Normal Epididymis Research Articles

Diffusion tensor imaging and fiber tractography of the normal epididymis.

To evaluate the feasibility of diffusion tensor imaging (DTI) and fiber tractography (FT) of the normal epididymis and to determine normative apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values. Twenty-eight healthy volunteers underwent MRI of the scrotum, including DTI on a 3.0T system. For each anatomic part of the epididymis (head, body and tail) free-hand regions of interest were drawn and the mean ADC and FA were measured by two radiologists in consensus. Parametric statistical tests were used to determine intersubject differences in ADC and FA between the anatomic parts of each normal epididymis and between bilateral epididymides. Fiber tracts of the epididymis were reconstructed using the MR Diffusion tool. The mean ADC and FA of the normal epididymis was 1.31 × 10-3 mm2/s and 0.20, respectively. No differences in ADC (p = 0.736) and FA (p = 0.628) between the anatomic parts of each normal epididymis were found. Differences (p = 0.020) were observed in FA of the body between the right and the left epididymis. FT showed the fiber tracts of the normal epididymis. Main study's limitations include the following: small number of participants with narrow age range, absence of histologic confirmation and lack of quantitative assessment of the FT reconstructions. DTI and FT of the normal epididymis is feasible and allow the noninvasive assessment of the structural and geometric organization of the organ.

Epididymis cell atlas in a patient with a sex development disorder and a novel NR5A1 gene mutation.

This study aims to characterize the cell atlas of the epididymis derived from a 46,XY disorders of sex development (DSD) patient with a novel heterozygous mutation of the nuclear receptor subfamily 5 group A member 1 (NR5A1) gene. Next-generation sequencing found a heterozygous c.124C>G mutation in NR5A1 that resulted in a p.Q42E missense mutation in the conserved DNA-binding domain of NR5A1. The patient demonstrated feminization of external genitalia and Tanner stage 1 breast development. The surgical procedure revealed a morphologically normal epididymis and vas deferens but a dysplastic testis. Microfluidic-based single-cell RNA sequencing (scRNA-seq) analysis found that the fibroblast cells were significantly increased (approximately 46.5%), whereas the number of main epididymal epithelial cells (approximately 9.2%), such as principal cells and basal cells, was dramatically decreased. Bioinformatics analysis of cell-cell communications and gene regulatory networks at the single-cell level inferred that epididymal epithelial cell loss and fibroblast occupation are associated with the epithelial-to-mesenchymal transition (EMT) process. The present study provides a cell atlas of the epididymis of a patient with 46,XY DSD and serves as an important resource for understanding the pathophysiology of DSD.

Triorchidism: a rare case report

BackgroundThe presence of an extra testis is referred to as polyorchidism and is a rare congenital anomaly. There are with less than 200 cases reported, globally. It carries with it, a risk of malignancy making astute diagnosis and follow-up important. The management protocol of polyorchidism is ambiguous with factors such as age of the patient, location, size and anatomical organization of the testicular system playing an important role.Case presentationA 28-year-old male who presented with a non- tender scrotal swelling which on clinical and sonographic examination was diagnosed to be a case of triorchidism (the most common type of polyorchidism). Type 2 polyorchidism with normal epididymis and vas deference was observed. The case was conservatively managed and regular follow-up was advised.ConclusionPolyorchidism is a rare congenital anomaly. Patients with Polyorchidism can be conservatively managed. The reproductive potential and possible concomitant symptoms and complications including cryptorchidism, inguinal hernia and torsion will affect the management strategy. However, if the supernumerary testis is suspected of undergoing neoplastic transformation, it should be resected.

An atlas of human proximal epididymis reveals cell-specific functions and distinct roles for CFTR.

Spermatozoa released from the testis are unable to fertilize an egg without a coordinated process of maturation in the lumen of the epididymis. Relatively little is known about the molecular events that integrate this critical progression along the male genital ducts in man. Here, we use single cell RNA-sequencing to construct an atlas of the human proximal epididymis. We find that the CFTR, which is pivotal in normal epididymis fluid transport, is most abundant in surface epithelial cells in the efferent ducts and in rare clear cells in the caput epididymis, suggesting region-specific functional properties. We reveal transcriptional signatures for multiple cell clusters, which identify the individual roles of principal, apical, narrow, basal, clear, halo, and stromal cells in the epididymis. A marked cell type-specific distribution of function is seen along the duct with local specialization of individual cell types integrating processes of sperm maturation.

