SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Adenocarcinoma of the rete testis is a rare tumor of the genital tract. An advanced case of adenocarcinoma thought to arise from the rete testis is presented. We believe this is the eighteenth reported case.
The rete testis in the domestic fowl (Gallus gallus domesticus), Japanese quail (Coturnix coturnix japonica), guinea-fowl (Numida meleagris galeata) and drake (Anas platyrhynchos) was studied histologically and with both the scanning and transmission electron microscopes. All the birds have rete epithelial cells varying between squamous and high cuboidal. A cilium-like structure projects from the luminal portion of most cells into the rete lumen, and the outline of the cells varies from polygonal to elongate. Sparse, stubby microvilli were concentrated on the cell borders. Ultrastructural features suggest only moderate secretory and absorptive activities in the cells. The rete testis of birds is amply supplied with blood as well as lymphatic vessels and nerves. Intraepithelial lymphocytes form part of the rete epithelium, and macrophages are present in large numbers in the rete lumen of the domestic fowl and drake and, to a lesser degree, also in the rete epithelium of the drake.
The proximity and, in some instances, communication between several structures in the testis and paratestis (rete testis, epididymis, mesothelium, vestigial epithelium and paratesticular soft tissue) result in a plethora of interesting tumors and tumor-like lesions that together pose a formidable diagnostic challenge both because of their morphologic overlap and rarity. The occasional spread of tumors primarily at other sites to this region adds to the potential problem encountered. This review provides an overview of the pathology of nonmesenchymal paratesticular neoplasms and pseudotumors with a focus on the approach to tubulopapillary neoplasms for which diagnostic considerations may include carcinoma of the rete testis, malignant mesothelioma, ovarian-type epithelial tumors, epididymal carcinoma and metastatic carcinomas. The cornerstone of accurate characterization of these lesions is still a comprehensive, traditional clinicopathologic approach, clinical history (of another primary), gross examination (location) and routine light microscopy, but judicious incorporation of contemporary immunohistochemical markers may aid or in some instances be crucial in resolving the problems encountered.
The fine structure of the rete testis was examined in several primates, domestic animals and rodents. The rete testis consists of a series of interconnected wide channels lined with a simple cuboidal to columnar epithelium, resting on a thick basal lamina. Beneath the basal lamina dense bundles of collagen fibrils and a few blood vessels, lymphatics or nerve tissue are found. The epithelial cells are characterized by large, deeply indented nuclei, spherical or short rod-shaped mitochondria, supranuclear Golgi profiles, some cisterns of rough endoplasmic reticulum, free ribosomes and numerous micropinocytotic vesicles in the ectoplasmic regions. Smooth endoplasmic reticulum, secretory granules, lysosomes or other types of dense bodies are rarely seen. The apical surface of the cells bears numerous microvilli and a single very long flagellum which is presumed to be motile. Ajoining lateral cell membranes exhibit a juxtaluminal tight junction, elaborate interdigitations and desmosomes. The basal plasma membrane is highly irregular greatly increasing its surface area of contact with the underlying interstitium. The nuclei of the rete epithelial cells contain pale-staining, spherical structure, 2 mum in diameter, composed of circularly oriented fine filaments. The significance of the nuclear structures remains unknown. Thorotrast was injected into the lumen of the hamster and rat rete testis and 30 minutes later the proximal portion of the excurrent duct system of the testis was prepared for electron microscopy. Whereas the ductuli efferentes and first part of the epididymis possessed numerous apical vesicles filled with the thorotrast, this electron opaque substance was rarely found in the epithelium of the rete testis. Thus, incorporation of particulate matter into the lining cells of the rete from its lumen is apparently less active than in the epithelium of the ductuli and epididymis. Vascularly introduced intercellular tracer compounds such as lanthanum nitrate or horseradish peroxidase did not enter the lumen of the rete testis from the interstitium. The tracer molecules appeared to be blocked by the juxtaluminal tight junction separating adjacent epithelial cells. This latter observation suggests that a blood-testis barrier exists at the level of the rete testis epithelium. Although physiological studies have indicated that the composition of fluid secreted in the seminiferous epithelium is considerably modified in the rete testis, the present morphological study does not provide additional evidence to support a secretory or absorptive function for this region of the excurrent duct system of the testis.
