De Luna Arlene M, Ortenberg Joseph, Craver Randall D
Department of Pediatric Pathology, Louisiana State University, Children's Hospital of New Orleans, USA.
J Urol. 2003 Apr;169(4):1486-9. doi: 10.1097/01.ju.0000056970.02793.e6.
Testicular remnants identified during exploration for cryptorchidism contain vascularized fibrous nodules at the termination of the vas deferens, hemosiderin, calcification, a pampiniform plexus or occasionally residual seminiferous tubules that may contain germ cells. An absent testis lacks the features of testicular remnants. To our knowledge testicular remnants have not been described in a crossed ectopic location. We reviewed orchiectomy specimens obtained at exploration for a nonpalpable testis to characterize the features of testicular remnants, including the frequency of seminiferous tubules, germ cells and crossed ectopia, as well as to clarify the diagnostic criteria for testicular remnants.
From 1990 to mid 2000 medical records and histological slides from 101 boys with nonpalpable testes who had undergone inguinal exploration and orchiectomy were reviewed.
Of the 71 testicular remnants identified 7 (9.8%) contained residual tubules, of which 4 (5.6%) contained germ cells. In 4 boys the testis was deemed absent but 3 did not undergo laparoscopic exploration. There were 2 ectopic remnants (2.8%) on the contralateral side-the pelvis or in the scrotum. Both crossed remnants demonstrated dissociation of the testis from the vas/epididymis which remained on the correct side associated with a pampiniform plexus. No müllerian remnants were encountered.
Adequate exploration for nonpalpable testis requires laparoscopy with visualization of the contralateral pelvic region because an ectopic remnant may be dissociated from the vas/epididymis and vessels. Identification of a pampiniform plexus, vas and spermatic vessels may not be a reliable indicator of a testicular remnant. Continued removal of testicular remnants is warranted because at least 9.8% contain residual viable tubules.
在隐睾探查术中发现的睾丸残迹包含输精管末端的血管化纤维结节、含铁血黄素、钙化、蔓状静脉丛，或偶尔含有生殖细胞的残余生精小管。未降睾丸则缺乏睾丸残迹的特征。据我们所知，尚未有关于交叉异位位置睾丸残迹的描述。我们回顾了因不可触及睾丸而进行探查时获取的睾丸切除标本，以明确睾丸残迹的特征，包括生精小管、生殖细胞及交叉异位的发生率，并阐明睾丸残迹的诊断标准。
回顾了1990年至2000年年中101例因不可触及睾丸而接受腹股沟探查及睾丸切除术的男孩的病历和组织学切片。
在71个被识别出的睾丸残迹中，7个（9.8%）含有残余小管，其中4个（5.6%）含有生殖细胞。4例男孩被判定睾丸缺如，但3例未接受腹腔镜探查。有2个异位残迹（2.8%）位于对侧——盆腔或阴囊内。两个交叉残迹均显示睾丸与输精管/附睾分离，而输精管/附睾仍位于正确一侧并伴有蔓状静脉丛。未发现苗勒管残迹。
对于不可触及睾丸的充分探查需要进行腹腔镜检查并观察对侧盆腔区域，因为异位残迹可能与输精管/附睾及血管分离。识别蔓状静脉丛、输精管和精索血管可能不是睾丸残迹的可靠指标。由于至少9.8%的睾丸残迹含有残余的存活小管，因此有必要持续切除睾丸残迹。