Peroxisome proliferator-activated receptor gamma expression along the male genital system and its role in male fertility.

Peroxisome proliferator-activated receptor gamma (PPARγ) acts as a ligand activated transcription factor and regulates processes, such as energy homeostasis, cell proliferation and differentiation. PPARγ binds to DNA as a heterodimer with retinoid X receptor and it is activated by polyunsaturated fatty acids and fatty acid derivatives, such as prostaglandins. In addition, the insulin-sensitizing thiazolidinediones, such as rosiglitazone, are potent and specific activators of PPARγ. PPARγ is present along the hypothalamic-pituitary-testis axis and in the testis, where low levels in Leydig cells and higher levels in Sertoli cells as well as in germ cells have been found. High amounts of PPARγ were reported in the normal epididymis and in the prostate, but the receptor was almost undetectable in the seminal vesicles. Interestingly, in the human and in pig, PPARγ protein is highly expressed in ejaculated spermatozoa, suggesting a possible role of PPARγ signaling in the regulation of sperm biology. This implies that both natural and synthetic PPARγ ligands may act directly on sperm improving its performance. Given the close link between energy balance and reproduction, activation of PPARγ may have promising metabolic implications in male reproductive functions. In this review, we first describe PPARγ expression in different compartments of the male reproductive axis. Subsequently, we discuss the role of PPARγ in both physiological and several pathological conditions related to the male fertility.

Case 267.

History A 28-year-old man presented with lifelong anejaculation, which had become an issue because of family planning. The patient had a history of normal erections and experienced the sensation of orgasm without ever ejaculating. On physical examination, both testes were present in the scrotum, with normal dimensions and a normal epididymis bilaterally. The patient had a slightly tender left testicle, and digital rectal examination findings were normal. The patient underwent further investigation for the possibility of retrograde ejaculation with urine cytology, the results of which were negative. Genetic testing was performed to exclude Y chromosome microdeletions. Serum-luteinizing and follicle-stimulating hormone levels were normal, with a borderline low level of testosterone (7.6 nmol/L; normal range, 8.0-29.0 nmol/L). All other pertinent laboratory results were noncontributory. Pelvic MRI was requested to exclude an anatomic cause of anejaculation. MRI was performed in accordance with the standard clinical prostate protocol, with a dynamic contrast material-enhanced study ( Figs 1 - 3 ). CT of the upper abdomen was also performed ( Fig 4 ). The patient subsequently underwent cystoscopy, which revealed an intravesicular fluid-filled mass near the left ureteric orifice ( Fig 5 ). Figure 1a: (a) Coronal and (b, c) axial fast spin-echo T2-weighted MR images of the pelvis, with b being superior to c. Figure 1b: (a) Coronal and (b, c) axial fast spin-echo T2-weighted MR images of the pelvis, with b being superior to c. Figure 1c: (a) Coronal and (b, c) axial fast spin-echo T2-weighted MR images of the pelvis, with b being superior to c. Figure 2a: (a) Coronal T2-weighted (repetition time msec/echo time msec, 4574/86.5) MR image of the pelvis. (b) Axial T2-weighted (3000/85.4) MR image of the pelvis. Figure 2b: (a) Coronal T2-weighted (repetition time msec/echo time msec, 4574/86.5) MR image of the pelvis. (b) Axial T2-weighted (3000/85.4) MR image of the pelvis. Figure 3: Unenhanced axial fat-saturated T1-weighted (6.2/3.1) MR images. Figure 4: Coronal CT urogram. Figure 5: Image obtained at cystoscopy.