The ultrastructure of the normal human rete testis was analyzed. The rete testis cavities are irregularly shaped and contain virtually no spermatozoa. Smooth muscle cells often surround the cavities. In the epithelial lining, two cell types are distinguishable. Flat, dark cells exhibit numerous slender microvilli, and numerous apical and basal micro-vesicles. Prismatic, lighter cells have more cell organelles, mostly polarized towards a supranuclear position. Both cell types contain variable amounts of glycogen and fat, and an occasional cilium. All cells display intricate lateral cell surfaces that possess different cell-to-cell attachment devices. Intermediate cell types are frequently found. On a morphological basis, the epithelial cells seem to be involved in the release of substances into the lumen and probably also in transport towards the base. Connective tissue elements are found subjacent to the epithelium. Scattered among the fibrocytes are typical smooth muscle cells. Expansions of some smooth muscle cells are connected to the epithelial basement membrane by a network of microfibrillar materia. The smooth muscle cells may be involved in changing the shape of the rete testis channels, thus promoting the flux of the rete testis fluid. Different types of nerve fibre bundles are distinguished in the connective tissue of the rete testis which may correspond to autonomic and sensory nerves or sensory receptors.
Adenomatous hyperplasia of the rete testis (AHRT) is an uncommon benign lesion that preferentially involves the septal rete testis and mediastinal rete testis. It is usually an incidental finding in surgical specimens from cryptorchidism and testicular tumour. It can be found in autopsy specimens from patients dying with different chronic diseases and newborns with kidney diseases. Since its first description many articles have been published communicating new cases and putting forward some hypotheses on its aetiology and pathogenic mechanisms. Some authors suggest a role for hormonal changes, tumour invasion and action of chemical agents. We think that AHRT should be categorised into two main aetiological categories: congenital and acquired. The cases associated with different kidney and spermatic duct diseases, most cases associated with cryptorchidic testis and some cases associated with testicular germ cell tumour should be included in the congenital group. The remaining cases associated with chemical agents, some hormonal changes (i.e. androgen blockade) and most of the germ cell tumour cases can be considered as acquired AHRT. Differential diagnosis must be established mainly with metastatic adenocarcinoma of prostate to testis and primary adenocarcinoma of the rete testis. Pseudohyperplasia of the rete testis must also be considered in atrophic testes. Here we review the papers published on this subject and report our recent cases.
OBJECTIVES: The cystic ectasia of the rete testis is a benign entity with a typical ultrasound appearance as a collection of small hypoechoic structures in the confluence of the mediastinum testis. The clinical importance of these entity remains on doing an adequate differential diagnosis with testicular neoplasias with a cystic component. METHODS: We retrospectively reviewed the database of the Ultrasound Unit in the Department of Urology looking for patients with a diagnosis of cystic ectasia of the rete testis over a six-year period. RESULTS: Three cases of cystic ectasia of the rete testis were diagnosed over the six-year period, in all the indication for ultrasound was testicular pain. Mean patient age was 62 years. No patient developed testicular tumor on follow-up. CONCLUSIONS: The knowledge of the ultrasound characteristics found in the cystic ectasia of the rete testis helps to make a proper diagnosis of this benign entity without the need of indication of testicular biopsy.
A rete testis cannulation technique was used to compare the secretion of rete testis fluid with the production of spermatozoa and histological testicular parameters in Ile-de-France rams. Thirteen testes were cannulated and rete testis fluid variables were compared to histological variables of the same testis. The rate of flow of rete testis fluid was significantly (P less than or equal to 0.05%) correlated with testicular size, the area of the walls of the seminiferous tubules and the volume of the Leydig cells. These two latter factors accounted for 66% of the variation in the flow of rete testis fluid.
