Difference between revisions of "Male infertility"
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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = Male infertility -- intermed mag.jpg | | Image = Male infertility -- intermed mag.jpg | ||
| Width = | | Width = | ||
| Caption = Mixed pattern male infertility (Sertoli cells only mixed with hypospermatogensis). [[H&E stain]]. | | Caption = Mixed pattern male infertility (Sertoli cells only mixed with hypospermatogensis). [[H&E stain]]. | ||
| Line 7: | Line 7: | ||
| Micro = various patterns - see ''microscopic'' | | Micro = various patterns - see ''microscopic'' | ||
| Subtypes = | | Subtypes = | ||
| LMDDx = [[ | | LMDDx = [[germ cell neoplasia in situ]], [[germ cell tumour]], inflammation of the testis | ||
| Stains = | | Stains = | ||
| IHC = | | IHC = | ||
| Line 37: | Line 37: | ||
*Infertility is a [[clinical diagnosis]]. | *Infertility is a [[clinical diagnosis]]. | ||
It can be divided into:<ref name=pmid20670143>{{ | It can be divided into:<ref name=pmid20670143>{{cite journal |authors=Cerilli LA, Kuang W, Rogers D |title=A practical approach to testicular biopsy interpretation for male infertility |journal=Arch Pathol Lab Med |volume=134 |issue=8 |pages=1197–204 |date=August 2010 |pmid=20670143 |doi=10.5858/2009-0379-RA.1 |url=}}</ref> | ||
*Pre-testicular - e.g. hormonal, [[pituitary gland|pituitary]]. | *Pre-testicular - e.g. hormonal, [[pituitary gland|pituitary]]. | ||
*Testicular. | *Testicular. | ||
| Line 49: | Line 49: | ||
#Sertoli cells only. | #Sertoli cells only. | ||
#Seminiferous tubule hyalinization | #Seminiferous tubule hyalinization | ||
# | #Some combination of the above patterns. | ||
DDx: | DDx: | ||
*[[ | *[[Germ cell neoplasia in situ]] (GCNIS). | ||
*[[Germ cell tumour]]. | *[[Germ cell tumour]]. | ||
*[[Testicular adrenal rest tumour]] in the context of congenital adrenal hyperplasia - case report.<ref name=pmid23342900>{{Cite journal | last1 = Niedziela | first1 = M. | last2 = Joanna | first2 = T. | last3 = Piotr | first3 = J. | title = Testicular adrenal rest tumors (TARTs) as a male infertility factor. Case report. | journal = Ginekol Pol | volume = 83 | issue = 9 | pages = 700-2 | month = Sep | year = 2012 | doi = | PMID = 23342900 }}</ref> | |||
*Inflammation of the testis. | *Inflammation of the testis. | ||
| Line 64: | Line 65: | ||
*Hyalinization of the tubules. | *Hyalinization of the tubules. | ||
*Inflammation. | *Inflammation. | ||
*Absence of [[ | *Absence of [[germ cell neoplasia in situ]]. | ||
===Mixed pattern=== | ===Mixed pattern=== | ||
<pre> | <pre> | ||
LEFT TESTIS, BIOPSY | LEFT TESTIS, BIOPSY WITH SPERM RETRIEVAL: | ||
- SERTOLI CELLS ONLY REGIONS (25% OF BIOPSY) | - SERTOLI CELLS ONLY REGIONS (25% OF BIOPSY) INTERMIXED WITH | ||
HISTOLOGICALLY NORMAL TESTIS (75% OF BIOPSY) WITH NORMAL NUMBERS | HISTOLOGICALLY NORMAL TESTIS (75% OF BIOPSY) WITH NORMAL NUMBERS | ||
OF SPERM. | OF SPERM. | ||
- NEGATIVE FOR SIGNIFICANT SEMINIFEROUS TUBULE HYALINIZATION. | - NEGATIVE FOR SIGNIFICANT SEMINIFEROUS TUBULE HYALINIZATION. | ||
- NEGATIVE FOR SIGNIFICANT INFLAMMATION. | - NEGATIVE FOR SIGNIFICANT INFLAMMATION. | ||
