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Helpful Data for Evaluating an Undescended Testis in Childhood

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Clues in the Diagnosis of Non-tumoral Testicular Pathology

Abstract

Contrary to what it might seem macroscopically, throughout childhood the testicle undergoes profound changes. From birth to puberty, two waves of proliferation and differentiation of germ cells are produced. One of them takes place between 3 and 6 months of life and is known as mini-puberty. Under the action of FSH, LH, and the testosterone, gonocytes that still persist differentiate into Ad spermatogonia, and the Sertoli cells proliferate. The other wave takes place at 4 years of age, when first-order spermatocytes, coinciding with the appearance of androgen receptors in the Sertoli cells, appear transiently. In about half of the congenitally undescended testes, in the contralateral scrotal testis, in acquired undescended testes, and in retractile testicles, the diameter of the seminiferous tubules and the number of germ cells are not only too low but do not undergo the two waves of proliferation and differentiation of germ cells. Testicular biopsy performed at the time of early orchiopexy (6–12 months old) has been the evidence that provided more data to the knowledge of the pathogenesis of lesions in cryptorchidism. It is also considered the basis for selecting the group of patients who may benefit from hormonal treatment in addition to orchiopexy. In this chapter the most important data on the structure and function of the testis in fetal and childhood life, and both clinical and basic histological data to assess the reproductive capacity of an undescended testicle, are collected to finally provide a histological classification that facilitates the interpretation of the lesions.

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References

  1. Scott HM, Mason JI, Sharpe RM. Steroidogenesis in the fetal testis and its susceptibility to disruption by exogenous compounds. Endocr Rev. 2009;30:883–925.

    Article  CAS  PubMed  Google Scholar 

  2. Shima Y, Miyabayashi K, Haraguchi S, Arakawa T, Otake H, Baba T, Matsuzaki S, Shishido Y, Akiyama H, Tachibana T, Tsutsui K, Morohashi K. Contribution of Leydig and Sertoli cells to testosterone production in mouse fetal testes. Mol Endocrinol. 2013;27:63–73.

    Article  CAS  PubMed  Google Scholar 

  3. Anand-Ivell R, Ivell R, Driscoll D, Manson J. Insulin-like factor 3 levels in amniotic fluid of human male fetuses. Hum Reprod. 2008;23:1180–6.

    Article  CAS  PubMed  Google Scholar 

  4. Hutson JM, Li R, Southwell BR, Newgreen D, Cousinery M. Regulation of testicular descent. Pediatr Surg Int. 2015;31:317–25.

    Article  PubMed  Google Scholar 

  5. Kuiri-Hänninen T, Sankilampi U, Dunkel L. Activation of the hypothalamic-pituitary-gonadal axis in infancy: minipuberty. Horm Res Paediatr. 2014;82:73–80.

    Article  PubMed  Google Scholar 

  6. Hadziselimovic F. Cryptorchidism, its impact on male fertility. Eur Urol. 2002;41:121–3.

    Article  CAS  PubMed  Google Scholar 

  7. Wilkerson ML, Bartone FF, Fox L, Hadziselimovic F. Fertility potential: a comparison of intra-abdominal and intracanalicular testes by age groups in children. Horm Res. 2001;55:18–20.

    CAS  PubMed  Google Scholar 

  8. Prader A. Testicular size: assessment and clinical importance. Triangle. 1966;7:240–3.

    CAS  PubMed  Google Scholar 

  9. Takihara H, Sakatoku J, Fujii M, Nasu T, Cosentino MJ, Cockett AT. Significance of testicular size measurement in andrology. I. A new orchiometer and its clinical application. Fertil Steril. 1983;39:836–40.

    Article  CAS  PubMed  Google Scholar 

  10. Taskinen S, Taavitsainen M, Wikström S. Measurement of testicular volume: comparison of 3 different methods. J Urol. 1996;155:930–3.

    Article  CAS  PubMed  Google Scholar 

  11. Lambert B. The frequency of mumps and of mumps orchitis and the consequences for sexuality and fertility. Acta Genet Stat Med. 1951;2:1–166.

    CAS  PubMed  Google Scholar 

  12. Kuijper EA, van Kooten J, Verbeke JI, van Rooijen M, Lambalk CB. Ultrasonographically measured testicular volumes in 0- to 6-year-old boys. Hum Reprod. 2008;3:792–6.

