Division of Urology, Department of Radiation Oncology, Centre Hospitalier de l'Universite de Montréal, and Department of Surgery, McGill University, Montreal, Quebec, Canada.
Urology. 2010 Jun;75(6):1436-40. doi: 10.1016/j.urology.2009.10.039. Epub 2009 Dec 29.
To evaluate the patterns of spermatogenesis in the normal testicular parenchyma of primary testicular cancers and estimate the feasibility of sperm retrieval at the time of radical orchiectomy.
We reviewed the archived histologic sections of 39 consecutive patients who had undergone radical orchiectomy for primary testicular cancer at 3 university-affiliated hospitals. We examined all areas of normal (noncancerous) testicular parenchyma to evaluate the level of spermatogenesis and presence of mature spermatozoa in these sections. A minimum of 100 seminiferous tubules were scored per case. We also evaluated the epididymal tubules for the presence of mature spermatozoa. A review of the clinical chart was performed to evaluate the relationship between clinical data and histologic findings.
In nearly 40% of the cases evaluated (15/38), the predominant histologic pattern was full spermatogenesis. Mature spermatozoa were identified in nearly 80% (30/38) of the testicular histologic sections and in 50% (14/28) of the evaluable epididymal sections. Clinical stage (presence of extranodal disease) and tumor marker levels were related to the probability of identifying mature spermatozoa in the testis.
The data suggest that sperm retrieval at the time of radical orchiectomy is a feasible fertility option, with a 40% probability of recovering spermatozoa by random biopsy of the noncancerous testicular parenchyma and an 80% probability of recovering spermatozoa with a more extensive dissection. In 50% men, spermatozoa may be recovered by epididymal aspiration alone.
评估原发性睾丸癌正常睾丸实质内的生精模式，并评估在根治性睾丸切除术时进行精子获取的可行性。
我们回顾了 39 例连续在 3 所大学附属医院接受根治性睾丸切除术治疗原发性睾丸癌的患者的存档组织学切片。我们检查了所有正常（非癌性）睾丸实质区域，以评估这些切片中生精的水平和成熟精子的存在。每个病例至少对 100 个精曲小管进行评分。我们还评估了附睾管中成熟精子的存在。对临床图表进行了审查，以评估临床数据与组织学发现之间的关系。
在评估的近 40%病例中（15/38），主要的组织学模式是完全生精。在近 80%（30/38）的睾丸组织学切片和 50%（14/28）的可评估附睾切片中鉴定出成熟精子。临床分期（是否存在结外疾病）和肿瘤标志物水平与在睾丸中鉴定成熟精子的可能性相关。
数据表明，在根治性睾丸切除术时进行精子获取是一种可行的生育选择，随机活检非癌性睾丸实质中精子的可能性为 40%，更广泛的解剖中精子的可能性为 80%。在 50%的男性中，仅通过附睾抽吸即可回收精子。
