HISTOPATHOLOGICAL CHANGES AND IMMUNOHISTOCHEMICAL CHARACTERISTICS OF THE TESTICLE IN CHILDREN WITH SUBCOMPENSATED ISCHEMIA DURING ACUTE TORSION

Abstract

Background. Acute testicular torsion is a urological emergency in adolescent boys and young men characterized by twisting of the spermatic cord, along with its vessels, around a vertical or horizontal axis. The occurrence of this condition leads to testicular ischemia, and timely diagnosis and appropriate treatment are critical to prevent loss of the organ.
 Aim: to investigate the histopathological changes and immunohistochemical characteristics of testicles in children with acute torsion within 6.1 to 12 hours from the onset of clinical symptoms.
 Materials and methods. A histological, histochemical, and immunohistochemical study of testicular tissue biopsies taken during detorsion and orchiopexy surgery within 6.1 to 12 hours from the onset of clinical symptoms of acute unilateral torsion in 7 patients was conducted.
 Results. According to our data, with each hour of the disease in the period from 6.1 to 12 hours after acute torsion of the testicle, negative dynamics of changes in the morphological structures of the affected genital gonad were observed. If at the limit of 6-7 hours from the onset of the disease, we observed reversible damage to testicular tissues in almost 100% of cases, then in patients with 12-hour torsion, irreversible focal changes in the testicle were diagnosed in almost 28,6% of cases. Morphological signs of loss of viability were focal death of incretory (steroidogenesis) and excretory (spermatogenesis) cells of the testis, severe damage to the spermatogenic epithelium of the seminiferous tubules. Morphologically, large hemorrhages and diffuse blood penetration of the interstitium, thrombi, single leukocytes were observed, pyknosis of the nuclei of the spermatogenic epithelium and desquamation of cells were determined, and deformed seminiferous tubules with their partial or complete devastation were diagnosed. In some histological slides, Leydig cells were absent or shadow cells were diagnosed, especially around devastated and necrotic tubules. However, a small number of cells of the spermatogenic epithelium in the seminiferous tubules were characterized by a PAS-positive reaction to glycogen and glycoproteins, which meant their functional preservation.
 Conclusion. It was established that progressive morphological changes in the gonad develop with increasing time of acute complete testicular torsion. In patients with 12-hour torsion, irreversible focal changes in the testicle were diagnosed in almost 28,6% of cases, characterized by focal death of incretory (steroidogenesis) and excretory (spermatogenesis) cells of the testicle, damage to cells of the spermatogenic epithelium.
 With the aim of unifying and systematizing pathological changes in the testicle by its torsion depending on the time since the onset of the disease, we propose to disintegrate testicular ischemia as compensated (the first 6 hours from the onset of the disease), subcompensated ischemia (6.1-12 hours from the onset of the disease) and critical ischemia (12.1-24 hours or more from the onset of the disease).