spermatogenesis is disruptedOrderly pattern of spermatogenesis is disrupted
and epithelium has a jumbled disorganizedand epithelium has a jumbled disorganized
appearanceappearance
Centre of tubules appear cellular than peripheryCentre of tubules appear cellular than periphery
and may produce hypocellularity of germinaland may produce hypocellularity of germinal
epithelium liningepithelium lining
28. Scattered tubules with completeScattered tubules with complete
spermatogenesis presentspermatogenesis present
Mild degree of peritubular fibrosis andMild degree of peritubular fibrosis and
collagenous deposits in intertubular areacollagenous deposits in intertubular area
Leydig cells normalLeydig cells normal
Classify in this group if more than 50%Classify in this group if more than 50%
tubules affectedtubules affected
Sertoli cells and spermatogonia normal atSertoli cells and spermatogonia normal at
peripheryperiphery
29.
30. Causes of sloughing of immatureCauses of sloughing of immature
cellscells
VaricoceleVaricocele
Prior VasectomyPrior Vasectomy
Mumps orchitisMumps orchitis
IdiopathicIdiopathic
31. HypospermatogenesisHypospermatogenesis
Also called germinal cell hypoplasiaAlso called germinal cell hypoplasia
Seminiferous tubule diameter is within normal limitsSeminiferous tubule diameter is within normal limits
Quantitative reduction of spermatogenesisQuantitative reduction of spermatogenesis
Overall thinning of the germinal epithelium and lumenOverall thinning of the germinal epithelium and lumen
enlargedenlarged
Paucity of germinal cell causing sertoli cells to be morePaucity of germinal cell causing sertoli cells to be more
conspicuous; thereby resembling sertoli cell onlyconspicuous; thereby resembling sertoli cell only
syndromesyndrome
Tubules contain sloughed immature spermatogenic cellsTubules contain sloughed immature spermatogenic cells
Leydig cells normalLeydig cells normal
Patients oligo spermic with normal hormonal levelsPatients oligo spermic with normal hormonal levels
32.
33. Causes of hypospermatogenesisCauses of hypospermatogenesis
MalnutritionMalnutrition
Chronic wasting illnessChronic wasting illness
Advancing ageAdvancing age
Exposure to excessive heatExposure to excessive heat
IdiopathicIdiopathic
Down’s syndromeDown’s syndrome
Klinefelter’s mosaicKlinefelter’s mosaic
Ductal obstructionDuctal obstruction
Glucocorticoid excessGlucocorticoid excess
HypothyroidismHypothyroidism
Fertile eunuch syndromeFertile eunuch syndrome
ChemotherapyChemotherapy
34. Spermatogenic mature arrestSpermatogenic mature arrest
One of the most prevalent causes of infertilityOne of the most prevalent causes of infertility
Failure of spermatogenesis to proceed beyondFailure of spermatogenesis to proceed beyond
the primary spermatocyte levelthe primary spermatocyte level
Arrested cells increased in number andArrested cells increased in number and
sloughed in the tubular luminasloughed in the tubular lumina
Tubular diameter, normal sertoli cells, basementTubular diameter, normal sertoli cells, basement
membrane,T.propria and leydig cells normalmembrane,T.propria and leydig cells normal
Patients oligospermic or azospermic. HormonePatients oligospermic or azospermic. Hormone
levels normallevels normal
37. Sertoli Cell only SyndromeSertoli Cell only Syndrome
Also calledAlso called germinal aplasiagerminal aplasia oror del Castillo'sdel Castillo's
syndromesyndrome, first described in 1947, first described in 1947
11 to 20% of testicular biopsy11 to 20% of testicular biopsy
Complete absence of germinal cells from STComplete absence of germinal cells from ST
without impairment of sertoli or leydig cellswithout impairment of sertoli or leydig cells
ST decreased in diameter and devoid of germST decreased in diameter and devoid of germ
cellscells
Tubular basement membrane normalTubular basement membrane normal
Patients with azospermia and increased FSHPatients with azospermia and increased FSH
levelslevels
40. Peritubular Fibrosis and TubularPeritubular Fibrosis and Tubular
HyalinisationHyalinisation
Germinal epithelium damaged by increased fibrousGerminal epithelium damaged by increased fibrous
tissuestissues
May involve tunica propria only with increasedMay involve tunica propria only with increased