Partial Priapisim: A rare presentation of sickle cell anemia

Introduction Partial segmental thrombosis of the corpus cavernosum (PSTCC); known as partial priapism; is an uncommon urological condition which predominantly affects young men in which the proximal part of one corpus cavernosum is thrombosed. Many risk factors are described in the literature, the exact etiology of penile thrombosis and its pathogenesis remains unclear. Several treatment options are available ranging from conservative medical treatment with NSAIDs, antibiotics, analgesics, low molecular weight heparin, acetylsalicylic acid and antibiotics, surgical or to a follow-up observation without treatment. In this study we presented a sickle cell patient who presented with pain and perineal swelling and diagnosed with PSTCC using MRI and was treated conservatively. Case description A 23-year-old male, known case of sickle cell anemia, presented to casualty with a 1-day history of perineal pain of a sudden onset, increasing in severity, no aggravating or relieving factors. It was associated with perineal swelling, decrease in urine output and vomiting, not associated with urethral discharge, erectile dysfunction, trauma, sexual contact, fever, abdominal pain, lower urinary tract symptoms, change in bowel habits, or bleeding per rectum. He had a past history of left pyeloplasty in childhood. He was a smoker, non-alcohol consumer with a family history of liver malignancy. Examination revealed a stable vitals, abdomen was soft and non-tender, genitourinary exam findings confirmed the absence of priapism. There was a normal circumcised penis, normal bilateral testis and epididymis, separated perineal mass slightly hard in consistency, fixed and tender at the proximal part of the penis. Digital rectal examination was unremarkable. The complete blood count showed mild leukocytosis, electrolytes, coagulation profile, urine analysis and urine culture were unremarkable. MRI perineal and penis showed the right intratunical corpus cavernosum with altered signal intensity involving the root, proximal and mid third sparing the distal third of corpus cavernosum, maximum width of 26mm (predominantly hyposignal intensity with few areas of hypersignal intensity). Visualized Buck’s fascia and tunica albuginea were intact. Features mostly suggestive of right corpus cavernosum hematoma. Conservative treatment was initiated with 6 hourly IV paracetamol and the response was observed with gradually disappearing pain, reduction in swelling size and leukocytic count. On follow up patient was pain free, reduction in swelling size with a recovery of painless erection. A follow up ultrasound of the scrotum and a hematologist referral were arranged. Results and conclusions PSTCC is not an urological crisis and has an excellent prognosis. Conservative treatment appears to be a reliable therapeutic option. Surgery is reserved for patients in whom conservative management fails.

Localized amyloidosis of the epididymis: a previously unreported phenomenon

BackgroundLocalized amyloidosis has not been documented in the epididymis; we report this phenomenon for the first time.Case presentationThe first aim of this work is to report three cases of localized epididymal amyloidosis. Two cases were clinically detected as epididymal nodules, and a third after reviewing 120 epididymides obtained with neighbouring pathological processes. Amyloid deposits showed Congo red positivity, with yellow-green birefringence, and immunohistochemical expression for light chains kappa and lambda, transthyretin, amyloid P and cytokeratin AE1 AE3. No immunoreactivity for amyloid A was seen. Amyloid deposit location was intraluminal, with partial or total loss of the epididymal epithelium and subsequent passage to the interstitium, forming large masses. No amyloid deposits were observed around blood vessels. A secondary objective was to explore in normal epididymis the amyloid tested in epididymal amyloidosis. In normal epididymides, expression of amyloid P and transthyretin was detected in the apical surface of epithelial cells. Amyloid P also showed strong expression in spermatozoa.ConclusionWe contribute the existence of localized epididymal amyloidosis, which presents a distinctive, initial intratubular location, where there is a unique proteome and where functional amyloids act during sperm maturation.

