American Urological Association - Cryptorchid Testes


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Cryptorchid Testes

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  • Derived from Greek word crypto – hidden and orchid – testicle.
  • Most common birth defect of male genitalia; affects 2-4% of male infants.
  • Failure of testis to descend into scrotum and accounts for ~25% of cases of empty scrotum.
  • Testes are generally found in the inguinal canal or upper scrotum; occasionally intraabdominal.
  • Causes: anatomical abnormalities of the gubernaculum; hormonal dysfunction; mechanical impairment (short spermatic cord, underdeveloped vaginal process); dysgenesis (primary testicular anomaly); heredity.
  • Opposite testis involved in 20%.
  • Gross: cryptorchid testis is often smaller than the contralateral testis.
  • Histology:
    • Decreased diameter of seminiferous tubules (image A) & (image B).
    • Tubules may contain only Sertoli cells and no spermatogonia.
    • Tubular sclerosis and thickened hyalinized basement membranes are present.
    • Relative Leydig cell "hyperplasia" – look more numerous because the rest of testis is atrophic.
    • Hypoplastic rete testis.
    • May have "pick adenoma" or Sertoli cell nodule.
    • Precursor intratubular germ cell neoplasia (ITGCN) may be present.
  • Increase risk of testicular cancer (5-10X, especially germ cell neoplasms, most commonly seminoma) and infertility.