    Article  Google Scholar 

  13. Niedzielski J, Pisarska K, Przewratil P. The usefulness of testicular atrophy index in the assessment of undescended testicle–preliminary report. Rocz Akad Med Bialymst. 2003;48:112–4.

    CAS  PubMed  Google Scholar 

  14. Spinelli C, Strambi S, Busetto M, Pucci V, Bianco F. Effects on normalized testicular atrophy index (TAIn) in cryptorchid infants treated with GnRHa pre and post-operative vs surgery alone: a prospective randomized trial and long-term follow-up on 62 cases. Pediatr Surg Int. 2014;30:1061–7.

    Article  PubMed  Google Scholar 

  15. Jallouli M, Rebai T, Abid N, Bendhaou M, Kassis M, Mhiri R. Neoadjuvant gonadotropin-releasing hormone therapy before surgery and effect on fertility index in unilateral undescended testes: a prospective randomized trial. Urology. 2009;73:1251–4.

    Article  PubMed  Google Scholar 

  16. Schwentner C, Oswald J, Kreczy A, Lunacek A, Bartsch G, Deibl M, Radmayr C. Neoadjuvant gonadotropin-releasing hormone therapy before surgery may improve the fertility index in undescended testes: a prospective randomized trial. J Urol. 2005;173:974–7.

    Article  CAS  PubMed  Google Scholar 

  17. Caterino S, Lorenzon L, Cavallini M, Cavaniglia D, Ferro F. Epididymal-testicular fusion anomalies in cryptorchidism are associated with proximal location of the undescended testis and with a widely patent processus vaginalis. J Anat. 2014;225:473–8.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Mack WS, Scott LS, Ferguson-Smith MA, Lennox B. Ectopic testis and true undescended testis: a histological comparison. J Pathol Bacteriol. 1961;82:439–43.

    Article  CAS  PubMed  Google Scholar 

  19. Müller J, Skakkebaek NE. Quantification of germ cells and seminiferous tubules by stereological examination of testicles from 50 boys who suffered from sudden death. Int J Androl. 1983;6:143–56.

    Article  PubMed  Google Scholar 

  20. Queizán de la Fuente A, Nistal M. Contribution to the study and treatment of cryptorchism. Cir Pediatr. 1989;2:157–67.

    PubMed  Google Scholar 

  21. Paniagua R, Nistal M. Morphological and histometric study of human spermatogonia from birth to the onset of puberty. J Anat. 1984;139:535–52.

    PubMed  PubMed Central  Google Scholar 

  22. Cortes D, Thorup JM, Beck BL. Quantitative histology of germ cells in the undescended testes of human fetuses, neonates and infants. J Urol. 1995;154:1188–92.

    Article  CAS  PubMed  Google Scholar 

  23. Zivkovic D, Bica DT, Hadziselimovic F. Relationship between adult dark spermatogonia and secretory capacity of Leydig cells in cryptorchidism. BJU Int. 2007;100:1147–9.

    PubMed  Google Scholar 

  24. Hadziselimovic F, Zivkovic D. Is the prohibition of hormonal treatment for cryptorchidism, as suggested by the Nordic consensus group, justifiable? Acta Paediatr. 2007;96:1368–9.

    Article  PubMed  Google Scholar 

  25. Docampo MJ, Hadziselimovic F. Molecular pathology of cryptorchidism-induced infertility. Sex Dev. 2015;9:269–78.

    Article  CAS  PubMed  Google Scholar 

  26. Bilius V, Verkauskas G, Dasevicius D, Kazlauskas V, Malcius D, Hadziselimovic F. Incidence of high infertility risk among unilateral cryptorchid boys. Urol Int. 2015;95:142–5.

    Article  PubMed  Google Scholar 

  27. Hadziselimovic F, Hoecht B. Testicular histology related to fertility outcome and postpubertal hormone status in cryptorchidism. Klin Padiatr. 2008;220:302–7.

    Article  CAS  PubMed  Google Scholar 

  28. Nistal M, Paniagua R. Occurrence of primary spermatocytes in the infant and child testis. Andrologia. 1984;16:532–6.

    Article  CAS  PubMed  Google Scholar 

  29. Huff DS, Hadziselimovic F, Snyder 3rd HM, Duckett JW, Keating MA. Postnatal testicular maldevelopment in unilateral cryptorchidism. J Urol. 1989;142:546–8.

    CAS  PubMed  Google Scholar 

  30. Codesal J, Nistal M, Queizan A, Carretero JL, de Vega RM, Perez A, Paniagua R. Number and DNA content of hypertrophic spermatogonia in normal and cryptorchid human testes. Arch Androl. 1992;29:157–62.