Urine Pain

HISTORY: 19-year-old male collegiate lacrosse player presented to the training room with abdominal pain, emesis, and gross hematuria following a cross-check to his abdomen during a game one day prior. Symptoms cleared with a negative urine dipstick 48 hours after injury and he was cleared for competition. One week later, he was cross-checked again in the abdomen, resulting in similar symptoms including hematuria, abdominal pain, anorexia, and emesis. He denied significant medical history, denied taking medications, previous trauma, surgeries or smoking. He reported a history of split urinary stream. Symptoms persisted 4 days post injury at which time he was sent to the ER for further evaluation. PHYSICAL EXAM: Gen: No acute distress, well-appearing GU: uncircumcised penis, normal descended testes bilaterally, no mass/hernias, normal phallus, normal epididymis, normal scrotum, urethral meatus normal without blood. Abdomen: no ecchymosis, normal bowel sounds, abdomen tender to palpation in the LUQ, suprapubic area, and left flank. No rigidity, guarding, or organomegaly. DIFFERENTIAL DIAGNOSIS: Bladder wall hematoma/contusion/perforation Renal contusion Splenic injury Ureteral/urethral Injury FINAL/WORKING DIAGNOSIS: Abdominal pain, hematuria, and trace intraperitoneal free fluid status post blunt abdominal trauma without evidence of bladder, ureteral, urethral, or kidney injury TESTS AND RESULTS: CBC and BMP normal Urine analysis moderate blood with >50 RBCs FAST ultrasound - normal CT abdomen/pelvis with contrast - trace intraperitoneal free fluid behind bladder, no bladder injury CT/cystogram- negative for bladder rupture or injury TREATMENT AND OUTCOMES: Urology consulted in the ED and discharged following CT cystogram failed to show organ damage. At one week, he was asymptomatic and had a negative urine dipstick. Urology suggested cystoscopy if hematuria re-occurred. He was cleared for gradual return to play and recommended to use abdominal guarding in the future. While hematuria following abdominal trauma is not rare, subsequent free fluid spurs questions of whether there were predisposing factors (i.e. stricture) or if an acute injury resulted in the clinical and diagnostic findings. This is an unusual problem following such an injury and a unique workup with questions on his safe return to play.

İnguino-Skrotal Fistül: Testis Kanserini Taklit Eden Testiküler Tüberküloz Sonrası Gelişen Nadir Bir Komplikasyon

Isolated testicular tuberculosis is a rare clinical condition. A 20 year-old man presented with the complaint of right testicular swelling without clear pain. At physical examination a painless, solid mass was palpated at the lower pole of the right testis with normal epididymis. Tumor markers were normal. Scrotal ultrasonography revealed a heterogen, hipoechogenic solid mass in 33x33x28 mm diameter in the right testis. Abdominal ultrasonography and chest X-ray was normal. Patient was considered as testicular cancer and right radical inguinal orchiectomy was performed. Final pathology report revealed tuberculous orchitis. Antituberculosis treatment was initiated after the pathology report. Inguino-scrotal fistula developed 30 days after the operation. The wound completely healed secondarily after antituberculosis treatment. Genitourinary tuberculosis must be kept in mind for the differential diagnosis of young patients presenting with testicular swelling, especially in countries where tuberculosis is endemic.

Isolated Testicular Tuberculosis Mimicking Testicular Cancer: A Case Report and Literature Review

Isolated testicular Tuberculosis (TB) is a rare clinical condition. A 36-year old male patient presented to our clinic with an 8-month history of a painless mass in the right testis. No sign of tuberculosis was present and the physical examination revealed a solid mass arising from the upper pole of the right testis. The chest radiograph, urine examination, and tumor markers were normal, and lactate dehydrogenase was elevated. Scrotal ultra sonography and magnetic resonance imaging revealed a contrast-enhancing mass, 15x10 mm in size, in the upper pole of the right testis with normal epididymis and testicular blood flow. Due to the possibility of diagnosis of right testicular cancer, right inguinal partial orchiectomy was performed. The patient presented with tuberculotic granuloma with caseous necrosis in histopathological examination. The purified protein derivative test was positive (20 mm). No Acid-Resistant Bacilli (ARB) was found in culture of sputum and no tuberculosis bacilli were found in smear and culture. To date, no clinical method has been defined for the definitive diagnosis of such cases and the definitive diagnosis is only achieved by surgical exploration and histopathological examination.

AB147. Identification of different dendritic cell subpopulations in chronic epididymitis

Chronic inflammatory conditions of the male reproductive tract are thought to be a primary etiological factor in male infertility. The epididymis is considered to be the most common site of intrascrotal inflammation and a significant cause of male fertility disorders rather than the prostate or seminal vesicles. The purpose of the present study was to identify the distribution of DCs of various phenotypes in control and chronically inflamed human epididymis. Immunohistochemistry and immunofluorescence of double staining were performed at control and inflammatory group. The results showed that (I) normal human epididymis contained only immature intraepithelial LCs, interstitial CD11c, and CD209 DCs whereas CD123pDCs and CD83 mature DCs were virtually absent; (II) the number of both CD11cIL-23 mDCs and CD123IFN-αpDCs were significantly elevated in inflamed epididymis; (III) the mDC populations of CD1a, CD209 immature DCs and CD83mature DCs also increased in inflamed group; (IV) Th17 (CD4IL-17) cells were predominantly distributed under chronic inflammation of human epididymis. Our results indicate that, under inflammatory conditions, the modified actions of different DC subpopulation induce autoimmune response and promote Th17 cells polarization.

