Histopathological and immunohistochemical study of the wall of spermatic veins and its potential role in the development of varicocele testis

Abstract

IntroductionVaricocele is defined as a pathological alteration in the venous circulation of the testis which appears almost exclusively on the left side.The aim of current work was to compare the normal structure of the wall of the veins of the pampiniform plexus and also to highlight the occurrence of any structural alterations in these veins in cases of primary varicocele through a combined histopathologic and immunohistochemical study. MethodsHistopathological examination and immunohistochemical studies using monoclonal antibodies against CD31 (a marker for endothelial cells) and neurofilament-200 (NF-200) (nerve fiber marker) were performed on spermatic vein fragments of 30 varicocele patients and 30 normal spermatic veins obtained from patients undergoing inguinal herniectomy. ResultsNormal spermatic veins showed an inner circular smooth muscle (SM) layer in the tunica media, and an outer longitudinal SM layer in the tunica adventitia. Grade I varicocele cases, showed an increase in the connective tissue of the adventitia and of the tunica media, which increased proportional to the degree of varicocele. The outer longitudinal smooth muscle layer of the large spermatic veins was significantly degraded in the presence of varicocele grades I and II, and did not even exist in varicocele grade III. Immunostaining for CD31 and NF-200 revealed that vasa vasorum and nerve fibers were decreased in the wall of large spermatic veins in patients with grades I and II varicocele, and were minimal to absent in patients with grade III varicocele. ConclusionThe wall of pampiniform plexus veins is a complex structure of smooth muscle organization, inner circular and outer longitudinal fibers which is important for providing an effective blood transport through the pampiniform plexus. This mechanism is obviously damaged in varicocele patients.