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PubMed1984

Age-related changes in the cat testis and epididymis.

Forty-two pairs of testes and epididymides were obtained from clinically healthy cats and were examined histologically for age-related changes. All of the following testicular features increased with age: thickness of the testicular tunica adventitia, the amount of lipofuscin in the interstitial cell, hyperplasia of interstitial cells, vacuolation of Sertoli cell cytoplasm, degeneration of seminiferous tubules and thickness of the seminiferous tubular basement membrane. Two spermatoceles were found in the oldest cat. Age-related changes in the cat epididymis included increased thickness of the epididymal tunica adventitia, occasional intraepithelial cysts and hyperplasia of the epithelium, and one spermatocele in the head of the epididymal duct. Lymphocytic foci were common in testicular and epididymal connective tissue of cats of all ages and were reactive in the 2 oldest cats. Several changes were most frequent in 3- to 6.9-year-old cats: eosinophilic to amphophilic round cytoplasmic bodies in interstitial cells, proteinaceous tubular luminal debris, and spermatozoa in the epididymal duct. Cats less than 1 year old had significant (P less than 0.05) amounts of seminiferous tubular degeneration and a high percentage of epididymal intraepithelial cysts and hyperplasia.

Aging↗
PubMed1994

[Microsurgical therapy of occlusive azoospermia].

From 5/88 to 8/93 148 patients were operated on for obstructive azoospermia using a microsurgical technique. In 68 patients we performed a vasectomy reversal by vasovasostomy (VT), 42 patients underwent a tubulovasostomy (TT), and 8 patients had a VT with contralateral TT. Two patients had implantation of an alloplastic spermatocele, 9 patients had microsurgical epididymal sperm aspiration (MESA), and 19 patients microsurgical exploration. Patency was achieved in 89% of patients after VT and in 32% after TT. A pregnancy occurred in 34% after VT and in 13% after TT. No pregnancy was achieved after MESA or alloplastic spermatocele. A microsurgical procedure is necessary for the treatment of congenital or acquired obstructive azoospermia.

Adult↗
PubMed1996

High levels of soluble p55-TNF receptors in seminal and prostatic fluids of normal and infertile men.

PURPOSE: To study the role of tumor necrosis factor (TNF) in the male reproductive systems by examining the occurrence, source, and possible functional significance of soluble TNF receptors in seminal fluids of normal and infertile men. MATERIALS AND METHODS: Concentrations of soluble TNF receptors (p55-sTNF-R and p75-sTNF-R) were measured by ELISA in human sera, seminal fluids, prostatic fluid and fluid obtained from an epididymal spermatocele. RESULTS: The level of p55-sTNF-R in seminal fluids of normospermic men was approximately equal to 20-fold higher than in normal serum (13.9 +/- 6.9 ng./ml. versus 0.7 +/- 0.2 ng./ml.). In contrast, p75-sTNF-R, which occurs in serum at amounts higher than p55-sTNF-R, was almost indiscernible in the seminal fluids (<0.18 +/- 0.28 ng./ml. versus 1.9 +/- 0.6 ng./ml. in sera). Concentrations of p55-sTNF-R in seminal fluids of oligoasthenospermic and azoospermic men were similar to those of normospermic men (15.6 +/- 8.5 ng./ml. and 14.9 +/- 6.5 ng./ml., respectively). Higher p55-sTNF-R concentrations were found in prostatic fluids and first split ejaculates (39.8 +/- 1.2 ng./ml. and 32 +/- 1.7 ng./ml., respectively), while second split ejaculates and the fluid from an epididymal spermatocele were found to contain p55-sTNF-R at lower levels (10.8 +/- 1 ng./ml. and 1 ng./ml., respectively). CONCLUSIONS: These findings suggest intense local biosynthesis of p55-sTNF-R in the prostate occurring independently of spermatogenesis. Possible functional implications are: 1) shielding of spermatozoa from the inhibitory effect of TNF in the female reproductive tract; 2) a role for TNF in the normal physiology of the prostate; and 3) blocking TNF-mediated immune response in the prostate, which may have bearings on the development of prostatic hypertrophy or cancer.