Value of diffusion weighted magnetic resonance imaging in diagnosis and characterization of scrotal abnormalities

BackgroundMRI of scrotal lesions represents an important diagnostic tool in the evaluation of scrotal diseases. Diffusion weighted (DW) MR imaging is a promising technique which proved to improve tissue characterization. AimTo assess the diagnostic value and role of DWMR imaging in the detection and characterization of scrotal lesions. ResultsA prospective study included 50 scrotal lesions (35 intratesticular and 15 extra testicular) with 50 normal testes used as control. DW sequences were obtained using a b factor of 0, 500 and 900s/mm22. The accuracy of conventional sequences, DW images alone and DW imaging combined with conventional images in differentiating benign from malignant scrotal lesions was calculated. There was significant difference between apparent diffusion coefficient (ADC) values of testicular malignancies, normal testis and benign intratesticular lesions, and the ADC values of benign extra testicular lesions from those of normal epididymis. The overall accuracy of conventional imaging, DW imaging alone and DWMR combined with conventional sequences in the characterization of intratesticular lesions was 90%, 87% and 100%, respectively. ConclusionOur findings suggest that DWMR imaging and ADC values may provide valuable information in the diagnosis and characterization of scrotal diseases.

Bilateral Synchronous Granulomatous Orchitis in a Patient with Erectile Disfunction: Clinical and Pathologic Study of the Case

A 50-year-old male patient presented with erectile failure and loss of libido. In the physical examination, there were stone-hard indurations in his bilateral testes. The ultrasonographic study demonstrated multiple hypoechoic areas in the testes and normal epididymis. Since the lesion was presumed as malignancy, bilateral inguinal exploration was performed and intraoperative frozen biopsies were studied and diagnosed as inflammatory process. Nevertheless, we decided to perform left orchiectomy to a deeper histopathologic analysis which revealed granulomatous orchitis, mastocytosis, and severe depletion of Leydig cells at the testicular interstitium. Differential diagnosis between testicular tumor and granulomatous orchitis is very difficult in any examination except by histological findings. Bilateral cases of this pathology are relatively rare, but it is necessary to distinguish them from the testicular tumor before surgical intervention to avoid an unnecessary orchiectomy.

Oncogenic Wnt/β-catenin signalling pathways in the cancer-resistant epididymis have implications for cancer research

Aberrant activation of the Wnt/β-catenin pathway occurs in cancers. This review presents several important cancer-related aspects of Wnt/β-catenin signalling relevant to the epididymis, provides evidence of such epididymal gene expression and suggests a new direction for further research. The data presented here indicate that besides containing many Wnt/β-catenin-pathway components, the normal adult human epididymis expresses much more β-catenin than the colorectal carcinoma cell line HCT116, which possesses elevated β-catenin expression. The low cancer incidence in the epididymis may be due to factors present in the human epididymis that regulate this oncogenic Wnt/β-catenin pathway, including (i) 14 of 17 secreted pathway inhibitors, (ii) the majority of the micro-RNAs known to target this pathway, (iii) plasma membrane-associated E-cadherin and CEACAM1 that anchor β-catenin, preventing its availability for nuclear entry and oncogenic transcriptional activity, (iv) the recently identified membrane-located tumourigenesis inhibitors RNF43 and ZNRF3 that mediate the degradation of the Wnt receptor components Fzds and Lrp5/6 and (v) nuclear KLF4, which competes with TCF for β-catenin, limiting its transcriptional activity and stabilizing telomeres, thereby reducing mutation incidence. The above regulatory factors expressed by the human epididymis, and the absence of androgen receptor translocation known to promote nuclear translocation of β-catenin in tumourigenesis in an animal model, may act synergistically to provide hostility in different cell compartments towards tumour formation. The lack of evidence for β-catenin in epididymal nuclei is noteworthy. Studying this phenomenon may help reveal the mechanisms underlying oncogenic Wnt/β-catenin signalling and shed new light on cancer therapy and prevention.

