Abstract
SummaryTesticular hyperechogenic foci (THF) are associated with Klinefelter's syndrome, cryptorchidism, infertility, and testicular germ cell neoplasia. The aims of the study were to evaluate THF in relation to etiology of azoospermia and to Sertoli cell dysfunction. The structures inside the scrotum of consecutive non‐vasectomized, azoospermic were examined by ultrasonography, and hormone (FSH, LH, testosterone, and prolactin), and genetic analyses (karyotype, Y microdeletions, and CFTR mutations) were performed. At testicular ultrasonography, patients were graduated into: pronounced THF (>7 THF per transducer field), distributed universally (uTHF) or collected in plaques (pTHF), borderline THF (bTHF; 3–7 THF per transducer field), or no THF (<3 THF per transducer field). Diagnostic testicular biopsy was taken open or with TruCut needle (14G). THF status was sufficiently described in 382 of 449 potential participants, and testicular histology was available in 300 cases. Presence of ultrasonographically detectable THF was compared to presence of testicular microlithiasis (TM) detected histologically. Sertoli cell dysfunction was investigated in a subgroup using a three‐stage immunoperoxidase technique for detection of cytokeratin‐18 (CK‐18). The prevalence of THF was 13.4%. uTHF was found in 11 men (2.9%), the pattern was bilateral in four while other four had bTHF in the other testis. pTHF was detected in eight cases (2.1%), and except for one case with Klinefelter's syndrome, pTHF was in all cases occurring unilaterally. bTHF was detected in 32 cases (8.4%), bilaterally in 17 (53%). Pronounced THF was significantly associated with testicular malignancy. CK‐18 was detected in more azoospermic men with sperm production in ≤50% seminiferous tubules than in azoospermic men with spermatogenesis in ≥90% of seminiferous tubules and normal controls (p < 0.05). Unfortunately, TM detected histologically was not detected in any patient expressing THF, and neither THF nor TM was detected in any of the patients examined for CK‐18. Sertoli cell dysfunction was not associated with testicular microlithiasis or hyperechogenic foci.
Highlights
In 1987, Doherty et al (1987) described a 23-year-old man, who at age 10 had an orchiopexy for cryptorchidism
More than seven Testicular hyperechogenic foci (THF) in one transducer field is in this study considered as clearly pathological
All azoospermic men went through the full evaluation program, the presence of small testicular hyperechogenic foci was only sufficiently described in 382 patients (33 Æ 6 years of age; Table 1), and the remaining 67 were excluded for further analysis
Summary
In 1987, Doherty et al (1987) described a 23-year-old man, who at age 10 had an orchiopexy for cryptorchidism. The atrophic and previously cryptorchid testis was removed by an inguinal orchiectomy. As this report was published, several studies evaluating the prevalence of men with such white spots (testicular hyperechogenic foci = THF) in the testis tissue and its association with pathological, andrological conditions, have been performed. The evidence documenting that THF in all cases represents TM seems insufficient, and presence of such white spots in the testis in this study is termed THF, usually termed TM in the literature. >5 or ≥5 THF 1–3 mm of size in one transducer field (Backus et al, 1994 & Peterson et al, 2001) or in one testis (Goede et al, 2009, 2010) is considered pathological. The limit of five THF per transducer field has been used uncritically as the limit for abnormally high numbers
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