Cultures of rete testis epithelial cell-enriched preparations from testes of adult rams have been investigated, and some of their properties have been determined. In monolayers, the cells form mosaic-like borders, and retain many ultrastructural features characteristic of rete epithelial cells in situ, including an indented nucleus with prominent heterochromatin clumps, short rod-shaped or round mitochondria that are easily distinguished from the elongated mitochondria of Sertoli cells, the presence of desmosomes, and few if any lipid droplets or vacuoles. Unlike Sertoli cell-enriched aggregates in culture, rete testis epithelial cell preparations do not form cytoplasmic extensions, and no associated germ cells are present. Rete cells in culture express cytokeratin and vimentin in the cytoskeleton, whereas Sertoli cells prepared from testes of adult rams contain vimentin but not cytokeratin. Both rete cells and Sertoli cells stain positively for laminin but not for fibronectin, Collagen Type I, or Collagen Type III. The rete cells synthesize and secrete several proteins into the culture medium, evident in gel electrophoresis patterns of radiolabeled proteins. This pattern is similar, but not identical, to that secreted by Sertoli cell-enriched preparations. Rete cells in culture in the presence of serum continue to undergo mitotic division, but Sertoli cells do not. A variety of criteria were employed to estimate the relative numbers of Sertoli cells present in the rete testis epithelial cell-enriched preparations from testes of adult rams, including morphological and ultrastructural differences between the two cell types, and the presence of desmosomal proteins and cytokeratin in rete cells but not in Sertoli cells. The relative number of fibroblast-like cells was determined by measuring the expression of fibronectin and Collagen Type I, and an immunocytochemical probe for the detection of Factor VIII was used to estimate the degree of contamination by vascular endothelial cells. Using these markers, we determined that the rete testis epithelial cell-enriched preparations were about 93% pure. Primary cultures under defined conditions contained relatively few Sertoli cells (0.4%), but were contaminated to a larger extent by fibroblast-like cells (approximately 4%) and by endothelial cells (about 3%). The possible functions of rete testis epithelial cells are discussed herein.
Clusterin is a protein present in the rete testis fluid of the ram that elicits aggregation of erythrocytes and Sertoli cells in vitro. In view of its possible biologic function in relation to cell-cell interaction in the testis, we isolated this protein from ram rete testis fluid using sequential high-performance liquid chromatography columns and performed a detailed physicochemical characterization. This protein consists of two molecular variants designated form I and form II clusterin. Each form of clusterin consists of two subunits with an apparent molecular weight of 40,000. It is of note that the two subunits have no homology in their N-terminal amino acid sequences. However, the N-terminal amino acid pairs of the two subunits derived for the two forms of clusterin are identical. Using o-phthalaldehyde to block the Lys residue at the fourth amino acid pair from the N-terminus which leaves the Pro residue free for subsequent Edman degradation, we have deduced the N-terminal sequence of each of the two subunits for form I clusterin. Comparison of the NH2-terminal sequences of the two subunits of clusterin with the release 10.0 of the protein sequence data base of the Protein Identification Resource indicated no homology between either of the subunits of clusterin and any of the known proteins in the data base. A highly specific radioimmunoassay developed for clusterin was used to measure its concentrations in the fluids of the rete testis and cauda epididymis. Since a significant amount of immunoreactive clusterin was found in serum, the protein was partially purified from this source by immunoaffinity chromatography. Immunoreactive serum clusterin was smaller than the testicular clusterin (Mr 37,000 vs 40,000), but both proteins share common epitopes as demonstrated by radioimmunoassay and immunoblots. However, serum clusterin does not possess the biologic activity of the testicular clusterin in that it does not elicit cell aggregation in vitro. It is of note that deglycosylation of testicular clusterin can also eliminate this in vitro biologic activity, suggesting that the serum clusterin might be a deglycosylated form of the testicular protein and the carbohydrate core plays an important role in determining the cell aggregation activity. Studies on the distribution of this protein in the reproductive compartment indicate that it is highly concentrated in the rete testis and the cauda epididymal fluids. This suggests that this protein might have some important functions in the reproductive tract.
Adenocarcinoma of the rete testis (ACRT) is extremely rare and has only been the subject of sporadic case reports, in most of which the neoplasm manifested as a scrotal mass with diffuse enlargement of the testis. Only a few cases of scrotal infiltration by a contiguous ACRT have been described. To our knowledge, none have reported distant skin metastases. We report a case of ACRT presenting with suprapubic skin metastases. The diagnosis was based on clinical and histopathological findings and supported by the results of immunohistochemical and ultrastructural studies. We discuss the differential diagnosis to this rare entity, which include metastatic adenocarcinoma, serous tumor of the testis, and mesothelioma of the tunica vaginalis.
