Search

Purpose: We reviewed the literature on protozoan infections in the male genital tract, with special reference to histopathological findings and their repercussions on different andrological functions., Materials and Methods: A literature search of the MEDLINE data base from 1966 to May 1995 was done and related articles were identified. The considered terms were parasitology and the male genital organs. Additional searches on infertility, semen and sexually transmitted diseases were performed., Results: Protozoan infections of the male genital tract are rare and only a few species of parasites are involved. Trichomonas vaginalis, Trypanosoma species, Leishmania donovani, Entamoeba histolytica, Acanthamoeba species, Toxoplasma gondii and Plasmodium falciparum have been described in the male genital tract as producing testicular damage or secondary hypogonadism via hypothalamic-hypophyseal axis alterations., Conclusions: Topics of interest were the role of sexual transmission by some parasites, principally T. vaginalis, relationship with subfertility or infertility in the male subject, clinical significance in differential diagnosis with other inflammatory processes, and for some parasites the relationship with opportunistic behavior and immunodeficiency syndromes, including the acquired immunodeficiency syndrome.

The DNA content of spermatogonia was studied by cytophotometric quantification in the testes of cryptorchid children and adults, as well as in age-matched control males. In most cases, the average DNA content of spermatogonia was significantly increased in the cryptorchid testes of children with uni- or bilateral cryptorchidism, as well as in the contralateral scrotal testes of children with unilateral cryptorchidism. In the group of adult men the average DNA content of spermatogonia in the testes was even more increased than in children. There were not significant differences between 4 and 14 years of age, between unilateral and bilateral cryptorchidism, or between cryptorchid testes and contralateral normally descended testes. The DNA content of spermatogonia in the surgically descended testes of 3 children who were re-biopsied 3-4 years after orchidopexy was similar before and after orchidopexy. These findings suggest that the spermatogonia of many cryptorchid males bear a congenital lesion.

A testicular fibroma in a 67-year-old man is reported. The tumor presented with expansive growth and myxoid areas. Atypias were absent. Differential diagnosis was made with immunohistochemical techniques that are useful for the diagnosis of nonspecialized gonadal stromal tumors. The origin of the tumor was probably in the interstitial or peritubular myofibroblasts.

Testicular microlithiasis, associated with bilateral cryptorchidism, is studied in 2, 6-year-old children. In case 1 autopsy revealed that 60 per cent of the seminiferous tubules contained completely calcified microliths. Similar mineralized concretions also were found in different areas of the cerebrum and cerebellum. In the testicular biopsy obtained from case 2, 30 per cent of the seminiferous tubules contained microliths showing different degrees of calcification. The study of such calcifications supports the hypothesis that the mineralization process occurs according to the following stages: 1) accumulation of cellular debris in the tubular lumen, 2) deposit of concentric rings of glycoprotein material surrounding the central core and 3) calcification of the glycoprotein lamellar material. The presence of similar concretion in the nervous system as well as the lung in other reported cases suggests that microlithiasis could be a systemic disease.

We describe a boy with testicular lymphangiectasis and Noonan's syndrome. Both testes showed seminiferous tubules with a reduced tubular diameter, containing few spermatogonia. The testicular interstitium exhibited a number of large, dilated lymphatic vessels forming irregular channels among the seminiferous tubules and surrounding them. Since there was no accompanying pathological condition to indicate an obstruction to the lymphatic flow at the level of the spermatic cord or in the regional lymph nodes, the abnormal development of testicular lymphatic vessels suggests a congenital malformation.

We report on a 3-month-old infant with cystic intra-abdominal testicular torsion. He presented with abdominal distension and pain. Physical examination showed a movable, well delineated mass in the right iliac and lumbar fossae. Exploration revealed that the mass was connected to the abdominal aorta by a thin vascular cord that was twisted before reaching the mass. The histological study showed that the mass corresponded to a testis with cystic formations. The testicular parenchyma was necrotized, although isolated seminiferous tubules were found. The cystic cavities were filled by hematic and necrotic material, and exhibited no epithelial lining. A fibrous layer in continuity with interstitial hemorrhage surrounded the cysts. The twisted vascular cord corresponded to a spermatic cord with dilated pampiniform plexus veins. The differential diagnosis and the etiopathogenesis of the lesion are discussed.

A 12-year-old boy had an embryonal rhabdomyosarcoma in the distal portion of the spermatic cord. The tumor partially surrounded the testis, infiltrated the testicular tunics and formed an intratesticular nodule near the rete testis. The unaffected testicular parenchyma exhibited the characteristic germ cells of carcinoma in situ. We describe an association between these 2 types of tumors.

The histological study of epididymides obtained from autopsies (41 children, 7 young adults and 8 elderly men) and surgical specimens (10 young adults and 3 elderly men) revealed the presence of multiple diverticula in the cauda epididymis in all elderly men and in only 2 young adults (32 and 33 years old). The diverticula appeared as evaginations of the epithelial lining of the duct, disrupting the muscular coat and expanding into the surrounding connective tissue. The formation of epididymal diverticula seems to be an age-related process that might be caused by repeated increases in the intraluminal pressure in the cauda epididymis.

A case of müllerian pseudohermaphroditism in a male subject with a uterus is described. The patient showed normal secondary sex characteristics as well as normal external genitalia, except for right cryptorchidism and a painful tumoral mass in the left testis. Examination of surgical specimens revealed a uterus attached to the left ductus deferens. Areas of seminoma and embryonal carcinoma were present in the left testis. In addition, there was a thin insufficiently collagenized albuginea that contained a cellular connective tissue resembling the ovarian stroma, as well as hypoplastic and atrophic seminiferous tubules. In the testicular parenchyma most of the seminiferous tubules located far away from the tumor possessed the atypical malignant germ cells characteristic of intratubular undifferentiated germ cell tumors. No spermatogenesis was seen. The right abdominal testis was atrophic and showed a normal albuginea. However, there was an undifferentiated germ cell tumor similar to that observed in the left testis. We describe the first case of a tumor in a scrotal testis of a male subject with a uterus. The occurrence of this tumor is discussed with regard to tubular dysgenesis present in both testes and supported by the intrinsically abnormal germ cells as well as by the immature Sertoli cells found in both testes.