From the Department of Pathology, NYU Langone Medical Center, New York, New York (Lin, Marcus, Deng, Adler).
From the Department of Pathology, NYU Long Island School of Medicine, Mineola, New York (Hernandez).
Arch Pathol Lab Med. 2022 Jun 1;146(6):742-748. doi: 10.5858/arpa.2021-0199-OA.
CONTEXT.—: Gender-affirming surgery is part of a multidisciplinary approach in gender transitioning. Deeper histologic examination may strengthen care for transmasculine individuals and increase the understanding of the influence of hormonal therapy in specific organs.
OBJECTIVE.—: To evaluate and catalogue histologic findings of tissue obtained from gender-affirming gynecologic surgery and cervical cytology specimens.
DESIGN.—: This is an institutional review board-approved retrospective study that included transmasculine individuals who underwent gender-affirming gynecologic surgery from January 2015 to June 2020. All surgical gynecologic pathology and cervical cytology slides were reviewed by 2 pathologists.
RESULTS.—: Fifty-five patients were included, which represented 40 uteri, 35 bilateral ovaries, 15 vaginectomy specimens, and 24 cervical cytology results. The median age was 27 years (range, 18-56), and 94% (50 of 53) of patients were receiving testosterone for at least 1 year. Seventy-five percent (30 of 40) of endometria were inactive, while 25% (10 of 40) showed evidence of cycling. Transitional cell metaplasia was the most common finding in the cervix (17 of 40) and vagina (15 of 15), reflecting a high percentage (4 of 24) of unsatisfactory or ASC-US (atypical squamous cells of undetermined significance) cervical cytologies. Prostatic-type glands were identified in 20% (8 of 40) of cervices and 67% (10 of 15) of vaginectomy specimens. Multiple bilateral cystic follicles and evidence of follicular maturation were present in 57% (20 of 35) of cases. Four cases showed paratubal epididymis-like mesonephric remnant hypertrophy.
CONCLUSIONS.—: A comprehensive evaluation of tissue from gender-affirming surgery increases knowledge of the changes following androgen therapy in transmasculine individuals and may contribute to optimal patient care by raising awareness of normal histologic variations in this population.
性别肯定手术是性别过渡多学科方法的一部分。更深入的组织学检查可以加强对跨性别男性个体的护理，并增加对激素治疗在特定器官中的影响的理解。
评估和分类性别肯定性妇科手术和宫颈细胞学标本中获得的组织的组织学发现。
这是一项机构审查委员会批准的回顾性研究，包括 2015 年 1 月至 2020 年 6 月期间接受性别肯定性妇科手术的跨性别男性个体。由 2 名病理学家对所有手术妇科病理学和宫颈细胞学切片进行了回顾。
共纳入 55 例患者，其中包括 40 例子宫、35 例双侧卵巢、15 例阴道切除术标本和 24 例宫颈细胞学结果。中位年龄为 27 岁（范围 18-56 岁），94%（50/53）的患者接受至少 1 年的睾酮治疗。75%（40/40）的子宫内膜无活性，而 25%（10/40）显示出周期性的证据。宫颈（40/40）和阴道（15/15）最常见的发现是移行细胞化生，反映了较高比例（24/24）的不满意或 ASC-US（意义未明的非典型鳞状细胞）宫颈细胞学。在 20%（40/40）的宫颈和 67%（15/15）的阴道切除术标本中发现前列腺型腺体。在 57%（35/35）的病例中存在多个双侧囊性卵泡和卵泡成熟的证据。4 例显示副输卵管样中肾残余肥大。
对性别肯定性手术的组织进行全面评估可以增加对跨性别男性个体接受雄激素治疗后的变化的了解，并通过提高对该人群正常组织学变异的认识，有助于为患者提供最佳护理。
