De novo point mutations arise predominantly in the male germline and increase in frequency with age, but it has not previously been possible to locate specific, identifiable mutations directly within the seminiferous tubules of human testes. Using microdissection of tubules exhibiting altered expression of the spermatogonial markers MAGEA4, FGFR3, and phospho-AKT, whole genome amplification, and DNA sequencing, we establish an in situ strategy for discovery and analysis of pathogenic de novo mutations. In 14 testes from men aged 39-90 y, we identified 11 distinct gain-of-function mutations in five genes (fibroblast growth factor receptors FGFR2 and FGFR3, tyrosine phosphatase PTPN11, and RAS oncogene homologs HRAS and KRAS) from 16 of 22 tubules analyzed; all mutations have known associations with severe diseases, ranging from congenital or perinatal lethal disorders to somatically acquired cancers. These results support proposed selfish selection of spermatogonial mutations affecting growth factor receptor-RAS signaling, highlight its prevalence in older men, and enable direct visualization of the microscopic anatomy of elongated mutant clones.iscerning the source of spontaneous germline mutations is fundamental to understanding the causes of many diseases, including monogenic developmental disorders (1) and complex conditions such as autism (2, 3) and schizophrenia (4). Recent whole genome sequencing studies of parent-child trios show that most mutations (such as nucleotide substitutions) originate from the paternal germline and increase in frequency with the father's age (5, 6), an issue of particular significance given the demographic shift to delayed reproduction in many populations (7). The deduction that the testes of older men harbor a greater burden of mutations, compared with younger men, is consistent with indirect measures of genetic decline, ranging from high indices of arrested germ cell divisions to complete involution of the seminiferous tubules (7-9). Surprisingly, however, it has not previously been possible to trace specific mutations back to their origins within individual germ cells (spermatogonia) of human testes.One mechanism proposed to contribute to the age-related increase in male mutations is selfish spermatogonial selection, a process equivalent to neoplasia but occurring in the unique context of the germ cell (10). In this process, specific point mutations that confer gain-of-function to components of the growth factor receptor-RAS signaling pathway occur rarely in spermatogonial stem cells of the adult testis but show a steep increase in prevalence with age, attributed to clonal expansion of mutant spermatogonia over time (11)(12)(13)(14)(15)(16). Fertilization of the egg by a mutant sperm leads to serious congenital disorders in the next generation, characterized by multiple malformations and, in some cases, a predisposition to malignancy. These disorders include Apert, Crouzon, and (16, 26). Based on the unexpectedly high birth prevalence of several of the associated congenital d...