Antigens, CD↗
PubMed2005

Ectopic prostate tissue within the processus vaginalis: insights into prostate embryogenesis.

We report an 11-year-old boy who presented with a scrotal mass superior to the epididymis in the processus vaginalis. The mass consisted of prostate tissue, including glands and fibromuscular stroma, communicating with a spermatocele. Strong immunostaining for prostate-specific antigen was seen in the glandular epithelium. Immunostaining for peanut agglutinin highlighted the luminal plasma membrane in a subset of epithelial cells, mainly those located around the periphery of the nodule. To the best of our knowledge, this represents the first report of a pediatric patient with ectopic prostate tissue located outside the urinary tract and the first instance altogether of ectopic prostate noted at this location. The young age of the patient, the lesion's constituents, and its location suggest that the finding represents a disorder of development.

Child↗
PubMed1985

Primary intrascrotal nontesticular schwannoma.

A supratesticular intrascrotal mass clinically mimicking a spermatocele was found to be a scrotal neoplasm histologically identified as a schwannoma. We herein present the first case of intrascrotal schwannoma to our knowledge.

Diagnosis, Differential↗
PubMed1981

Current status of radionuclide scrotal imaging.

Scrotal imaging with technetium-99m sodium pertechnetate consists of a radionuclide angiogram and static scrotal scans. Utilization of this study in patients presenting with an acute scrotum can dramatically reduce the number of surgical explorations for acute epididymitis. It can also aid in other aspects of differential diagnosis in patients presenting with either an acutely enlarged and/or painful scrotum or a scrotal mass. Ambiguities in previous descriptions of perfusion through the spermatic and extraspermatic cord vessels are described and distinguished from scrotal perfusion. The clinical and scintigraphic spectrum of testicular torsion, including spontaneous detorsion, early acute testicular torsion, midphase testicular torsion, and late phase or "missed testicular torsion," is discussed and illustrated. The variety of patterns seen in acute epididymitis, including lateral and medial epididymal location, and focal epididymitis are described, as is the appearance of hydrocele as both a primary and secondary entity. The relationship of scrotal imaging to the overall clinical presentation and evaluation of these patients is emphasized in testicular torsion, torsion of the testicular appendages, epididymitis, abscess, trauma, tumor, spermatocele, and varicocele. The techniques, clinical utility, and relationship to radionuclide imaging of Doppler ultrasound and gray scale ultrasound scanning are reviewed. Doppler ultrasound results in many false negative studies in testicular torsion. Gray scale ultrasound is useful in clarifying the nature of scrotal masses.

Abscess↗
PubMed1983

[A new simple procedure for immersion sonography of the scrotal contents in real time technic. II: contribution to the differential diagnosis of diseases of the scrotal contents].

In this communication the experiences obtained in 221 patients with a newly developed immersion method for scrotal sonography are analysed. The specific criteria for testicular neoplasms are derived from 22 patients with 100% true-positive diagnosis. In this context, the diagnostic difficulties in defining and identifying the benignity of an affection are discussed. The typical sonographic alterations of scrotal structures in diseases like epididymitis, epididymo-orchitis, spermatocele, varicocele and trauma are also described. An approach to calculating the testicular volume and hydrocele volume is given. The increase in diagnostic reliability makes this method suitable for pre-invasive diagnosis. The simple and non-hazardous procedure can be recommended as a routine method.

Epididymitis↗
PubMed2006

Expression of SLC26A3, CFTR and NHE3 in the human male reproductive tract: role in male subfertility caused by congenital chloride diarrhoea.