Epidermal growth factor regulates connexin 43 in the human epididymis: role of gap junctions in azoospermia

Gap junctions (GJs) allow for direct communication between adjacent cells. They are composed of connexons consisting of transmembrane proteins, connexins (Cxs). The objectives of this study were to determine if GJ proteins GJA1 (Cx43), GJB1 (Cx32) and GJB2 (Cx26) are present in the epididymis of men with a normal epididymis, to assess whether or not Cx expression and localization are altered in azoospermic patients, and to determine if epidermal growth factor (EGF) regulates GJA1 expression. Epididymides were obtained from men with localized testis cancer with active spermatogenesis and histologically normal epididymal tubule (group 1), men with non-obstructive azoospermia secondary to Sertoli-cell only syndrome (group 2) and from azoospermic men with normal spermatogenesis and epididymal obstruction (group 3). Epididymides were subdivided into three segments: caput, corpus and cauda. Quantitative real-time RT-PCR was performed to assess GJA1, GJB1, GJB2 and EGF receptor (EGFR) mRNA levels in epididymides from patients from each group (all n=3, except n=1 for caput blockage). A human caput epididymal cell line was then used to determine the role of EGFR signaling on the regulation of human epididymal GJA1. Real-time RT-PCR analysis revealed that GJA1, GJB1, GJB2 and EGFR were expressed along the human epididymis. In the cauda epididymidis of group 2 and 3 men, we observed a significant decrease in GJA1 (P=0.0456 and P=0.0465, respectively) and GJB1 (P=0.0450 and P=0.0497, respectively) mRNA levels when compared with group 1 men. We also observed a decrease in EGFR mRNA levels (P=0.0358) in the cauda epididymidis of group 3 men when compared with group 1. Immunocytochemistry revealed that in the epididymis, GJA1 and EGFR were localized between basal and principal cells and between adjacent principal cells. In group 2 and 3 patients, however, we noted a dramatic increase in cytosolic immunostaining for both GJA1 and EGFR in both principal and basal cells. Using a human caput epididymal cell line derived from fertile men, we demonstrated that changes in GJA1 phosphorylation could be regulated by EGF (P=0.015) and the extracellular regulated kinase 1/2 signaling pathway (P=0.03). Furthermore, while the phosphoinositide-3-kinase (PI3K)/AKT signaling pathway did not alter GJA1 phosphorylation, treatment with PI3K/AKT inhibitor LY294002 significantly (P=0.024) inhibited the EGF-stimulated increase in GJA1 total protein levels at 24 h. Immunolocalization indicated that loss of PI3K/AKT signaling was associated with increased cytosolic localization of Cx43 in this cell line. Together, these data suggest that in azoospermic men decreased expression of EGFR may be responsible for decreasing GJA1 levels and increasing its cytosolic localization via the PI3K/AKT signaling pathway.

Diffusion-weighted MR imaging of normal and abnormal scrotum: preliminary results

Magnetic resonance (MR) imaging of the scrotum represents an important supplemental diagnostic tool in the evaluation of scrotal diseases. Diffusion-weighted (DW) MR imaging is a developing technique, proved to improve tissue characterization. We evaluated the feasibility and diagnostic performance of DW MR imaging in the detection and characterization of scrotal lesions. We retrospectively evaluated 31 scrotal lesions (23 intratesticular and 8 extratesticular) in 26 men. All MR examinations were performed on a 1.5-T unit, using a pelvic-phased array coil. DW sequences were obtained using a single shot, multislice spin echo planar diffusion pulse sequence and a b factor of 0 and 900 s mm(-2). The DW MR characteristics and the apparent diffusion coefficient (ADC) values of normal scrotal contents and scrotal diseases were evaluated. Comparison between the ADC values of normal scrotum, benign lesions and scrotal malignancies was performed. The accuracy of conventional sequences, DW images alone and DW imaging combined with conventional images in differentiating benign from malignant scrotal lesions was calculated. The ADC values of testicular malignancies were different from those of normal testis and benign intratesticular lesions, and the ADC values of benign extratesticular lesions from those of normal epididymis (P<0.05). The overall accuracy of conventional imaging, DW imaging alone and DW MR combined with conventional sequences in the characterization of intratesticular lesions was 91%, 87% and 100%, respectively. Our findings suggest that DW MR imaging and ADC values may provide valuable information in the diagnosis and characterization of scrotal diseases.

