29

CASE 29


During the examination of a full-term male infant, it was discovered that his right testis did not descend into the scrotum. One year later the testis remained undescended. The infant was diagnosed with cryptorchidism and an orchiopexy was performed.



WHAT IS THE MOST LIKELY LOCATION OF A CRYPTORCHID TESTIS?


The most frequent location of an undescended testis is in the inguinal canal (Fig. 4-4). Other locations are anywhere along the pathway that the testis travels to descend into the scrotum. Cryptorchidism is slightly more common with the right testis than the left and occurs bilaterally in 25% of cases.


image

FIGURE 4-4 Sites of cryptorchid testes, numbered in order of frequency.


(Moore K and Persaud TVN: The Developing Human, 7e. WB Saunders, 2003. Fig. 13-47.)



WHY DID THE PHYSICIAN WAIT 1 YEAR BEFORE PERFORMING AN ORCHIOPEXY?


An orchiopexy is a surgical procedure that moves and fixes an undescended testis in the scrotum. The physician waited 1 year to see if the cryptorchid testis would spontaneously descend into the scrotum. Surgical correction is necessary before 2 years of age to stave off histologic deterioration.



WHAT ARE THE MORPHOLOGIC CHARACTERISTICS OF A CRYPTORCHID TESTIS?


A cryptorchid testis exhibits the following morphologic characteristics:


• The basal laminae of the seminiferous tubules become thickened.

• The seminiferous tubules become dense cords of connective tissue.

• The interstitial cells (of Leydig) are unaffected.

• The testis atrophies.

• Interestingly, a patient with unilateral cryptorchidism will experience deterioration of germ cells in the contralateral descended testis.


HOW DO THE TESTES DEVELOP?


Development of the testes requires primordial germ cells and the SRY gene located on the short arm of the Y chromosome. The SRY gene encodes the protein, testis-determining factor (TDF).

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Jun 16, 2016 | Posted by in ANATOMY | Comments Off on 29

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