Natural history of testicular regression syndrome and consequences for clinical management

Abstract 

Aims

Testicular regression syndrome (TRS or ‘vanishing testis’) is a condition in which a testis is thought to have once existed but has atrophied and disappeared during early development. The natural history of TRS is in completely understood, due to the absence of any prospectively studied cohort of patients. This study aimed to quantify the cardinal features of the disease and correlate these with age.

Materials and methods

A total of 117 cases of TRS were submitted for histopathological examination. Patient age ranged from birth to 12years, with a median age of 2years. The proportion of each histological feature present was analysed according to age, using the χ² test.

Birth Results

The 117 cases accounted for 21% of the testicular/paratesticular specimens examined. Only 12 cases (10%) were found to contain testicular tissue, with no readily identifiable germ cells and in particular no atypical germ cells identified. Features such as haemosiderin-laden macrophages, calcification, the presence of a nodule, vas or epididymis were less prevalent amongst specimens from older boys.

Conclusions

This is the largest series studied to date. With only 10% of the removed specimens containing identifiable testicular tissue with no germ cells seen, a negligible risk of future germ-cell cancer on the affected side is implied. If the laparoscopic findings suggest a diagnosis of vanishing testis, we contend that a groin exploration may be no longer indicated.

Keywords: Testicular regression, Vanished testis