Incidental testicular tumors in infertile men (original) (raw)
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Fertility and Sterility, 1999
Objective: To describe a relatively new percutaneous large-needle aspiration biopsy technique for histologic examination of the testis in infertile patients. Design: Retrospective analysis of clinical and pathologic data. Setting: Clinical and academic research environment. Patient(s): Sixty-six infertile patients who underwent testicular biopsy. Intervention(s): Local anesthesia was induced through spermatic cord block with lidocaine, and a relatively large needle (usually 18-or 20-gauge) was introduced percutaneously into the testicle without a scrotal incision. Main Outcome Measure(s): The number of seminiferous tubules per histologic section of each testicular biopsy sample.
An XX male with an intratubular undifferentiated germ cell neoplasia
Fertility and Sterility, 2008
Objective: To report a case of a 46,XX male with an intratubular undifferentiated germ cell neoplasia within an extra-abdominal gonad. Design: Case report. Setting: Molecular, cytogenetic, pathologic, and clinical units of three tertiary hospitals. Patient(s): A male with ambiguous genitalia at birth and descended testes observed in a pediatric endocrinology setting. Intervention(s): Physical examination, hormonal assays, cytogenetic investigation, molecular analysis, surgical intervention for biopsies and bilateral orchiectomy, and pathologic evaluation. Main outcome measure(s): Pathologic evaluation with immunostaining for placental alkaline phosphatase and C-kit. Result(s): Conventional chromosome analysis revealed a 46,XXqÀ karyotype, and fluorescence in situ hybridization experiments with the SRY probe found a signal at the short arm of the deleted X chromosome. Molecular analysis indicated the presence of a portion of the short arm of the Y chromosome including the proto-oncogene TSPY. Pathologic evaluation of the gonads revealed an intratubular undifferentiated germ cell neoplasia. Conclusion(s): This is the first case of a 46,XX male with descended testes in whom an intratubular undifferentiated germ cell neoplasia developed. When proposals of management in this subgroup of disorders of sexual differentiation are formulated, the risk of germ cell malignancy must be taken into account. (Fertil Steril Ò 2008;90:2005.e3-e5.
Fertility and Sterility, 2000
Objective: To assess the effects of two methods of freezing on testicular sperm DNA from subjects with obstructive azoospermia and to compare these with samples of fresh and freeze-thawed testicular sperm from fertile men. Design: The Comet assay was used to determine the percentage of undamaged DNA in fresh testicular sperm, testicular sperm freeze-thawed in suspension and in a biopsy sample (men with obstructive azoospermia), and in fresh and freeze-thawed testicular sperm (fertile men). Setting: The Regional Fertility Center, Royal Maternity Hospital, Belfast, Northern Ireland, United Kingdom. Patient(s): Twelve males with obstructive azoospermia (normal testicular volume and hormone profiles) and nine fertile control subjects.
Andrologia, 2008
Several studies have suggested that male infertility and testicular cancer may have common aetiological factors. Scrotal ultrasonography (US) has an important role in the diagnosis of testicular tumours when not palpable by physical examination. In this study, we present two infertile men referred to our clinic. Patients were evaluated by a detailed physical examination, semen analyses and hormonal assessment. Both patients underwent scrotal US examination. Semen analysis of the patients revealed oligoasthenospermia in both patients. Scrotal US revealed hypoechoic masses in the left and right testes of both patients, which were nonpalpable by physical examination. Scrotal exploration and subsequent orchidectomy were performed. Histopathological examination revealed mixed germ cell tumour and Sertoli–Leydig cell tumour in case 1 and case 2 respectively. With these cases, we discussed the role of scrotal US in the routine diagnostic evaluation of infertile men.
Fertility and Sterility, 2017
Objective: To study the pathologic findings among men evaluated for infertility. Design: A retrospective, single-center, cross-sectional study. Setting: University hospital-based research center. Participant(s): We included data from 1,213 medical records from infertile men referred for diagnostic work-up from 2005 to 2009. Interventions(s): None. Main Outcome Measure(s): Health history, clinical findings, chromosome/genetic aberrations, semen quality, reproductive hormones. Result(s): In total, 64.4% of the infertile men had one or more reproductive disorders or factors influencing fertility, leaving 35.6% diagnosed as idiopathic infertile. In 244 patients (20%), including seven cases of testicular cancer and/or germ cell neoplasia in situ, a pathologic finding was first detected during diagnostic work-up. Two hundred four patients (16.8%) had a history of cryptorchidism and 154 (12.7%) of varicocele (grade 2 and 3). Thirty-three patients had chromosomal abnormalities, including 16 with sex chromosome abnormalities (11 with 47,XXY). Y-chromosome microdeletions were detected in 65 patients (5.4%). One hundred thirty-three had azoospermia, of which 58 had testicular biopsy findings (Sertoli cell-only syndrome: n ¼ 23; spermatogenic arrest: n ¼ 7; impaired spermatogenesis and atrophy: n ¼ 28). Additionally, in idiopathic infertile men and infertile men with additional symptoms of testicular dysgenesis syndrome, 22.5% presented with a degree of Leydig cell insufficiency, with the highest frequency (33.1%) among patients with sperm concentration <5 million/mL. Conclusion(s): We report pathologic findings that could explain the male-factor infertility in two-thirds of infertile men referred to our center. Thus, male infertility may be a sign of an underlying disease that warrants attention. (Fertil Steril Ò 2017;107:74-82. Ó2016 by American Society for Reproductive Medicine.
