CRYPTORCHIDISM

It is a complete or partial failure of the intra abdominal testis to descend into the scrotal sac & is associated with testicular dysfunction and an increased risk of testicular cancer.
Incidence – 1% of 1 year old boys and 0.2% in adult males
Etiology
- Hormonal factors – abnormality in hormones which control the descent can lead to undescended testis. Descent of testis occurs in two phases.
  - Transabdominal phase: Testis comes to lie within lower abdomen or brim of pelvis during this phase. This phase is controlled by hormone called “Mullerian inhibiting substance”.
  - Inguinoscrotal phase – Testis descends through the inguinal canal into the scrotal sac. This phase is under the influence of androgen & is mediated by androgen induced release of calcitonin gene related peptide from the genitofemoral nerve.
- Mechanical factors – Narrow inguinal canal, short spermatic cord and adhesions to peritoneum
- Genetic factors – mal development of the scrotum or cremaster muscle and trisomy 13
The most common site of arrest of testicular descent is – Inguinal canal.
Arrest of descent in abdomen is rare & occurs in 5% to 10% of cases.
Morphology:
- Mostly unilateral (bilateral in 25% of cases)
- Gross – Cryptorchid testis is small and firm in consistency due to fibrotic changes
- Histologic changes begin as early as 2 years of age.
- Microscopic features:
  - Semniferous tubules with arrested germ cell development associated with marked hyalinization & thickening of the basement membrane.
  - Later tubules become cords of hyalinized tissues.
Such changes can also be seen in contralateral descend testis which indicates some intrinsic defect in testicular development or function.
Clinical features:
- Usually asymptomatic
- Infertility
- Concomitant inguinal hernia accompanying undescended testis.
- Torsion and infarction of undescended testis located in inguinal canal
- 30 to 50 fold increased risk of developing testicular cancer in undescended testis. Most common malignancy is seminoma and embryonal carcinoma
Treatment:
- During the first year of life ,majority of inguinal testis descends down into the scrotum
- Undescended testes – surgical correction after 2 yrs (Orchiopexy)
- Extent of reduction of risk for cancer development is not clear cancers can develop in controlateral descended testis which indicates that cryptorchidism signals presence of defect in development & differentiation of testis.

References

Vinay kumar, Abul K.Abbas, Nelson Fausto, Jon C. Aster. The Breast. In: Robbins and Cotran Pathologic basis of disease. 8th edition.
Harsh mohan. Text book of Pathology.8th edition.2019

CRYPTORCHIDISM

It is a complete or partial failure of the intra abdominal testis to descend into the scrotal sac & is associated with testicular dysfunction and an increased risk of testicular cancer.

Incidence – 1% of 1 year old boys and 0.2% in adult males

Etiology

Hormonal factors – abnormality in hormones which control the descent can lead to undescended testis. Descent of testis occurs in two phases.

Transabdominal phase: Testis comes to lie within lower abdomen or brim of pelvis during this phase. This phase is controlled by hormone called “Mullerian inhibiting substance”.

Inguinoscrotal phase – Testis descends through the inguinal canal into the scrotal sac. This phase is under the influence of androgen & is mediated by androgen induced release of calcitonin gene related peptide from the genitofemoral nerve.

Mechanical factors – Narrow inguinal canal, short spermatic cord and adhesions to peritoneum

Genetic factors – mal development of the scrotum or cremaster muscle and trisomy 13

The most common site of arrest of testicular descent is – Inguinal canal.

Arrest of descent in abdomen is rare & occurs in 5% to 10% of cases.

Morphology:

Mostly unilateral (bilateral in 25% of cases)

Gross – Cryptorchid testis is small and firm in consistency due to fibrotic changes

Histologic changes begin as early as 2 years of age.

Microscopic features:

Semniferous tubules with arrested germ cell development associated with marked hyalinization & thickening of the basement membrane.

Later tubules become cords of hyalinized tissues.

Such changes can also be seen in contralateral descend testis which indicates some intrinsic defect in testicular development or function.

Clinical features:

Usually asymptomatic

Infertility

Concomitant inguinal hernia accompanying undescended testis.

Torsion and infarction of undescended testis located in inguinal canal

30 to 50 fold increased risk of developing testicular cancer in undescended testis. Most common malignancy is seminoma and embryonal carcinoma

Treatment:

During the first year of life ,majority of inguinal testis descends down into the scrotum

Undescended testes – surgical correction after 2 yrs (Orchiopexy)

Extent of reduction of risk for cancer development is not clear cancers can develop in controlateral descended testis which indicates that cryptorchidism signals presence of defect in development & differentiation of testis.

References

Vinay kumar, Abul K.Abbas, Nelson Fausto, Jon C. Aster. The Breast. In: Robbins and Cotran Pathologic basis of disease. 8th edition.

Harsh mohan. Text book of Pathology.8th edition.2019