    Article  CAS  PubMed  Google Scholar 

  31. Cortes D, Thorup J, Visfeldt J. Multinucleated spermatogonia in cryptorchid boys: a possible association with an increased risk of testicular malignancy later in life? APMIS. 2003;111:25–30.

    Article  PubMed  Google Scholar 

  32. Chemes HE. Infancy is not a quiescent period of testicular development. Int J Androl. 2001;24:2–7.

    Article  CAS  PubMed  Google Scholar 

  33. Nistal M, Abaurrea MA, Paniagua R. Morphological and histometric study on the human Sertoli cell from birth to the onset of puberty. J Anat. 1982;134:351–63.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Nistal M, Regadera J, Winitzky P, Tejerina E, Chemes H. Granular changes in Sertoli cells in children and pubertal patients. Fertil Steril. 2005;83:1489–99.

    Article  PubMed  Google Scholar 

  35. Hadziselimovic F, Herzog B, Seguchi H. Surgical correction of cryptorchism at 2 years: electron microscopic and morphometric investigations. J Pediatr Surg. 1975;10:19–26.

    Article  CAS  PubMed  Google Scholar 

  36. Nistal M, Paniagua R, Regadera J, Santamarìa L, Amat P. A quantitative morphological study of human Leydig cells from birth to adulthood. Cell Tissue Res. 1986;246:229–36.

    Article  CAS  PubMed  Google Scholar 

  37. Salle B, Hedinger C, Nicole R. Significance of testicular biopsies in cryptorchidism in children. Acta Endocrinol. 1968;58:67–76.

    CAS  PubMed  Google Scholar 

  38. Huff DS, Fenig DM, Canning DA, Carr MG, Zderic SA, Snyder 3rd HM. Abnormal germ cell development in cryptorchidism. Horm Res. 2001;55:11–7.

    CAS  PubMed  Google Scholar 

  39. De Miguel MP, Mariño JM, Gonzalez-Peramato P, Nistal M, Regadera J. Epididymal growth and differentiation are altered in human cryptorchidism. J Androl. 2001;22:212–25.

    CAS  PubMed  Google Scholar 

  40. Nistal M, Paniagua R, Díez-Pardo JA. Histologic classification of undescended testes. Hum Pathol. 1980;11:666–74.

    Article  CAS  PubMed  Google Scholar 

  41. Herruzo A, Sánchez Corral F, Nistal M, Ruíz Balda JA, Cuadrado C. Seminal pathology in patients with retractile testes. Acta Obstet Ginecol Hisp Lusit. 1979;27:181–93.

    CAS  PubMed  Google Scholar 

  42. Nistal M, Paniagua R. Infertility in adult males with retractile testes. Fertil Steril. 1984;41:395–403.

    Article  CAS  PubMed  Google Scholar 

  43. Tanyel FC. The descent of testis and reason for failed descent. Turk J Pediatr. 2004;46(Suppl):7–17.

    PubMed  Google Scholar 

  44. van Brakel J, Kranse R, de Muinck Keizer-Schrama SM, Hendriks AE, de Jong FH, Hack WW, van der Voort-Doedens LM, Bangma CH, Hazebroek FW, Dohle GR. Fertility potential in a cohort of 65 men with previously acquired undescended testes. J Pediatr Surg. 2014;49:599–605.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Universidad Autónoma de Madrid (UAM), Department of Anatomy, Histology and Neuroscience, School of Medicine, Madrid, Spain

    Manuel Nistal

  2. School of Medicine, Universidad Autónoma de Madrid (UAM), University Hospital La Paz, Department of Pathology, Madrid, Spain

    Pilar González-Peramato

  3. University Hospital Clinico San Carlos, Department of Urology, Madrid, Spain

    Álvaro Serrano

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  1. Manuel Nistal
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  2. Pilar González-Peramato
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  3. Álvaro Serrano
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Correspondence to Manuel Nistal .

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Nistal, M., González-Peramato, P., Serrano, Á. (2017). Helpful Data for Evaluating an Undescended Testis in Childhood. In: Clues in the Diagnosis of Non-tumoral Testicular Pathology. Springer, Cham. https://doi.org/10.1007/978-3-319-49364-0_11

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  • DOI: https://doi.org/10.1007/978-3-319-49364-0_11

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  • Print ISBN: 978-3-319-49363-3

  • Online ISBN: 978-3-319-49364-0

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