Radiological Findings in Infertile Men in a Fertility Centre in Jos, Nigeria
Infertility is a great psychological burden to the infertile couple. Scrotal ultrasonography and colour Doppler imaging of the scrotum are useful adjuncts to clinical examination in assessing intratesticular and extratesticular abnormalities. Methodology:All men who presented with infertility were evaluated. These included comprehensive history, physical examination and investigation, in this case seminal fluid analysis and scrotal ultrasonography. Results:This was prospective study carried out at the Jos University Teaching Hospital and a fertility centre in Jos from 2012 to 2017. A total of 67 men were involved in this study. The mean age was 39.39yrs. Age range was 28 to 59yrs. Sixty three (N=63) of the men had abnormal semen parameters representing 94.03% while four men (N=4) had normal semen parameters. Thirty eight patients representing 56.72% had azoospermia while 5.97% had normozoospermia following seminal fluid analysis. The mean volume of the right testis was 11.93ml. The range was 2.9ml to 25ml. The mean volume of the left testis was 11.76ml. The range was 2.9ml to 22ml. Overall mean testicular volume was 11.85ml. Forty two men (N=42) had abnormalities on scrotal ultrasound representing 62.69%. Abnormalities on ultrasonographyinclude varicocele33%, cryptorchidism31%, hydrocele 17%, testicularmicrolithiasis7%, multiple complex testicular cyst5%, epididymal cyst5% and echogenic testis2%. Conclusion:Scrotal ultrasonography is important in the assessment of testicular volume and abnormalities such as varicocele, cryptorchidism and hydrocele which affects male fertility.
Fertility and Sterility, 2004
To examine the outcome of assisted reproduction techniques (ART) using cryopreserved semen from patients with cancer. Design: Prospective. Setting: Therapeutic semen banking program at a tertiary healthcare center. Patient(s): Twenty-nine men with cancer who cryopreserved their sperm before treatment at our facility from 1982 to 2001 and withdrew their samples for assisted reproduction (IUI, IVF, or intracytoplasmic sperm injection [ICSI]). Intervention(s): Sperm bank records were used to identify the patients. Information on fertility potential indices was obtained from medical records and through interviews. Of the 29 patients, 9 had testicular cancer, 12 had Hodgkin's disease, and 8 had other types of cancer.
Clinical value of using an automated sperm morphology analyzer (IVOS)
Fertility and Sterility, 1999
To determine the clinical value of automated normal sperm morphology outcomes. Design: Prospective clinical study. Setting: Clinical and research assisted reproduction laboratory. Patient(s): Two hundred seven GIFT cycles. Intervention(s): The wife was induced to superovulate, laparoscopically aspirated, and the gametes were transferred laparoscopically. The husband's sperm morphology was evaluated with use of a sperm morphology analyzer using the strict criteria classification system. Main Outcome Measure(s): Normal sperm morphology, IVF, and pregnancy outcomes.
Significant medical pathology uncovered by a comprehensive male infertility evaluation
Fertility and Sterility, 1994
Objective: To determine if there was a specific screening regimen that could identify all patients with significant medical pathology found during a comprehensive male infertility evaluation. Design: A retrospective study. Setting: Two university-based male infertility clinics. Patients: Thirteen patients with male factor infertility identified with significant medical pathology. Main Outcome Measures: Initial presentation, history, physical examination, semen analysis, and hormone profile. Results: The identification of significant medical pathology was uncovered in 13 of 1,236 patients (1.1%) presenting to a male infertility clinic. The pathology was identified with a thorough history in 4 of 13 patients (30.8%) and by a complete physical examination in 8 of 13 patients (61.5%). Semen analyses were available on 12 patients, and 1 patient was anejaculatory. Two patients were azoospermic. Of the patients with sperm present, the mean sperm concentration was 8.6 X 10 6 /mL (range, 0.8 to 27), and the mean sperm motility was 32.0% (range, 0% to 65%). In 5 patients, endocrine abnormalities were specifically related to the subsequent pathology identified. A tumor was identified in 10 patients (6 testicular tumors, 3 brain tumors, and 1 spinal cord tumor). Two patients had ejaculatory dysfunction as a result of mesonephric duct anomalies affecting the ejaculatory duct or bladder neck closure. One patient had Klinefelter's syndrome. Conclusions: There was no pathognomonic finding on history, physical examination, semen analysis, or hormone profile that identified all patients with significant medical pathology. The significant medical pathology identified was represented in all semen quality groupings, that is, azoospermia, severe oligospermia, mild oligospermia, and normospermia. We recommend a comprehensive urologic evaluation for all male partners of infertile couples with a male factor or unexplained infertility in an attempt to identify significant and potentially treatable medical pathology before engaging in a series of therapies with assisted reproductive techniques.