Testicular regression syndrome — a pathological study of 77 cases

Abstract

Testicular regression syndrome is characterized by a rudimentary epididymis and spermatic cord with absence of testicular tissue. Although it has been well-described in the surgical literature, few pathological studies have been performed. We report 77 cases of the syndrome, deriving from a 26-year retrospective review. Typical gross descriptions described several cm of spermatic cord with a small mass of firm, fibrotic tissue at one end; elements of the vas deferens, spermatic artery and venous plexuses were usually present. Histologically, the distal expansion of most of the specimens was composed of dense fibrovascular tissue with no evidence of seminiferous tubules or normal testicular elements. Instead, scattered foci of calcification and brown pigment were present. The finding of dystrophic calcification and haemosiderin deposition, with no evidence of viable testicular tissue, in the presence of relatively normal spermatic cord elements, supports the concept of generally unilateral and occasionally bilateral anorchia secondary to remote infarction. The young age of the patients, coupled with the history of an absent testis from birth, is supportive of in utero damage. These histopathological findings provide support for the concept of in utero torsion of the testis as the basis for the testicular regression syndrome.

Vanishing Testis Syndrome: Report of Two Cases

“…TRS is characterized by partial or total absence of testicular tissue, unilateral or bilateral, with or without rudimentary epididymis and spermatic cord structure in 46XY Surgery Section individual with normal external genitalia [3]. Regarding the aetiology of TRS, the theory of an ischemic event in early or late foetal stage is the most accepted because finding such as dystrophic calcification, hemosiderin deposits and giant cells corroborate this hypothesis [4].…”

“…The surgical literature regarding TRS emphasizes the importance of identifying the vascular supply and drainage of the gonad. This is due to the fact that the testis cannot be present in a location absent of gonadal vein and because the vein and pampiniform plexus almost always indicate the location of the testis, regardless of the presence of vas deference and epididymis [3].…”

Intra Abdominal Testis- Role of Laproscopy in Search of Hidden Testis

“…It has an accuracy of 88-100% in determining the presence, position, size and structure of the testis in various series [4,5] Therapeutic procedures like laparoscopic orchiopexy or orchiectomy can also be performed at the same time. The European Association of Urology Guidelines on pediatric urology state that laparoscopy is the only examination that can reliably confirm or exclude non-palpable testes [6,7].…”

Compensatory function of the remaining testis is dissociated in boys and adolescents with monorchidism

“…Monorchidism can be congenital (5) or acquired as a consequence of different insults such as infection, testicular torsion and orchiectomy due to testicular tumours or testicular atrophy after orchiopexy. Its prevalence rate is 0.02% in newborn boys (6) and 1.7-4% in cryptorchid boys (6,7).…”