BackgroundThe brachial artery (BR) is the continuation of the axillary artery, beginning at the lower border of the teres major muscle. It terminates distal to elbow and divides into the ulnar and radial arteries and supplies the forearm and hand.During routine dissection, anomalies of the BR were found bilaterally in an 81‐year old male and unilaterally in an 89‐year old female. The bilateral variations were not identical. In the left arm, the BR divided into the ulnar and radial arteries 3.32 cm after the inferior border of the teres major muscle. High bifurcation of the BR has an incidence rate of 8%1. The radial artery branched medially from the BR following a course deep and medial to the median nerve, following a unique path as it descended to the forearm. The ulnar artery originated laterally from the BR, coursing deep to the median nerve and medial to the musculocutaneous nerve to descend to the forearm, giving off the common interosseous artery and anterior and posterior ulnar recurrent arteries below the elbow. In the right arm, the radial artery was observed originating from the axillary artery before the subscapular artery, a branch of the axillary artery. A high origin of the radial artery has an incidence rate of 15%1. The radial artery traveled through the two heads of the median nerve and traveled with it to cross the elbow into the forearm. The BR continued down the arm and became the ulnar artery below the elbow. The 89‐year old female showed a unilateral variation called a superficial ulnar artery (SUA). The BR gave rise to a SUA at the level of the inferior border of the teres major. The SUA passed between the two heads of the median nerve and traveled anteriolaterally to the medial epicondyle of the humerus. At the level of the neck of the radius, the BR divided into a deep ulnar artery and a radial artery. Once the SUA entered the medial aspect of the forearm, it ran laterally to the flexor carpi ulnaris muscle and travelled with the ulnar nerve. The SUA and ulnar nerve pass through Guyon's canal together to enter the hand. SUA are quite rare, with an incidence rate of 0.7% to 9.4%2,3. Surgeons must be aware of these variations of the BR as they may complicate procedures.Support or Funding InformationCenter for Anatomical Science and Education, Department of Surgery, Saint Louis University School of MedicineThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

In the current report, we describe an 83-year-old biological male who selfidentified as a female by legally changing his first and middle names to female ones and whose death certificate states his sex as a female. The medical history of this individual indicated complete penectomy without further specification. Postmortem physical examination revealed an absence of penis with a large scrotum, transposed urethral orifice, and small testes. The histological analysis of the testes identified abnormal epithelium in the seminiferous tubules that lacked germ and Sertoli cells as well as the interstitium without Leydig cells present. The exome sequencing of the individual's DNA using the Next Generation Sequencing (NGS) Illumina platform revealed no genetic variants associated with either penile or urethral cancer that could have explained the complete penectomy, but pointed toward a potentially impaired production of T3 and T4 thyroid hormones which could account for the observed testicular malformation. Overall, the data obtained raise an important question as to whether the thyroid hormone axis could be an important part of the hormonal architecture supporting male sexual behavior.An 83-year-old TF cadaver was received through Saint Louis University (SLU) School of Medicine Gift of Body Program from an individual who had given his written informed consent. The body was embalmed through the right femoral artery with a mixture of water and a solution (2:1) containing 33.3% glycerin, 28.8% phenol, 4.6% formaldehyde, and 33.3% methanol. Anatomical DissectionThe cadaveric body was dissected according to [11].A. Frolov et al. Histological AnalysisTesticular tissue was procured from the embalmed body. Tissue fixation, paraffin embedding, sectioning, and staining with hematoxylin & eosin were performed by Research Microscopy and Histology Core, Department of Pathology, Saint Louis University (SLU) School of Medicine according to the standardized procedures. Images were captured on Olympus 41BX-EPI microscope equipped with the 10× UPlan FL N, 20× LUCPlan FL, and 40× UPlan FL N objectives. The data acquisition and image analysis were performed by using CellSens Standard software. Bone DensitometryBone density of the lumbar spine and left femoral neck of the embalmed body was measured in triplicates using certified Hologic QDR-4500 X-ray Bone Densitometer in the dual energy X-ray absorptiometry (DEXA) mode following the manufacturer's protocol. The respective average T-score values were used throughout the text. LimitationsThe deleterious (pathologic) genetic variants were identified by the exome sequencing of a single proband. The high scientific value of a single proband approach to unique human cases has been recently demonstrated [27].

BackgroundTransgender is a broad term which describes an individual whose gender self‐identification is different from the assigned sex at birth. When the latter becomes overwhelming and causes a significant psychological impact, the term gender dysphoria is used thereby presenting itself as an extreme case of transgenderism. The individuals with gender dysphoria often seek a medical intervention, surgical or therapeutic, to correct the existing discordance between their gender self‐identification and physical appearance.ResultsIn the current report, we describe a rare case of an 83‐year‐old male who self‐identified as a female by legally changing his first and middle names to female ones and whose death certificate states his sex as a female. Yet, an initial visual examination of the body revealed an absence of penis with a large scrotum and atrophied testes. It was an opinion of an experienced urologic surgeon that this individual most likely underwent a penectomy with perineal urethrostomy. Dissection of the pelvic cavity and perineum revealed normal male anatomy with testes, spermatic cords, ductus deferens, seminal vesicles, and prostate intact. Histological analysis of the testes and prostate revealed striking anomalies within the tissues. The seminiferous tubules had an abnormal epithelium with no germ, Sertoli, or Leydig cells present. Histological analysis of the prostate pointed to its non‐functional state whereas the gross tissue structure was more consistent with a prostate of a young adult. Yet amyloid deposits were found in the vasculature in the testes and prostate, which would support sepsis being the official cause of death. In order to gain additional insights into the current case, a genetic screen was performed by exome sequencing of DNA extracted from the embalmed cadaveric tissue using the Next Generation Sequencing (NGS) Illumina platformConclusionThe available personal information pertinent to the examined body identifies this individual as a transgender. The results of the genetic screen will help to define this case further by establishing a probable cause for penectomy and choosing between two most obvious alternatives; an elective surgery for the correction of gender discordance or a surgery associated with penile or urethral cancer. Yet, the genetic screen could also indicate an impaired hormonal production and/or signaling that would explain the observed testicular and prostatic atrophies. If not, the latter could be caused by a chemical castration. Overall, all those data will help to assess the severity of the current case of transgenderism and its possible progression to gender dysphoria.Support or Funding InformationCenter for Anatomical Science and Education, Department of Surgery, Saint Louis University School of MedicineThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.