- NEGATIVE FOR INTRATUBULAR GERM CELL NEOPLASIA. | - NEGATIVE FOR GERM CELL NEOPLASIA IN SITU (INTRATUBULAR GERM CELL NEOPLASIA). | ||
</pre> | |||
===Hypospematogensis=== | |||
<pre> | |||
A. Left Testis, Biopsy with Sperm Retrieval: | |||
- Hypospematogensis (70% of biopsy) intermixed with histologically normal | |||
test (30% of biopsy) with normal numbers of sperm. | |||
- NEGATIVE for significant semineferous tubule hyalinization. | |||
- NEGATIVE for significant inflammation. | |||
- NEGATIVE for germ cell neoplasia in situ. | |||
</pre> | </pre> | ||
Latest revision as of 15:03, 14 November 2025
| Male infertility | |
|---|---|
| Diagnosis in short | |
 Mixed pattern male infertility (Sertoli cells only mixed with hypospermatogensis). H&E stain. | |
|
| |
| LM | various patterns - see microscopic |
| LM DDx | germ cell neoplasia in situ, germ cell tumour, inflammation of the testis |
| Site | testis, vas deferens and other sites |
|
| |
| Prevalence | not very common |
| Prognosis | benign |
| Clin. DDx | (clinical diagnosis) |
| Treatment | dependent on underlying cause |
Male infertility is a clinical diagnosis. It is pretty much the only reason for a testicular biopsy.
This article focuses on the testicular causes of infertility. Testicular biopsy redirects to here.
General
- Infertility is a clinical diagnosis.
It can be divided into:[1]
- Pre-testicular - e.g. hormonal, pituitary.
- Testicular.
- Post-testicular - e.g. blockage of vas deferens.
Microscopic
Male infertility on testicular biopsy shows one the following patterns:[1]
- Normal testis.
- Hypospermatogensis.
- Maturation arrest.
- Sertoli cells only.
- Seminiferous tubule hyalinization
- Some combination of the above patterns.
DDx:
- Germ cell neoplasia in situ (GCNIS).
- Germ cell tumour.
- Testicular adrenal rest tumour in the context of congenital adrenal hyperplasia - case report.[2]
- Inflammation of the testis.
Sign out
- The diagnosis should be the pattern (#1-6 above).
The following should be commented on:
- The number of tubules.
- The number of tubules with sperm.
- Hyalinization of the tubules.
- Inflammation.
- Absence of germ cell neoplasia in situ.
Mixed pattern
LEFT TESTIS, BIOPSY WITH SPERM RETRIEVAL: - SERTOLI CELLS ONLY REGIONS (25% OF BIOPSY) INTERMIXED WITH HISTOLOGICALLY NORMAL TESTIS (75% OF BIOPSY) WITH NORMAL NUMBERS OF SPERM. - NEGATIVE FOR SIGNIFICANT SEMINIFEROUS TUBULE HYALINIZATION. - NEGATIVE FOR SIGNIFICANT INFLAMMATION. - NEGATIVE FOR GERM CELL NEOPLASIA IN SITU (INTRATUBULAR GERM CELL NEOPLASIA).
Hypospematogensis
A. Left Testis, Biopsy with Sperm Retrieval: - Hypospematogensis (70% of biopsy) intermixed with histologically normal test (30% of biopsy) with normal numbers of sperm. - NEGATIVE for significant semineferous tubule hyalinization. - NEGATIVE for significant inflammation. - NEGATIVE for germ cell neoplasia in situ.
See also
References
- ↑ 1.0 1.1 Cerilli LA, Kuang W, Rogers D (August 2010). "A practical approach to testicular biopsy interpretation for male infertility". Arch Pathol Lab Med 134 (8): 1197–204. doi:10.5858/2009-0379-RA.1. PMID 20670143.
- ↑ Niedziela, M.; Joanna, T.; Piotr, J. (Sep 2012). "Testicular adrenal rest tumors (TARTs) as a male infertility factor. Case report.". Ginekol Pol 83 (9): 700-2. PMID 23342900.