A rare variant of inguinal hernia: Cryptorchid testis at the age of 50 years. Etiopathogenicity,prognosis and management

INTRODUCTIONCryptorchidism is characterized by the extra-scrotal position of the testis. The surgical community has little to no knowledge of cryptorchid testis in adults apart from of pediatric surgeons. Therefore, we sought to describe this unusual cause of inguinal hernia.PRESENTATION OF CASEA 50-year-old man was referred with a inguinal hernia. Diagnosis of cryptorchidism was made during surgery, as the patient underwent an operation for repair of his left inguinal hernia. The testicle was non-viable and a left testicle was resected. Histopathology report confirmed a atrophic testis without testicular germ cell tumor (TGCT).DISCUSSIONThis is an extremely rare case of cryptorchidism revealed in an adult. The patient remained asymptomatic for 50 years. Most studies have concluded that there is a direct correlation between how long the testis was subjected to a cryptorchid position and TGCT incidence. The recommended age of surgical correction is before the age of 2 years. In our case, we did not find correlation between the time of surgery and risk of TGCT. Histopathology report confirmed the presence of leydig cells, seminiferous tubule and Sertoli cells without TGCT. Very little is known about link between cryptorchidism and TGCT. The correct diagnosis of inguinal hernia is usually made during an inguinal hernia repair.CONCLUSIONThe surgeon must always be alert to the possibility of cryptorchid testis during a surgical exploration of an inguinal hernia. In suspected cases, laparoscopy ultrasonographic, CT scan and laparoscopy evaluation may be helpful in diagnosing of this atypical inguinal hernia before surgery.     

小鼠隐睾模型制作方法的改进

目的:简化隐睾模型的制作方法,提高隐睾模型的质量。方法:60只68周龄昆明白小鼠随机分为实验组、模型对照组、正常对照组,每组20只。实验组,速眠新麻醉,常规消毒阴囊,将睾丸挤入腹腔,于阴囊根部连续性缝合结扎阴囊。模型对照组用经典的方法,切开腹壁,将睾丸脂肪垫靠近附睾处固定在腹壁,关闭腹腔。3组均饲养75d后,切取睾丸进行形态学和组织化学比较。结果:实验组无死亡,切取睾丸时腹腔内未见粘连,模型对照组死亡率10%,腹腔内均见粘连。两组睾丸形态、大小相似,均较对照组小;形态学比较,实验组与模型对照组相似,管腔内未见成熟精子,与正常对照组比较,细胞形态改变相似;3β羟类固醇脱氢酶(3βHSD)染色显示实验组与模型对照组酶含量无显著性差异(P>0.05),较对照组低(P<0.01)。结论:这种新的方法操作简单,没有粘连,模型质量较经典的方法好。     

隐睾或去垂体大鼠血清中抑制素与FSH的关系

本研究观察了实验性隐睾与去垂体大鼠的血清、睾丸与间质液中抑制素水平与血清中FSH的水平。发现隐睾大鼠术后1～2周末,血清中抑制素水平下降到对照组的20～40％左右,FSH水平可增加到对照组水平的200％,二者之间有一个明显的负相关(r=-0.38,P=0.013)。去垂体大鼠的FSH水平下降到不能探测水平时,抑制素水平也明显下降。本实验认为抑制素调节着FSH的分泌,而FSH也部分地控制了抑制素的产生。     

Changes in the arrangement of actin filaments in myoid cells and sertoli cells of rat testes during postnatal development and after experimental cryptorchidism

Background: Abundant actin filaments are present in myoid cells and Sertoli cells in the testis. In the adult rat, the filaments form a lattice arrangement within the myoid cell, and show a hexagonal pattern in the basal junctional regions of Sertoli cells. Methods: Isolated seminiferous tubules and frozen sections were prepared from juvenile to adult Wistar rat testes, stained with FITC-conjugated phalloidin, and observed by confocal microscopy. Unilateral cryptorchidism was induced in adult rats, and seven days later, their testes were also examined. Results: In the myoid cell, parallel actin filaments running circularly around the seminiferous tubules were observed at 15 and 20 days of age. Then, at 30 days, actin filaments arranged longitudinally along the tubular long axis appeared in addition to the circular bundles. A lattice arrangement of actin-filament bundles in myoid cells became obvious at 40 days, when elongated spermatids are found in the tubule. Actin filaments in the basal junctional regions of Sertoli cells did not acquire the hexagonal pattern seen in the adult testis until 30 days of age. In the cryptorchid testes, the arrangement of actin filaments in the both cells showed a remarkable change compared to the control testis; the filaments became thinner and disrupted. Conclusions: A lattice arrangement of the actin filaments in the myoid cell appear at around 30 days, before the completion of spermatogenesis. A hexagonal pattern of the filaments in the junctional regions of Sertoli cells has already developed at this age. Cryptorchidism affects the actin filaments of the both cells. © 1995 Wiley-Liss, Inc.     

胰岛素样因子3研究进展

胰岛素样因子3属于胰岛素超家族松弛素亚族,是睾丸间质细胞分泌的主要产物,其合成完全依赖睾丸间质细胞的分化状态.胰岛素样因子3除了在睾丸下降方面起重要作用,对于评估睾丸间质细胞功能也很敏感,有很大的临床价值.胰岛素样因子3在生殖细胞存活、骨代谢调控中发挥重要作用.     