We attempted to characterize the cells collected from the rete testis via ultrasonographically guided puncture. Unilateral puncture of the rete testis was performed in nine men with obstructive azoospermia and 51 men with nonobstructive azoospermia. All the aspirated samples from the rete testis were observed via confocal scanning laser microscope and some of them after fluorescent in situ hybridization techniques. Then therapeutic testicular biopsy was performed in the punctured testis of each man. Spermatozoa were found in all rete testis samples and all biopsy samples from obstructed men. Twenty-two nonobstructed men demonstrated absence of spermatozoa in biopsy samples. Twenty-nine nonobstructed men showed spermatozoa in biopsy material and 24 of these men (82%) had demonstrated spermatozoa in rete testis samples. There were no significant differences in fertilization and cleavage rate between intracytoplasmic sperm injection trials using biopsy spermatozoa and rete testis spermatozoa both in obstructed and nonobstructed men. Considering that puncture of the rete testis does not reduce the volume of testicular parenchyma, is less invasive and apparently causes less detrimental effect on testicular vasculature than biopsy, puncture of rete testis is recommended as first line approach for the treatment of azoospermic men. If puncture is negative for spermatozoa in nonobstructed men, biopsy is indicated.
We report a case of adenocarcinoma of rete testis in 64-year-old man. His first diagnosis was hydrocele of left testis, but aspiration cytology showed malignancy. The patient underwent left orchiectomy. The pathological diagnosis was adenocarcinoma of the rete testis. The cancer was suspected to be arising from the duct of rete testis on the histological examination, and no other malignancy was found elsewhere in his body. However, he died at 10 months after the operation for lung metastasis. Adenocarcinoma of rete testis is one of the rarest malignancies. Only 25 cases have been reported since the first case was described by Feek and Hunter in 1945. This is the twenty-sixth case in the literature.
We report a case of a simple cyst in the upper pole and connected to the mediastinum testis at the rete testis. The cyst appeared to arise from a dilated rete duct, and it was spherical, smooth-walled and filled with clear fluid. The epithelium was lined with a single layer of cuboidal or flattened cells, with no evidence of squamous differentiation.
Adenocarcinoma of the rete testis is very rare. It is highly malignant with potential of early metastasis. We are reporting such a case occurring in a 34-year-old man who remains tumor-free 7 years after orchiectomy. Another 20 reported cases of such a tumor from the English literature are reviewed.
Adenocarcinoma of the rete testis is a rare testicular tumour, which often presents late, with metastatic disease present in a significant proportion of patients. We record the clinicopathological findings in a man who presented with an apparently localized testicular tumour. He however went on to develop a rapidly progressive local recurrence and metastatic disease, despite primary radiotherapy. Detailed immunohistochemical examination was performed and we record positivity of this tumour for the recently developed markers HBME1 and thrombomodulin.
A papillary adenocarcinoma of the rete testis in a 67-year-old man is presented. The tumor was localized in the rete testis, showing no involvement of the adjacent testicular parenchyma or the epididymis. The tumor cells manifested a transition to the normal epithelial cells of the rete testis. The electron microscopic features of this tumor are compared with those of the normal epithelial cells of the rete testis.
Ram testicular spermatozoa, collected continuously from the cannulated testis, were frozen in rete testis fluid in straws using the cryoprotective agents egg yolk and glycerol. The effect of cryopreservation on the viability of the spermatozoa was assessed by studying their metabolism, morphology, ultrastructure, and radioiodination patterns. Freeze-thawing significantly depressed the respiration rate and glycolytic activity of testicular spermatozoa. Morphologically, there was little evidence of cryodamage in frozen-thawed testicular spermatozoa. Except for some slightly corrugated acrosomes and a more loosely attached plasma membrane over the sperm head, frozen-thawed testicular spermatozoa were indistinguishable from nonfrozen control spermatozoa. Surface radioiodination of frozen-thawed testicular spermatozoa was highly selective and resulted in a labeling pattern similar to that of the nonfrozen controls. In contrast, the radiolabeling pattern of frozen-thawed electroejaculated spermatozoa was characterized by high background radioactivity and low selectivity. These results confirm previous suggestions that testicular spermatozoa have a greater low-temperature tolerance than do ejaculated spermatozoa and indicate that cryopreservation of immature testicular spermatozoa in rete testis fluid with added egg yolk and glycerol may be a useful approach to extend the availability of these cells.