Diagnosing testicular biopsies involves a careful examination of tissue samples to identify and characterized any abnormalities. Here’s a basic approach to the diagnosis of testicular biopsies:
- Clinical History:
- Begin by reviewing the patient’s clinical history, including any symptoms, medical conditions, or previous treatments.
- Note relevant information such as age, duration of symptoms, and any history of trauma or surgery.
- Gross Examination:
- Examine the biopsy specimen grossly to assess its size, color, and consistency.
- Note any focal lesions, cysts, or areas of hemorrhage.
- Fixation:
- Properly fix the biopsy specimen in formalin to preserve tissue architecture and cellular details.
- Microscopic Examination:
- Prepare thin sections of the tissue and stain with hematoxylin and eosin (H&E) for basic cellular visualization.
- Normal Testicular Tissue:
- Familiarize yourself with the normal histology of the testis, including seminiferous tubules, interstitial tissue, and blood vessels.
- Identify Germ Cells:
- Focus on identifying different stages of germ cells within the seminiferous tubules.
- Look for spermatogonia, spermatocytes, spermatids, and mature spermatozoa.
- Assessment of Spermatogenesis:
- Evaluate the progression of spermatogenesis within the seminiferous tubules.
- Note any disruptions or abnormalities in the various stages of germ cell development.
- Interstitial Tissue Examination:
- Examine the interstitial tissue for Leydig cells, blood vessels, and connective tissue.
- Look for any signs of inflammation, fibrosis, or atrophy in the interstitial space.
- Identification of Pathological Features:
- Identify and characterize any pathological features, such as atrophy, hypospermatogenesis, Sertoli cell-only syndrome, or presence of neoplastic lesions.
- Evaluate for signs of inflammation, including infiltrating immune cells.
- Special Stains and Immunohistochemistry:
- Consider using special stains or immunohistochemical markers if needed for further characterization of specific lesions or to differentiate between various entities.
- Integration and Reporting:
- Integrate the findings from both clinical history and microscopic examination.
- Provide a clear and concise report, including a diagnosis, relevant histological features, and any additional recommendations for further evaluation if needed.
NORMAL STRUCTURES SEEN IN TESTICULAR BIOPSIES AND SPERM MATURATION
OVERVIEW OF MICROSCOPIC CHARACTERISTICS OF THE CELLS SEEN IN TESTICULAR BIOPSY
- Seminiferous tubules:
- 150 – 250 microns in diameter, the average total length in each testes is 540 m (range 299 – 981 m)
- Lined by multilayered epithelium with most mature cells towards lumina
- Have basal lamina, outer myoid cells (positive for desmin, muscle specific actin, vimentin) and collagen
- Contain Sertoli cells, spermatogonia (types A and B), primary spermatocytes, secondary spermatocytes, spermatids and spermatozoa
- All except spermatozoa are held together by a narrow cytoplasmic bridge
- Immature tubules are positive for alpha inhibin
- Sertoli cells:
- Columnar, on basement membrane, surround germ cell elements with cytoplasmic extensions, form blood – testis barrier
- 7% of tubular cells
- May contain Charcot-Bottcher crystalloids (bundles of microfilaments)
- Have irregular, highly folded nuclei with prominent nucleoli
- Produce anti-Müllerian hormone, which causes regression of Müllerian duct structures in utero
- After birth, secrete androgen binding protein and are responsive to FSH
- Also produce inhibin
- Leydig cells:
- Single (20 microns) or in clusters between seminiferous tubules, produce testosterone in response to luteinizing hormone (LH)
- Often associated with nerve fibers and blood vessels
- Have abundant pink cytoplasm with lipid, lipochrome pigment, Reinke crystalloids (hexagonal prisms by EM), round nuclei with distinct nucleoli
- Fewer Leydig cells in elderly
A SIMPLIFIED APPROACH TO TESTICULAR BIOPSIES
TRY TO ANSWER THE THE QUESTION
Testicular biopsy of a 32 year old male . What is your diagnosis?
Your message has been sent
This biopsy shows Sertoli cells only- Sertoli cell only syndrome.
💨Note the wind swept appearance . The sertoli cells have oval nuclei and punctate nucleoli. Leydig cells are usually normal in appearance but may appear to be increased in number due to reduced tubular diameter.
Causes of Sertoli cell-only syndrome include:
🎯Gonadotropin deficiency
🎯Cryptorchidism
🎯Viral orchitis
🎯Irradiation,
🎯Alkylating agents
🎯Hormonal therapy for prostate cancer etc
Reference article: https://meridian.allenpress.com/aplm/article/134/8/1197/461131/A-Practical-Approach-to-Testicular-Biopsy
FOR ANSWERING DAILY QUESTIONS
https://www.whatsapp.com/channel/0029Va9k7AU2f3EJKuwwlg3e
https://www.instagram.com/pathology_mcqs
Join our approach based course for useful tips, pitfalls, notes, reporting templates
and worksheets- find details below.
Find summaries below.
Leave a Reply