Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA.
Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA.
Hum Pathol. 2022 Sep;127:21-27. doi: 10.1016/j.humpath.2022.05.017. Epub 2022 Jun 2.
Gender affirmation surgery performed for gender dysphoria is increasing to instigate changes more closely approximating gender identity. We investigated the clinicopathologic features of gender-affirming orchiectomies performed at our institution and devised a grossing protocol for these increasingly encountered specimens. We obtained 45 orchiectomies from 23 patients and reviewed clinicopathologic features. The number of sections per case was noted and reviewed to devise an optimal grossing protocol to assess pathologic findings. Twenty-three patients had bilateral orchiectomy with 1 unilateral. The average patient age was 39.4 years (range, 21-71 years); all received hormones for a mean of 66.1 months (range, 12-348 months). The average number of slides per orchiectomy was 8 slides (range, 1-11). Aspermatogenesis occurred in 32 (71%), hypospermatogenesis in 8 (18%), and normal spermatogenesis in 5 (11%) testes. Twenty-five (56%) exhibited scattered cells with nuclear cytomegaly, concerning for germ cell neoplasia in situ (GCNIS), but OCT4 negative. Six (13%) had multinucleated stromal cells. Leydig cells were markedly reduced/absent in 38 testes (85%). Epithelial hyperplasia was identified in 15 rete testes (33%) and 24 epididymes (53%), while 18 (40%) showed periepididymal muscular hyperplasia. All findings were identified in the initial 2 slides including rete testis/epididymis, except for 3 cases, missing only focal tubular sclerosis. Despite all received treatment, only a subset showed changes of exogenous hormone therapy. The presence of nuclear cytomegaly can mimic GCNIS and may be a potential pitfall. Two sections to include rete testis/epididymis and a third of cord margin are sufficient to identify the relevant pathology and germ cell tumors overall are uncommon in orchiectomies performed for gender affirmation.
性别认同手术用于治疗性别焦虑症，以促使身体变化更接近其性别认同。我们研究了在我们机构进行的性别肯定睾丸切除术的临床病理特征，并为这些日益常见的标本设计了一种大体检查方案。我们从 23 名患者中获得了 45 例睾丸切除术，并回顾了临床病理特征。记录了每个病例的切片数量，并进行了回顾，以设计出一种最佳的大体检查方案来评估病理发现。23 名患者行双侧睾丸切除术，其中 1 例为单侧。平均患者年龄为 39.4 岁（范围 21-71 岁）；所有患者均接受激素治疗，平均时间为 66.1 个月（范围 12-348 个月）。平均每例睾丸切除术的切片数为 8 张（范围 1-11 张）。32 例（71%）发生无精子发生，8 例（18%）发生少精子发生，5 例（11%）发生正常精子发生。25 例（56%）表现为散在的细胞核巨细胞，考虑为原位生殖细胞肿瘤（GCNIS），但 OCT4 阴性。6 例（13%）有多核基质细胞。38 例（85%）睾丸中勒迪希细胞明显减少/缺失。15 例（33%）睾丸网和 24 例（53%）附睾上皮增生，18 例（40%）附睾旁肌层增生。除 3 例仅缺失局灶性小管硬化外，所有病例均在最初的 2 张切片中发现了睾丸网/附睾、包括睾丸网/附睾和睾丸网/附睾，而仅在最初的 2 张切片中发现了睾丸网/附睾、包括睾丸网/附睾和睾丸网/附睾。尽管所有患者均接受了治疗，但只有一部分患者出现了外源性激素治疗的变化。核巨细胞的存在可能模仿 GCNIS，是一种潜在的陷阱。两个切片包括睾丸网/附睾和第三个睾丸网/附睾的切片足以识别相关的病理学，并且总体上在性别肯定睾丸切除术切除的睾丸中生殖细胞瘤并不常见。