Different surgical findings in congenital and acquired undescended testes

To compare surgical findings in congenital and acquired undescended testes (UDT). A review of 139 boys with 158 congenital UDT and 69 boys with 84 acquired UDT was performed. The most caudal testicular position preoperatively, testis position at surgery, patency of the processus vaginalis and epididymal anomalies were prospectively recorded. In the congenital group, orchiopexy had been performed at median age (range) 4.9 (1.5-14.6) years, while the median age (range) in the acquired group was 11.9 (3.8-23.3) years. Preoperatively, only congenital UDT were found not palpable or emergent inguinal, while only acquired UDT could be manipulated in an unstable scrotal position. In comparison with congenital UDT, acquired UDT were significantly more often located at the scrotal entrance, 27/158 vs 32/84 respectively (P < 0.001). At surgery anorchia, vanished testis or testes lying intra-abdominally were only registered in the congenital UDT group. Also 37/158 congenital UDT were located in the superficial inguinal pouch vs 52/84 of the acquired UDT (P = 0.04). In congenital UDT the processus vaginalis was wide open in 74/158, while in acquired UDT the processus vaginalis was closed in 46/84 (P < 0.001) and small open in 26/84 (P = 0.04). Epididymal anomalies were more often seen in the congenital UDT group (37%) than in the acquired group (11%). The most caudal position of congenital UDT after manipulation before surgery was at the scrotal entrance. These testes were frequently associated with epididymal anomalies and wide open processus vaginalis. This was in contrast to acquired UDT, which can often be pushed down well below the scrotal entrance and are more likely to be situated in the superficial inguinal pouch, with a normal epididymis and closed processus vaginalis.

Small blue cells mimicking small cell carcinoma in spermatocele and hydrocele specimens: a report of 5 cases

We identified 5 cases of hydrocele and spermatocele resections containing detached small cellular "blue" clusters, raising questions of small cell carcinoma by contributors to our consult service. Patients were 37, 39, 52, 67, and 70 years old. None of the 4 patients with follow-up developed small cell carcinoma. On routine stained sections, there were multiple clusters of detached hypercellular cells with focal streaming, high nuclear-to-cytoplasmic ratios, and hyperchromatic nuclei without prominent nuclei. There were no mitotic figures, apoptotic bodies, or necrosis. In 4 of 5 cases, there was sufficient tissue to perform immunohistochemistry along with 10 cases each of normal rete testis and epididymis. CD56 was positive in 4 of 4 cases of the "blue cells" and in 9 of 10 of normal rete testis; yet, it was positive in only 2 of 10 normal epididymis. Synaptophysin and chromogranin were negative in all cases of "blue cells." PAX2 was negative in all cases of "blue cells" similar to the 1 of 9 positive staining in rete testis and in contrast to the positivity seen in 9 of 9 cases of normal epididymis. Ki-67 was negative or showed only rare positive cells in all of the cases of the "blue cells." Clusters of blue cells suggestive of sloughed rete testis cells can mimic small cell carcinoma in hydrocele and spermatocele specimens based on their low power appearance and positive CD56 staining. Closer examination of the cells' bland morphology, low expression of Ki-67, and lack of chromogranin and synaptophysin, along with recognition of this entity, can prevent a misdiagnosis of malignancy.

Effect of continuous local microdose norethisterone enanthate on the epididymis of adult rat.

Unilateral implantation of a small silastic capsule containing crystalline Norethisterone Enanthate (NE, average observed rate of release, 17-22 micrograms/24 h) into the epididymal fat-pad of adult rats induced drastic impairment of epididymal functional anatomy in the adjacent epididymis six weeks later without affecting the contralateral epididymis. Tubular elements in the ipsilateral epididymis were highly shrunken with their luminal epithelial height greatly reduced and the lumen devoid of spermatozoa as compared with the normal epididymis (full of spermatozoa) on the sham operated contralateral side.