Royal Children's Hospital, Melbourne, Vic., Australia.
Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.
Clin Endocrinol (Oxf). 2017 Sep;87(3):279-285. doi: 10.1111/cen.13377. Epub 2017 Jul 2.
Advances in cancer treatment have led to improved long-term survival after childhood cancer, but often at a price of impaired future fertility. Fertility preservation (FP) in male children and early adolescents poses unique challenges as efficacy is unproven.
To describe characteristics of testicular tissue cryopreservation (TTCP) specimens taken from paediatric and adolescent patients, stratified by age, and prior chemotherapy, if any, and to demonstrate evidence for germ cells.
Retrospective review of gonadal biopsies and clinical records of patients consented into the Royal Children's Hospital FP programme between 1987 and 2015. Tissue was sliced into blocks, with one section sent for histopathology prior to cryopreservation. In boys ≥12 years where spermatogenesis could be expected, a portion of tissue was disaggregated completely to look for mature sperm and if found, additional tissue was dissected and the resulting suspension frozen.
Testicular tissue cryopreservation specimens in 44 males (0.3-16.8 years) provided an average of 7.8 slices per patient. All the specimens were taken at the same time as another necessary surgical procedure, under one general anaesthesic. There was only one complication of scrotal wound dehiscence. Seven of the forty-four (15.9%) patients had chemotherapy prior to testicular biopsy, while the rest were chemotherapy naïve. Five of these were prepubertal, and two were pubertal patients. Eleven subjects had tissue dissected with mature sperm found in eight. Of these eight patients where sperm were found, all were pubertal with testicular size of more than 10 mL and showing histological evidence of spermatogenesis. No histologic specimen demonstrated any malignant cells.
Testicular tissue cryopreservation can be performed in young patients without delay, preferably prior to cancer treatment. As testicular tissue contains germ cells from which haploid spermatozoa are ultimately derived, future technologies may allow their utilization for fertility in humans. This may be the only hope for biological offspring in some patients undergoing fertility compromising treatment. Retrieval of mature sperm from some pubertal patients, however, offers realistic hope to these patients of future fertility.
癌症治疗的进步使儿童癌症患者的长期生存率得到提高，但往往是以损害未来生育能力为代价的。由于疗效尚未得到证实，因此对男童和青少年进行生育力保存（FP）具有独特的挑战。
描述 1987 年至 2015 年间在皇家儿童医院 FP 计划中同意进行性腺活检的儿科和青少年患者的睾丸组织冷冻保存（TTCP）标本的特征，按年龄和是否接受过化疗进行分层，并证明存在生殖细胞。
对 1987 年至 2015 年间在皇家儿童医院 FP 计划中同意进行性腺活检的患者的性腺活检和临床记录进行回顾性分析。组织切成块，其中一个切片在冷冻保存前进行组织病理学检查。在预期可以发生精子发生的≥12 岁男孩中，一部分组织被完全分散以寻找成熟精子，如果发现成熟精子，将进一步解剖组织并将获得的悬液冷冻。
44 名男性（0.3-16.8 岁）的睾丸组织冷冻保存标本平均每个患者提供 7.8 个切片。所有标本均在一次全身麻醉下，与另一次必要的手术同时采集。只有一例阴囊伤口裂开的并发症。44 例中有 7 例（15.9%）患者在睾丸活检前接受过化疗，其余患者未接受过化疗。其中 5 例为青春期前患者，2 例为青春期患者。11 名患者的组织被解剖，其中 8 名患者发现成熟精子。在发现精子的 8 名患者中，所有患者均为青春期，睾丸大小超过 10mL，且组织学显示有精子发生。没有组织学标本显示任何恶性细胞。
睾丸组织冷冻保存可以在年轻患者中进行，而不会延迟，最好在癌症治疗之前进行。由于睾丸组织中含有最终产生单倍体精子的生殖细胞，因此未来的技术可能允许在人类中利用这些生殖细胞来实现生育能力。对于某些接受生育能力受损治疗的患者来说，这可能是生育生物学后代的唯一希望。然而，从一些青春期患者中获取成熟精子，为这些患者提供了未来生育能力的现实希望。