Congenital chloride diarrhoea (CLD) is a rare inherited disease caused by mutations in the solute carrier family 26 member 3 (SLC26A3) gene. Disruption of intestinal Cl(-)/HCO(3)(-) exchange causes watery Cl(-) rich diarrhoea from birth, and recently male subfertility was observed as a novel manifestation. Expression of SLC26A3, together with interacting proteins cystic fibrosis transmembrane conductance regulator (CFTR) and Na(+)/H(+) exchanger 3 (NHE3), was studied using immunohistochemistry in the testis (n = 2) and efferent ducts (ED) (n = 1) of patients with CLD (V317del genotype) and in the testis and epididymis (n = 11), seminal vesicle (n = 9) and prostate (n = 4) of the controls. SLC26A3 was immunolocalized in the head of the elongating spermatids (stages III-VI) and CFTR in the elongating spermatids (stages III and IV) and pachytene (stages III-V) and diplotene spermatocytes. In the non-ciliated cells of the ED, apical expression of all three proteins was observed, but only SLC26A3 and CFTR were detected on the luminal border of the apical mitochondria-rich cells (AMRC) of the ductus epididymis and in the epithelium of the seminal vesicle. Only CFTR was present in the epithelium of the prostatic duct. In the patient with CLD, the expression of both SLC26A3 and CFTR was absent in the ED, but testicular expression was identical to that of the controls. These results suggest a primary role for SLC26A3 in male reproduction. Tissue-specific co-expression with CFTR and NHE3 supports diverse functions of SLC26A3 and may have an impact on pathophysiology of male subfertility both in CLD and in cystic fibrosis (CF), as well as spermatoceles.

Adult↗
PubMed2004

Benign intrascrotal lesions.

PURPOSE: We summarize important clinical, pathological and diagnostic features of benign intrascrotal lesions, including paratesticular lesions (adenomatoid tumors, fibrous pseudotumors, cystadenomas, spermatoceles, hydroceles, varicoceles and hernias) and intratesticular lesions (tunica albuginea cysts, testicular simple cysts, epidermoid cysts, cystic ectasia of the rete testis, intratesticular varicocele, adrenal rest tumors and splenogonadal fusion). This review provides the reader with a better understanding of benign lesions that occur in the scrotum. MATERIALS AND METHODS: A directed MEDLINE literature review of benign scrotal lesions and of each individual lesion was performed. This information was enhanced with relevant information from select journals and texts. Particular emphasis was placed on clinical, pathological and diagnostic features. RESULTS: Intrascrotal lesions continue to provide a diagnostic challenge for physicians. A diagnosis can be made with a thorough history, physical examination and understanding of the pathophysiological processes of the structures contained within the scrotum. Lesions that are suspicious for malignancy should prompt urological consultation and radiological imaging. Ultrasound aids in the diagnosis in instances of uncertainty. Ultimately surgery may be necessary to make a histological diagnosis. CONCLUSIONS: Clinical assessment, physical examination and an understanding of benign intrascrotal processes are key to making a diagnosis. Ultrasound has an important role and adds essential information. If surgery is necessary and a benign process is recognized, a testis sparing procedure should be performed.

Adenomatoid Tumor↗
PubMed1983

Vas deferens aplasia: clinical and anatomical features of 90 cases.

Out of 531 patients with excretory azoospermia, scrotal exploration for attempted epididymo-vasostomy showed vas aplasia in 90 of them (= 17%). In the latter group complete bilateral agenesis of the vas was seen in 64 cases while the remaining showed partial vas aplasia or different findings on both sides. The anatomical findings were classified into various groups of frequency. The typical peroperative picture included extensive paraepididymal bodies of fat, venous conglomerations at the place of missing epididymal structures and frequent Morgagni's hydatides and spermatoceles. Preoperative palpation and surgical findings did not correlate. Laboratory examination of the ejaculate showed volume and fructose values below the norm in the majority of cases. Electron- and light-microscopy showed dissolution of spermatozoa and sperm-phagocytosis within the dilated epididymal canal as well as within the bordering tissue. Since laboratory- and physical examinations are misleading in some cases with vas aplasia surgical exploration is necessary. A cup-shaped Silicone-Dacron reservoir was implanted upon the remaining epididymal structures in 16 men with vas aplasia, but insemination of the aspirated material in their wives did not lead to any lasting pregnancy. In other centers 3 conceptions and normal births were obtained by this method.

