Journal of the Anatomical Society of India

M Tariq Zaidi, Aijaz A Khan, Nafis A Faruqi
JN Medical College, AMU, Aligarh; India

Abstract: The fertility potential of patient having bilateral cryptorchid testes is said to be very low. Semen quality may be impaired in men with history of unilateral cryptorchidism as well, but reduction in paternity rates has not been conclusively established. Here we present a case of a forty-year unilateral cryptorchid male having normal paternity who underwent therapeutic orchidectomy. Samples from testis, epididymis, and vas deferens were fixed in 10% buffered formalin. Light microscopic observations were made on haematoxyline–eosin stained 10m thick paraffin sections. Testis showed seminiferous tubules of smaller diameters devoid of spermatogenenic cells with thickened and hyalinized basement membrane. Most of the tubules were completely occupied by the Sertoli cells. Leydig cells in the interstitium were found in clusters and appeared hyperplastic. Hypoplastic epididymis showed dilated lumen having flattened epithelial cells devoid of stereocilia. The vas deferens had vascular tunica adventitia; thick, trilaminar tunica musculosa and tunica mucosa having poorly developed longitudinal folds. It was concluded that unilateral cryptorchidism even with altered histology of testis and spermatic duct system may not affect fertility.

Key Words: Cryptorchidism, Epididymis, Vas deferens, Sertoli cell, Leydig cell.

Introduction:

common congenital anomaly. The incidence of cryptorchidism in term-infants is apparently 30% and decreases to 0.8% by one year of age Kogan (1985). The mechanism by which the testis descends into the scrotum still remains poorly understood Rajfer (1998). It has been shown that cryptorchidism is a cause of testicular atrophy and subsequent development of testicular neoplasm Rajfer (1998) and Beard et. al. (1977). The information regarding histological changes associated with unilateral cryptorchidism in otherwise healthy fertile individual still remains scanty and therefore the present case is being reported.

Materials and Methods

A forty-year male, father of five chlidren (2 male – 13 and 9 years and 3 female – 15, 11, 7 year old, all full-term normally delivered, with no apparent congenital anomalies) presented with unilateral undescended testis. There was no history of foetal loss. He underwent voluntary therapeutic orchidectomy to get relief from recurrent attacks of pain in the cryptorchid testis. Samples from testis, epididymis and vas deferens were immersion fixed in 10% buffered formalin for 2 weeks and processed for paraffin embedding. 10 µ thick sections were stained with haematoxyline-eosin and observed under the light microscope.

On gross examination testis appeared small and atrophic, the epididymis was hypoplastic and flabby while the vas deferens appeared unduly thickened. Light Microscopy of testis showed that seminiferous tubules had smaller diameters and were completely devoid of spermatogenic cells (Fig. 1). Tubules were fully occupied by the Sertoli cells (Fig. 2 and 6) a feature very much similar to 'Sertoli cell only syndrome'. The tubular basement membrane was thickened and hyalinized. Dysgenetic Sertoli cell were observed in all nonhyalinized seminiferous tubules. Interstitial cells of Leydig were found in prominent clusters, commonly interspersed in the intertubular interstitium and occasionally invaded the tubular lumen (Fig. 2 & 7). Epididymal cross- sections showed dilated lumen (Fig. 3) lined by flattened and occasionally columnar epithilium. The atrophic epithelial cells were devoid of characteristic stereocilia (Fig. 4). The vas deferens had thick trilaminar tunica musculosa (Fig. 5) and vascular tunica adventitia, and tunica mucosa had poorly developed and less numerous longitudinal folds. The pseudostratified columnar epithelium was devoid of cilia.

Fig. 1: Testis showing atrophic seminiferous tubules (*), tunica albuginea (1), tunica vasculosa (2), and H&E, X100

Fig. 2: Testis showing atrophic seminiferous tubule full of supporting cells (*), group of interstitial cells invaginating into the tubule (q) H&E, X400

Fig. 3: Epididymis showing dilated cross-sections of epididymal tube with atrophic epithelium (*). At places the epithelium is columnar. H & E, X100

Fig.4: Epididymal cross section showing follicular appearance (*) having flattened epithelium without stereocilia. H&E, X400

Fig. 5: Vas deferens showing thickened tunica musculosa. Tunica mucosa reveals poorly developed longitudinal folds. H&E, X40

Fig. 6: Testis showing seminiferous tubule occupied by Sertoli cells (+).

Fig.7: Testis showing cluster of interstitial cells (*) and atrophic seminiferous tubule (+)

Discussion:

Despite of the fact that the descent of testes is considered important for its normal functions the knowledge about the exact factor responsible for its descent during development remains poorly understood. The present case of unilateral cryptorchidism is reported where unilateral cryptorchid testis was associated with altered histology of testis, epididymis and vas deferens yet its harmful impact was not sufficient enough to make the individual infertile. In such situation it was suggested by Atillaertugrul et.al. (2002) that the contralateral testis and the spermatic tract system must have undergone favourable compensatory change to makeup for the deficit caused by unilateral cryptorchidism. Hyperplastic interstitial cells in the present study was found in agreement with the description given by Williams et.al. (1995). Impaired thermoregulation, Penson et. al. (1997), Bedford (1991) and Loughlin et.al. (1991) has been held responsible for the testicular damage in ectopic testis. P53 has also been implicated in the temperature-induced apoptotic germ cell loss Richie (1998). Many workers are of the opinion that altered microstructure of cryptorchid testis is primarily due to some defect at the genetic level which finds support from the fact that there is significantly higher incidence of testicular cancer, Rajfer (1998), Henderson et.al (1979), Sidransy et.al (1991) Bartkova et. al. (1991) and Lewis et. al. (1994) associated with undescended testis.

Cryptorchidism is also associated with anomalous epididymis which may be both gross and microscopic varying from simple epididymal elongation to more complex form such as complete disruption between testes and epididymis with an over all frequency of 36–90%, Koff and Scaletscky (1990) and Mollaeian et.al. (1994). The altered epididymal microstructure in the present study did not match with the findings of mechanically induced cryptorchidism, Atillaertugrul et.al. (2002) and Kocak et al (2001).

The unduly thickened tunica musculosa of normally thick-walled tube could not be fully explained. It may be due to continuous traction applied by the testicular ligament with cremaster muscle and gubernaculum towards its scrotal position resulting into its compensatory hypertrophy. The tunica mucosa showed poorly developed and less numerous longitudinal folds akin to disuse atrophic change due to absence of spermatogenesis and hence absence of local factor. It was concluded that while unilateral cryptorchidism affected the microstructure of the testis and spermatic tract of the same side the contralateral descended testis and tract remained unaffected. The role of therapeutic orchidopexy in the infertile individuals aimed at regaining normal testicular structure and function requires further study.

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