Testicular regression ("vanishing testis") syndrome - A pathological study of 77 cases

Abstract

Testicular regression syndrome is a condition characterised 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. To characterise the condition more clearly, a retrospective review was made, covering a 25 year period from 1965 to June 1990 at the Adelaide Children's Hospital Department of Histopathology. A total of 77 cases of testicular regression syndrome were found. Typical gross descriptions described several centimetres of spermatic cord with a small mass of firm, fibrotic tissue at one end. Elements of the spermatic cord, i.e. vas deferens, spermatic artery and venous plexi, 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. Von Kossa staining confirmed the presence of calcium while Perls' and Schmeltzer's staining demonstrated the presence of both ferric and ferrous ions. A few cases included atrophic seminiferous tubules. The finding of dystrophic calcification with evidence of remote haemorrhage with no evidence of viable testicular tissue in the presence of relatively normal spermatic cord elements supports the concept of secondary anorchia resulting from infarction. The young age of the patients, coupled with the history of an absent testis from birth, is also supportive of in ulero damage This histopathologic study provides morphological support for the concept of <i>in ulero</i> torsion of the testis as the basis for the testicular regression syndrome.