Abnormalities, Multiple↗
PubMed2001

Benign intratesticular cystic lesions: US features.

Benign intratesticular lesions are rare, but recognition is important to avoid unnecessary surgical intervention. The ultrasonographic (US) features that help differentiate benign from malignant intratesticular lesions are emphasized by the authors. Benign lesions include intratesticular simple cysts, tubular ectasia, epidermoid cyst, tunica albuginea cyst, intratesticular varicocele, abscess, and hemorrhage (infarction). US features of cystic malignant neoplasms that help in differentiation of them from benign cystic lesions are also presented. The US appearance of epidermoid cysts varies with the maturation, compactness, and quantity of keratin present. Of the cystic malignant testicular tumors, which can occur anywhere in testicular parenchyma, teratomas are the most frequent to manifest as cystic masses. An abnormal rind of parenchyma with increased echogenicity usually surrounds these lesions. An intratesticular spermatocele communicates with the seminiferous tubules, whereas simple ectasia of the rete testis does not do so directly. These cysts contain spermatozoa and can be septate. The US findings of intratesticular varicocele are similar to those of extratesticular varicocele and include multiple anechoic, serpiginous, tubular structures of varying sizes. Improvements in gray-scale and Doppler US technology allow subtle distinctions between benign and malignant testicular lesions that were not possible a decade earlier.

Abscess↗
PubMedDate not supplied

Role of fine needle aspiration cytology in nonneoplastic testicular and scrotal lesions and male infertility.

OBJECTIVE: To study the role of fine needle aspiration (FNA) in male infertility and in nonneoplastic lesions of the testis and scrotum. STUDY DESIGN: In a retrospective study over a 5-year period, 164 cases of FNA of testicular and scrotal nonneoplastic lesions were retrieved. Aspiration was performed with a 23-gauge needle on a 20-mL syringe. RESULTS: Of 164 cases, 27 (16%) remained inconclusive; they were mainly from epididymal lesions. The remaining 137 cases were categorized as inflammatory lesions, 52 (31.7%); noninflammatory lesions, 42 (25.6%); and infertility cases, 43 (26.2%). Among the inflammatory lesions, 33 cases had nonspecific inflammation, 13 had granulomatous epididymoorchitis, 3 cases were of spermatic granuloma, and 3 cases revealed microfilariae. Noninflammatory lesions included 25 cases of spermatocele, 8 of hematoma/torsion, 5 of hydrocele, 3 of benign epididymal cyst and 1 of calcinosis cutis. Among the patients investigated for infertility, 23 (53%) had normal spermatogenesis, 6 (14%) had Sertoli cells only, 5 (119%) had maturation arrest, 6 (14%) showed hypospermatogenesis, and 3 (7%) showed an atrophic pattern. CONCLUSION: FNA of the testis and scrotum is a simple, quick, minimally invasive and painless outpatient procedure. The sample obtained is more representative than biopsy as several separate punctures can be made, and there is no local scarring.

Biopsy, Fine-Needle↗
PubMed1989

Scrotal ultrasound in male infertility.

During an 18-month period, 200 male infertility patients had scrotal sonography examination. Fifty-seven percent showed abnormal sonogram; such as epididymitis, epididymo-orchitis, orchitis, varicocele, spermatocele, epididymal cyst and undescended testis. Among all lesions, infection was the commonest finding. There was no obvious relation between oligospermic and azospermic patients with scrotal sonographic findings except for testicular atrophy, which was very common among azospermic patients. This study indicates the role of scrotal sonography in male infertility patients.

Epididymis↗
PubMed1992

Tubular ectasia within the mediastinum testis.

