Ovary - nontumor
Gonadal dysgenesis
Testicular feminization

Author: Mohiedean Ghofrani, M.D. (see Authors page)

Revised: 14 September 2017, last major update December 2011

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: "Testicular feminization" ovary

Cite this page: Ghofrani, M. Testicular feminization. PathologyOutlines.com website. http://pathologyoutlines.com/topic/ovarynontumortesticularfeminization.html. Accessed October 21st, 2017.
Definition / general
  • Male genotype (46,XY) but impaired or absent masculinization of male genitalia or development of male secondary sexual characteristics at puberty due to partial or complete inability of cells to respond to androgens (androgen insensitivity)
  • Most common type of male pseudohermaphroditism
  • Patients present with amenorrhea or sterility
  • Vagina but no uterus
  • Also, bilateral cryptorchid testes with nodular masses of immature tubules resembling Sertoli-Leydig tumor
Terminology
  • Also called androgen insensitivity syndrome (AIS)
  • Divided into three categories:
    • Complete androgen insensitivity syndrome (CAIS): normal female external genitalia
    • Mild androgen insensitivity syndrome (MAIS): normal male external genitalia
    • Partial androgen insensitivity syndrome (PAIS): partially but not fully masculinized external genitalia
Etiology
  • Most commonly, a mutation in the androgen receptor (AR) gene
  • Other etiologies include: chromosomal abnormalities, dysfunctional androgen biosynthesis, developmental syndromes, teratogens
Clinical features
  • Depending on the severity of androgen insensitivity, patients may present with male, female or ambiguous phenotype
  • Given the presence of a Y chromosome (more specifically, SRY gene), gonads are testes regardless of phenotype
  • Physical exam may reveal a vagina but no ovaries or uterus
Prognostic factors
  • 9% develop tumors in cryptorchid testis, which should be removed after puberty
Case reports
Treatment
  • Currently limited to symptomatic management, including sex assignment, genitoplasty, gonadectomy, hormone replacement, counseling
Gross images

Images hosted on PathOut server:

Multiple hamartomas are present in a background of brown parenchyma; nodule at each upper (medial) pole is a mass of smooth muscle; the small white nodule at the lower (lateral) pole of the left testis was composed largely of fibromatous tissue and resembles an ovarian fibroma; the remaining hamartomas contained Sertoli and Leydig cells and stroma; a small adnexal cyst is present at the lower (lateral) pole of the left testis (AFIP)

Microscopic (histologic) description
  • Bilateral cryptorchid testes with nodular masses of immature tubules resembling Sertoli-Leydig tumor
Microscopic (histologic) images

Images hosted on PathOut server:

Ovarian type stroma with a storiform pattern containing a few lutein-like cells envelops two small solid tubules containing Sertoli cells

Tubules containing
immature Sertoli cells
are separated by cells
resembling Leydig cells

Testis is composed
almost entirely of
stroma resembling
ovarian stroma

Hamartomas are composed of Sertoli and Leydig cells and lie in the upper left, testicular parenchyma is at lower right