双侧短期隐睾大鼠睾丸形态及抑制素的研究

本文研究了双侧短期人为隐睾大鼠睾丸的形态及抑制素的变化。结果发现隐睾一周和四周的大鼠睾丸和付睾重量均减轻。曲细精管直径缩小(平均直径:对照组250μm±43.75μm,1周组,159.5±32.25;4周组139.25±22.5;与对照组比P均<0.01)。Leydig细胞切面面积比明显增大(对照组为(％)6±2.4,1周组为21.83±7.4,4周组为23±11.38,P均<0.01)。电镜发现隐睾组leydig氏细胞线粒体和内浆网数量均增多,局部呈囊性扩张。睾丸间液和血清抑制素含量均明显下降(与对照组比P分別<0.01和<0.05),表明曲细精管破坏与leydig细胞呈一定的负相关。支持精管控制leydig氏细胞的理论,是否抑制素参于这一过程有待证实。     

Gubernacular fibroblasts express the androgen receptor during testis descent in cryptorchid rats treated with human chorionic gonadotrophin

Cryptorchidism was provoked in 3 day old rats treated with 17--estradiol over 30 days to identify the cells that express the androgen receptor (AR) during experimental testis descent in the gubernaculum. In one group of animals, testis descent was induced with human chorionic gonadotrophin (hCG) applied daily for 5 or 10 days. A correlative study using a testosterone radioimmunoassay with electron microscopy and immunocytochemical detection of AR was performed in gubernacula of hCG treated and untreated control animals. The gubernaculum of rats undergoing testes descent showed a dramatic increase in the number of AR-positive cells. These were located in the connective tissue among smooth muscle cells in the gubernacular cord and between striated muscle fibers in the bulb. In both regions, the AR-positive cells were identified as fibroblasts. Several clusters of amorphous material appeared in the extracellular matrix of the connective tissue in hCG treated rats. Our results suggest that testosterone induces the expression of AR in gubernacular fibroblasts which seem to degrade the extracellular matrix during gubernacular involution.     

还原型谷胱甘肽对大鼠隐睾生精上皮保护作用的实验研究

目的:探讨单侧隐睾鼠双侧睾丸生殖细胞和Sertoli细胞变化和还原型谷胱甘肽(GSH)对睾丸的保护作用。方法:30只SD雄性大鼠分为对照组(A组),隐睾组(B组),隐睾加GSH组(C组),每组各10只。采用化学比色法测定双侧睾丸GSH、丙二醛(MDA)含量;生物素-dUTP/酶标亲和素法检测睾丸生殖细胞的凋亡;透射电镜观察Sertoli细胞的超微结构。结果:术后2周,与A组比较,B组双侧睾丸GSH明显降低,MDA和细胞凋亡明显增加(P<0.01),Sertoli细胞线粒体和滑面内质网扩张。C组这种变化则明显减轻(P<0.01),与A组比较无差别(P>0.05)。结论:外源性GSH对单侧隐睾鼠双侧睾丸生殖细胞和Sertoli细胞有保护作用。     

Ν-硝基-L-精氨酸甲酯对大鼠隐睾生殖细胞凋亡的保护作用

目的 :探讨一氧化氮合酶 (NOS)抑制剂N 硝基 L 精氨酸甲酯 (L NAME)对大鼠隐睾生殖细胞凋亡的保护作用。　方法 :用 2 2dSD雄性大鼠复制单侧隐睾模型。实验分假手术组、隐睾组、隐睾 +L NAME组 [术后腹腔注射L NAME ,10mg/(kg·d) ],每组大鼠各 10只。术后 7d ,用生物素 dUTP/酶标亲和素测定法检测睾丸生殖细胞凋亡 ,用硝酸还原酶法测定睾丸组织中N0含量 ,用化学比色法测定睾丸组织中NOS活性。　结果 :术后第 7d ,与假手术组睾丸相比 ,隐睾组睾丸发生凋亡的生殖细胞数显著增加 ,隐睾 +L NAME组睾丸发生凋亡的生殖细胞数比隐睾组显著减少 (P <0 .0 1) ,隐睾 +L NAME组睾丸组织中NO含量及NOS活性与隐睾组相比显著降低 (P<0 .0 1)。　结论 :隐睾组织中NO和NOS升高是隐睾生殖细胞凋亡增加的病理机制之一 ,L NAME通过抑制NOS活性、减少NO的产生来降低睾丸组织生殖细胞的凋亡发挥其保护作用。     

CLONING AND CHARACTERIZATION OF TEMPERATURE-RELATED GENE TRS1

To investigate the mechanism of spermatogenesis arrest derived from heat treatment and to screen temperature-related genes involved in spermatogenesis, the authors analyzed the differences in gene expression between cryptorchid and scrotal testes in rats, and cloned a full-length cDNA named TRS1. In situ hybridization showed that TRS1 mRNA was mainly expressed in spermatocyte and round spermatids in testis. The expression level decreased in cryptorchid testis, suggesting that the lower scrotal temperature is a key factor in keeping the normal expression of TRS1. At the N-terminal of TRS1, there was a plecstrin homology (PH) domain signature. This PH domain has high similarity to that in PEPP2, a homosapien protein, which has a characteristic of binding phosphatidylinositol 3-phosphate via its PH domain in vitro. These findings suggest that TRS1 may be important in spermatogenesis and give clues for further research on the function of TRS1.