Eleven scrotal sonographic examinations showing a spectrum of findings within the mediastinum testis were collected over a 2 year period. Each case showed numerous small tubular or rounded anechoic structures within the mediastinum testis; often, the findings mimicked a hypoechoic mass. Findings were bilateral in eight of ten patients; one additional patient had only one testis because of orchiectomy. All patients had an associated extratesticular finding, in most cases a spermatocele. Tubular ectasia shares several features with testicular cysts and mechanisms of formation are postulated to be similar to those previously proposed for testicular cysts. Recognizing tubular ectasia is important to avoid unnecessary concern and potential surgery.

Aged↗
PubMed1983

[Immersion testicular sonography with the automated multi-sector scanner (Octoson)].

Diagnostic ultrasound provides a high degree of accuracy in differentiation of cystic structures such as hydrocele and spermatocele and solid lesions in cases of testicular masses. Extratesticular lesions can be distinguished from testicular processes. Differentiation between tumors and inflammatory lesions is not possible in all cases. Immersion ultrasound produces a clear overview with good demonstration of anatomic relations and reveals excellently the echotexture by means of the compound effect.

Dysgerminoma↗
PubMed1993

Episodic scrotal mutilation with concurrent bilateral sperm granuloma in a dog.

Bilateral sperm granuloma with diffuse spermatocele was found to be the cause of infertility in a young Golden Retriever. Anamnesis indicated that the dog had intermittent episodes of self-inflicted ulcerative scrotal dermatitis, beginning when it was 4 to 5 months old and regardless of season or environment. A complete breeding soundness examination produced consistently azoospermic ejaculates in the presence of bilaterally firm, distinct swellings of the epididymides. Because of the poor reproductive prognosis, the owner requested castration and scrotal ablation. Although scrotal trauma was initially thought to be associated with the onset of sperm granuloma formation, evaluation of the history and physical examination and laboratory findings indicated that a bilateral congenital anomaly was the most likely cause of infertility.

Animals↗
PubMed1998

Testicular masses.

Family physicians often must evaluate patients with testicular pain or masses. The incidental finding of a scrotal mass may also require evaluation. Patients may seek evaluation of a scrotal mass as an incidental finding. An accurate history combined with a complete examination of the male external genitalia will help indicate a preliminary diagnosis and proper treatment. Family physicians must keep in mind the emergency or "must not miss" diagnoses associated with testicular masses, including testicular torsion, epididymitis, acute orchitis, strangulated hernia and testicular cancer. Referral to a urologist should be made immediately if one of these diagnoses is suspected. Benign causes of scrotal masses, including hydrocele, varicocele and spermatocele, may be diagnosed and managed easily in the primary care office.

Diagnosis, Differential↗
PubMed1998

Tumours and tumour-like conditions of the para-testicular region--a study of morphological features.

Twenty two patients with tumours or tumour-like conditions of the para-testicular region (PTR) were diagnosed over a 5 year period. Of these, 16 (73%) were benign with only one true neoplasm (papillary cystadenoma). The tumour-like conditions were comprised of 6 cases of adenomatous hyperplasia of epididymis, 4 cases of spermatic granuloma, 2 cases each of spermatocele and nodular-fibrous proliferation and one mesothelial cyst. Three patients with spermatic granuloma gave a history of trauma. No case of adenomatoid tumour was encountered. Six malignant neoplasms were diagnosed (27%) all of which were sarcomas. Five were primary to the PTR and one was a metastatic deposit from a primary leiomyoblastoma of the mesentery. Among the 5 primary sarcomas were 2 cases each of rhabdomyosarcoma and leiomyosarcoma, and 1 case of liposarcoma. The patient with leiomyoblastoma presented first with a measenteric mass which was followed a month later by a rapidly growing mass in the scrotum. Immunohistochemical staining (IHC) and Electron microscopy (EM) were done in this case. Intra-cytoplasmic myofilaments as well as desmosomes were observed. The patients ranged from 14 to 65 years of age and most presented with painless mass in the scrotum. Follow-up was not possible due to practical difficulties.

Adenoma↗