Jones M A, Sharp G H, Trainer T D
Department of Pathology, University of Vermont College of Medicine, Burlington 05405.
Am J Clin Pathol. 1988 Mar;89(3):321-8. doi: 10.1093/ajcp/89.3.321.
Testicular varicocele, the most common cause of male infertility, frequently presents in early adolescence. To determine whether testicular damage occurs early in the natural history of varicocele, testicular biopsy specimens from 13 patients, 13 to 18 years of age (mean age, 15.5 years), were studied. The biopsies were compared with testicular tissue from six normal control subjects 15 to 28 years of age (mean age, 23.2 years). Nine of the patients with varicoceles (69.2%) demonstrated some degree of tubular sclerosis. Ultrastructural study demonstrated that the tubular sclerosis was due to collagen deposition by fibromyocytes in the peritubular sheath. Premature germ cell sloughing was present in greater than 50% of tubules examined in all but one biopsy. Six patients (46%) demonstrated small vessel sclerosis. Quantitation of the germinal epithelium revealed that the mean germ cell/Sertoli cell ratio and the percentage of germ cells present as late stage forms (secondary spermatocytes, spermatids and spermatozoa) were significantly reduced in the varicocele group. The testes of two patients exhibited severe hypospermatogenesis approaching germ cell aplasia. None of these changes were seen in the control group. The authors conclude that pathologic changes in the testes of patients with varicoceles are found at or soon after puberty. The histopathologic features include peritubular sclerosis, small vessel sclerosis, premature germ cell sloughing, and variable degrees of hypospermatogenesis.
睾丸静脉曲张是男性不育最常见的原因，常在青春期早期出现。为了确定睾丸损伤是否在静脉曲张的自然病程早期就已发生，对13例年龄在13至18岁（平均年龄15.5岁）患者的睾丸活检标本进行了研究。将这些活检标本与6例年龄在15至28岁（平均年龄23.2岁）的正常对照受试者的睾丸组织进行比较。9例患有静脉曲张的患者（69.2%）表现出一定程度的小管硬化。超微结构研究表明，小管硬化是由于纤维肌细胞在小管周围鞘中沉积胶原蛋白所致。除1例活检外，在所有检查的小管中，超过50%存在过早的生殖细胞脱落。6例患者（46%）表现出小血管硬化。对生精上皮的定量分析显示，静脉曲张组的平均生殖细胞/支持细胞比率以及晚期形式（次级精母细胞、精子细胞和精子）的生殖细胞百分比显著降低。2例患者的睾丸表现出严重的精子发生减少，接近生殖细胞发育不全。对照组未观察到这些变化。作者得出结论，静脉曲张患者睾丸的病理变化在青春期或青春期后不久就已出现。组织病理学特征包括小管周围硬化、小血管硬化、过早的生殖细胞脱落以及不同程度的精子发生减少。
