Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Eur Urol Focus. 2020 Sep 15;6(5):1124-1129. doi: 10.1016/j.euf.2020.05.009. Epub 2020 May 31.
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), involves multiple organs. Testicular involvement is largely unknown.
To determine the pathological changes and whether SARS-CoV-2 can be detected in the testes of deceased COVID-19 patients.
DESIGN, SETTING, AND PARTICIPANTS: Postmortem examination of the testes from 12 COVID-19 patients was performed using light and electron microscopy, and immunohistochemistry for lymphocytic and histiocytic markers. Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the virus in testicular tissue.
Seminiferous tubular injury was assessed as none, mild, moderate, or severe according to the extent of tubular damage. Leydig cells in the interstitium were counted in ten 400× microscopy fields.
Microscopically, Sertoli cells showed swelling, vacuolation and cytoplasmic rarefaction, detachment from tubular basement membranes, and loss and sloughing into lumens of the intratubular cell mass. Two, five, and four of 11 cases showed mild, moderate, and severe injury, respectively. The mean number of Leydig cells in COVID-19 testes was significantly lower than in the control group (2.2 vs 7.8, p < 0.001). In the interstitium there was edema and mild inflammatory infiltrates composed of T lymphocytes and histiocytes. Transmission EM did not identify viral particles in three cases. RT-PCR detected the virus in one of 12 cases.
Testes from COVID-19 patients exhibited significant seminiferous tubular injury, reduced Leydig cells, and mild lymphocytic inflammation. We found no evidence of SARS-CoV-2 virus in the testes in the majority (90%) of the cases by RT-PCR, and in none by electron microscopy. These findings can provide evidence-based guidance for sperm donation and inform management strategies to mitigate the risk of testicular injury during the COVID-19 disease course.
We examined the testes of deceased COVID-19 patients. We found significant damage to the testicular parenchyma. However, virus was not detected in testes in the majority of cases.
由严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）引起的 2019 年冠状病毒病（COVID-19）涉及多个器官。睾丸受累在很大程度上尚不清楚。
确定 COVID-19 患者死亡后睾丸的病理变化，以及是否可以在睾丸中检测到 SARS-CoV-2。
设计、地点和参与者：对 12 例 COVID-19 患者的睾丸进行了光镜和电镜检查，并进行了淋巴细胞和组织细胞标记物的免疫组织化学检查。采用逆转录-聚合酶链反应（RT-PCR）检测睾丸组织中的病毒。
根据管状损伤的程度，将生精小管损伤评估为无、轻度、中度或重度。在 10 个 400×显微镜视野中计数间质中的 Leydig 细胞。
显微镜下，Sertoli 细胞表现为肿胀、空泡和细胞质稀疏、与管状基膜分离以及脱落和脱落到管腔内细胞团中。11 例中有 2 例、5 例和 4 例分别为轻度、中度和重度损伤。COVID-19 睾丸中的 Leydig 细胞数量明显低于对照组（2.2 对 7.8，p<0.001）。间质中存在水肿和由 T 淋巴细胞和组织细胞组成的轻度炎症浸润。透射电镜在 3 例中未发现病毒颗粒。RT-PCR 在 12 例中有 1 例检测到病毒。
COVID-19 患者的睾丸表现为生精小管显著损伤、Leydig 细胞减少和轻度淋巴细胞炎症。我们通过 RT-PCR 在大多数（90%）病例中未发现睾丸中的 SARS-CoV-2 病毒，通过电镜检查未发现病毒。这些发现可为精子捐赠提供循证指导，并为减轻 COVID-19 病程中睾丸损伤的管理策略提供信息。
我们检查了 COVID-19 患者的睾丸。我们发现睾丸实质有明显损伤。然而，在大多数情况下，在睾丸中未检测到病毒。
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