Summary
Background
Undescended testicles are a common finding in full-term male infants. In the majority
of these infants, the testicle spontaneously descends in the first year of life. However,
in others, it remains impalpable in an abnormal position or there may only be a small
abnormal testicular remnant present. For these infants there is still controversy
surrounding inguinal exploration and/or excision of these testicular remnants at the
time of operative intervention. The controversy centres on their potential future
malignant potential.
Aim
The aim of the study was to ascertain the incidence of the presence of either germ
cells (GCs) or seminiferous tubules (SNTS) in the excised testicular remnants. This
was performed at a paediatric surgical tertiary centre and contributes to the evidence
base for this condition.
Method
A retrospective data analysis occurring over a 15-year period of all excised testicular
remnants. The testicular remnants were analysed for age, laterality, histological
analysis and clinical diagnosis. Subset analysis included subdivision into both intra-abdominal
or inguinal positions, and age ranges. Statistical analysis was using Fisher's exact
test and a P-value of <0.05 was considered to be significant.
Results
A total of 140 paediatric male patients were identified as having had a testicular
remnant excised during the study period. Their demographics and also the main results
are summarised in the overall summary Table. The mean age at intervention was 3.5
years (range: 3 months to 17 years). A total of 132/140 of the boys underwent excision
of an inguinal testicular regression syndrome (TRS) remnant and 8/140 an intra-abdominal
remnant. Comparison of these two groups revealed no significant difference for the
presence of GCs (12 (9%) vs 2 (25%), P = 0.18). However, intra-abdominal TRS remnants were much more likely to contain SNTs
(27 (21%) vs 7 (88%), P = 0.0002). There was no decreased incidence of either GCs or SNTs with increased
patient age.
Discussion
The main reason for the debate over the management of boys with TRS is the variable
incidence of viable germ cells reported in different studies: it has been reported
between 0 and 16%. The incidence of GCs (10%) and also SNT (24%) in the present series
therefore contributes to this evidence base and is in the middle of this range. It
is still unclear as to whether these remnants have a future malignancy risk, as there
is only one case of intratubular germ cell neoplasia (ITGCN) in a testicular remnant
reported in the literature and this was not immunohistochemically supported. The presence
of ITGCN, although considered as a precursor to the development of a testicular germ
cell tumour in adult patients, has also not been established in paediatric patients.
The natural history of the GCs in TRS specimens is also unknown. In the present series,
however, there was no decreased incidence demonstrated with increased patient age,
although older patient numbers limited this subset analysis. Despite this controversy,
as these patients were already under general anaesthetic, an inguinal exploration
and excision of any TRS remnant that was present did not significantly increase the
operative procedure or time, and removed any potential malignancy risk.
Conclusion
TableOverall summary of the testicular regression syndrome cohort
| Testicular regression syndrome specimen characteristics | |
|---|---|
| Total patients | 140 |
| Mean age (range) | 3.5 (3 months–17 years) |
| Histology | |
| Viable germ cells | 14 (10%) |
| Seminiferous tubules | 34 (24%) |
| Laterality | |
| Right | 48 (34%) |
| Left | 92 (66%) |
| Age analysis | |
| (≤10 years vs > 10 years) | |
| Viable germ cells | 11/125 vs 3/15, P = 0.18 |
| Seminiferous tubules | 27/125 vs 7/15, P = 0.05 |
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cryptorchidism.Semin Pediatr Surg. 2010; 19: 215-224
- The testicular regression syndrome–do remnants require routine excision?.J Pediatr Surg. 2011; 46: 384-386
- Avoidance of inguinal incision in laparoscopically confirmed vanishing testis syndrome.J Urol. 2001; 166: 1421-1424
- Histologic evaluation of the testicular remnant associated with the vanishing testes syndrome: is surgical management necessary?.Urology. 2007; 70: 1204-1206
- The remnant orchiectomy.J Urol. 1996; 155 (discussion 4): 712-713
- Histopathological features of testicular regression syndrome: relation to patient age and implications for management.Fetal Pediatr Pathol. 2006; 25: 119-129
- Natural history of testicular regression syndrome and consequences for clinical management.J Pediatr Urol. 2007; 3: 206-208
- Laparoscopic and histologic evaluation of the inguinal vanishing testis.Urology. 1998; 52: 866-869
- Journal of Pediatric Surgery-sponsored Fred McLoed lecture. Undescended testis: the underlying mechanisms and the effects on germ cells that cause infertility and cancer.J Pediatr Surg. 2013; 48: 903-908
- Ante-natal testicular torsion: only one cause of the testicular regression syndrome?.J R Coll Surg Edinb. 1996; 41: 99-101
- Testicular degeneration in three patients with the persistent mullerian duct syndrome.Eur J Pediatr. 1995; 154: 187-190
- The value of finding a closed internal ring on laparoscopy in unilateral nonpalpable testis.J Pediatr Surg. 2013; 48: 542-546
- Clinical and histological significance of the testicular remnant found on inguinal exploration after diagnostic laparoscopy in the absence of a patent processus vaginalis.J Urol. 2005; 174: 1584-1586
- Histological evaluation of the testicular nubbins in patients with nonpalpable testis: assessment of etiology and surgical approach.Pediatr Surg Int. 2007; 23: 41-44
- Laparoscopy for the impalpable testis.Br J Surg. 1997; 84: 1430-1432
- Age at surgery for undescended testis and risk of testicular cancer.N Engl J Med. 2007; 356: 1835-1841
- Absence of intratubular germ cell neoplasia in testicular yolk sac tumors in children. A histochemical and immunohistochemical study.Arch Pathol Lab Med. 1988; 112: 641-645
- Vanishing testes: a literature review.J Clin Res Pediatr Endocrinol. 2012; 4: 116-120
- Initial scrotal incision for unilateral nonpalpable testis.J Urol. 2004; 172 (discussion 5): 1742-1745
Article info
Publication history
Published online: April 01, 2015
Accepted:
January 14,
2015
Received:
August 18,
2014
Identification
Copyright
© 2015 Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Re: Nataraja RM Asher CM, Nash R, Murphy FL. Is routine excision of testicular remnants in testicular regression syndrome indicated? J Pediatr Urol 2015;11:151.e1–5Journal of Pediatric UrologyVol. 12Issue 5
- PreviewMy eminent colleagues have done a retrospective review of 15 years looking at the frequency of germ cells and seminiferous tubules on histology of excised remnants. On finding one of 10 specimens containing germ cells and having some seminiferous tubules they conclude that excision is indicated to prevent testicular cancer.
- Full-Text
- Preview
