Testis and epididymis
General
Cryptorchidism

Author: Turki Al-Hussain, M.D. (see Authors page)

Revised: 5 May 2017, last major update August 2012

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

PubMed Search: Cryptorchidism [title] Testis and epididymis

Cite this page: Cryptorchidism. PathologyOutlines.com website. http://pathologyoutlines.com/topic/testiscryptorchidism.html. Accessed May 25th, 2017.
Definition / general
  • Permanent retention of testis outside scrotum
  • Due to complete or incomplete failure of intra abdominal testes to descend into scrotal sac, occasionally associated with other GU malformations such as hypospadias and with trisomy 13
  • Testicular descent occurs in 2 phases:
    1. Abdomen to pelvic brim: controlled by anti-Müllerian hormone
    2. Pelvic rim to scrotum: androgen dependent, may be mediated by androgen induced release of calcitonin gene related peptide from genitofemoral nerve
Clinical features
  • Occurs in 3% of newborn boys, 1% of 1 year old boys; more common in premature infants; usually NOT due to endocrine disorder
  • Bilateral in 25% of cases
  • Cryptorchid testis usually (80%) in inguinal canal
  • Cryptorchid testes are prone to trauma, torsion, inguinal hernia (10 - 20% of cases) and sterility
  • Associated with 5 - 50× increased risk of testicular carcinoma, usually seminoma (higher risk if abdominal vs. inguinal location); may have cancer in normal descended testes too; biopsies suggested of both testes to detect intratubular germ cell neoplasia (50% with positive biopsy develop germ cell tumor at 5 years vs. minimal with negative biopsy)
  • Orchiopexy (placement in scrotal sac) should be done before age 2 - 3 to reduce risk of malignancy; deficient spermatogenesis persists in 10 - 60%; better fertility if orchiopexy done at younger age (Hum Pathol 1980;11:666)
Gross description
  • Small, firm, brown testis
Microscopic (histologic) description
  • Marked hyalinization and thickening of tubular basement membrane, prominent Leydig cells, often hyperplastic Sertoli cells with atrophy of other cells (arrest in germ cell development)
  • Variable intratubular germ cell neoplasia
  • Other testis often has paucity of germ cells
  • May have nodules of hyperplastic Sertoli cells ("Pick's adenomas") or clusters of persistent immature tubules
Microscopic (histologic) images

Images hosted on PathOut server, contributed by Debra L. Zynger, M.D.:

Seminiferous tubule with Seroli cells, no spermatogenesis, medium power

Seminiferous tubule with Seroli cells, no spermatogenesis, high power

Peritubular fibrosis

Seroli cell nodule (immature Sertoli cells)

Retained Leydig cells

Granular cell change within Setoli cells

Microliths