peritubular myoid cells or hyalinized material betweenperitubular myoid cells or hyalinized material between
the basement membrane and myoid cells of T. propriathe basement membrane and myoid cells of T. propria
When changes > 10% of tubular fertility is reducedWhen changes > 10% of tubular fertility is reduced
With increasing fibrosis and hyalinization germinalWith increasing fibrosis and hyalinization germinal
epithelium is progressively lost followed by atrophy ofepithelium is progressively lost followed by atrophy of
sertoli cellssertoli cells
Tubules reduced in diameterTubules reduced in diameter
Leydig cells reduced in numberLeydig cells reduced in number
41. Causes of peripubular fibrosis andCauses of peripubular fibrosis and
tubular hyalinizationtubular hyalinization
IdiopathicIdiopathic
Klinefelter’s syndromeKlinefelter’s syndrome
Adrenogenital syndromeAdrenogenital syndrome
XYYXYY
Chronic orchitisChronic orchitis
Estrogen excessEstrogen excess
Irradiation damageIrradiation damage
Post pubertal hypopituitarismPost pubertal hypopituitarism
Post pubertal androgen excessPost pubertal androgen excess
Testicular traumaTesticular trauma
Decreased test. vas. supplyDecreased test. vas. supply
Myotonic muscular dystrophyMyotonic muscular dystrophy
• VaricoceleVaricocele
AlcoholismAlcoholism
Diabetes mellitusDiabetes mellitus
Cystic fibrosisCystic fibrosis
Spinal cord injurySpinal cord injury
ChemotherapyChemotherapy
Androgen insensitivity inAndrogen insensitivity in
otherwise normal menotherwise normal men
HyperprolactinemiaHyperprolactinemia
42. QUANTITATION ORQUANTITATION OR
ASSESSMENT OF TESTICULARASSESSMENT OF TESTICULAR
BIOPSYBIOPSY
JOHNSON’S SCORING SYSTEMJOHNSON’S SCORING SYSTEM
Score 1 to 10, each ST is examined & scored.Score 1 to 10, each ST is examined & scored.
10- germinal epithelium is multilayered around a open central lumen10- germinal epithelium is multilayered around a open central lumen
that count spermatozoa.that count spermatozoa.
9-many spermatozoa but disorganised spermatogenesis9-many spermatozoa but disorganised spermatogenesis
8- few spermatozoa seen8- few spermatozoa seen
7-no spermatozoa but spermatids7-no spermatozoa but spermatids
6-few spermatids seen6-few spermatids seen
5-no spermatozoa,spermatids but spermatocytes seen5-no spermatozoa,spermatids but spermatocytes seen
4-few spermatocytes4-few spermatocytes
3-only spermatogonia3-only spermatogonia
2-No germ cells only sertoli cells2-No germ cells only sertoli cells
1-No cells inside tubule1-No cells inside tubule
43. Mean score calculatedMean score calculated
N: 60% of ST- score of 10N: 60% of ST- score of 10
:<10%- score of 8:<10%- score of 8
Mean: 9.39+/- 0.24Mean: 9.39+/- 0.24
1970- added leydig cell scored1970- added leydig cell scored
LS 1- complete absence of leydig cellsLS 1- complete absence of leydig cells
LS6 - nodular/diffuse hyperplasia of leydigLS6 - nodular/diffuse hyperplasia of leydig
cellscells
44. Heller: Germ Cell/Sertoli Cell RatioHeller: Germ Cell/Sertoli Cell Ratio
Counting at least 30 tubules cross sectionCounting at least 30 tubules cross section
Stained- identified all stagesStained- identified all stages
SpermatogoniaSpermatogonia
Pr. SpermatocytePr. Spermatocyte
Sec.spermatocyte and spermatidsSec.spermatocyte and spermatids
SCR=SCR= total no of germ cells each typetotal no of germ cells each type
total no of sertoli celltotal no of sertoli cell
48. Role in carcinomaRole in carcinoma
ControversialControversial
Used for staging for disease inUsed for staging for disease in
contralateral testiscontralateral testis
49. ReferencesReferences
Steven G Silverberg, Ronald A Delellis, WilliamSteven G Silverberg, Ronald A Delellis, William
J Frable. Principles& Practice of SurgicalJ Frable. Principles& Practice of Surgical
Pathology& Cytopathology.III rd Edition. Vol III,Pathology& Cytopathology.III rd Edition. Vol III,
2237-51.2237-51.
PP Anthony, RNM Mac Sween. RecentPP Anthony, RNM Mac Sween. Recent
Advances in Histopathology 11, 135-147.Advances in Histopathology 11, 135-147.
Juan rosai.Ackerman’s Text Book of SurgicalJuan rosai.Ackerman’s Text Book of Surgical
Pathology,Vol I, Ch18,1257-62.Pathology,Vol I, Ch18,1257-62.
Campell Urology VII th Edition Vol II.Campell Urology VII th Edition Vol II.
Andersons Text Book of Pathology.Andersons Text Book of Pathology.