Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Çapa Fatih, 34093, Istanbul, Turkey.
Department of Pathology, Konya Education and Research Hospital, Konya, Turkey.
Int Urol Nephrol. 2024 Jul;56(7):2269-2274. doi: 10.1007/s11255-024-03963-4. Epub 2024 Feb 13.
Cryptorchidism is a well-defined risk factor for testicular germ cell tumors, whereas the underlying mechanisms have not been fully elucidated. Surgical procedures to reposition undescended testicles into the scrotum (orchidopexy) in early childhood are recommended both to increase fertility potential and to reduce the risk of developing testicular tumors. However, treatment in the post-pubertal period is controversial. The aim of this study is to review the histopathology of orchiectomy specimens and determination of spermatogenesis in post-pubertal patients with non-treated cryptorchidism.
Retrospective chart review was performed to assess the occurrence of TGCTs and determine spermatogenesis in post-pubertal individuals who underwent inguinal orchiectomy for undescended testis between January 2010 and December 2019. Age at the time of surgery, laterality, location of the undescended testis and pathology results were evaluated. All pathology specimens were reviewed by a blinded pathologist.
There were 23 patients in the cohort with a mean age of 21 years (range 13-46 years). All testes were in the inguinal canal. Our results indicated that 1 patient had seminoma. In the histological evaluation of the remaining 22 patients in whom no tumor was detected, normal spermatogenesis was not observed in any patient. Further, seminiferous tubules were not found in 19 patients. Maturation arrest was detected in the remaining 3 patients.
Testicular germ cell carcinoma was found in 4% of the patients who underwent post-pubertal orchiectomy. In addition, none of the undescended testes had normal spermatogenetic activity. Thus, orchiectomy should be considered in post-pubertal males with unilateral undescended testis that do not need the endocrinological activity of the testis.
隐睾是睾丸生殖细胞肿瘤的一个明确风险因素，但其潜在机制尚未完全阐明。建议在儿童早期进行外科手术将未降睾丸重新定位到阴囊（睾丸固定术），这既可以提高生育潜力，又可以降低发生睾丸肿瘤的风险。然而，青春期后的治疗仍存在争议。本研究旨在回顾青春期后未治疗的隐睾症患者的睾丸切除术标本的组织病理学和精原细胞发生情况。
回顾性病历分析评估了 2010 年 1 月至 2019 年 12 月间因未降睾丸而行腹股沟睾丸切除术的青春期后个体中 TGCT 的发生情况，并确定精原细胞发生情况。评估了手术时的年龄、侧别、未降睾丸的位置和病理结果。所有病理标本均由一位盲法病理学家进行评估。
队列中有 23 例患者，平均年龄为 21 岁（13-46 岁）。所有睾丸均位于腹股沟管内。我们的结果表明，有 1 例患者患有精原细胞瘤。在未检测到肿瘤的 22 例患者的组织学评估中，没有患者观察到正常的生精作用。此外，19 例患者未发现精曲小管。在其余 3 例患者中发现成熟阻滞。
行青春期后睾丸切除术的患者中有 4%发现睾丸生殖细胞癌。此外，未降睾丸均无正常的生精活性。因此，对于不需要睾丸内分泌功能的单侧未降睾丸的青春期后男性，应考虑行睾丸切除术。
