Angiotensin (1–7) and its receptor Mas are expressed in the human testis: implications for male infertility

The presence of classical components of the renin-angiotensin system has been demonstrated in the male reproductive tract, mainly in the testes and epididymis. The objective of this study was to verify the localization of angiotensin (Ang)-(1–7) and its receptor Mas in human testis. The study included 12 men with previously proven fertility submitted to orchiectomy for prostate cancer and 20 infertile men submitted to testicular biopsy for infertility work-up, comprising a subgroup with obstructive azoospermia/normal spermatogenesis (n = 8) and another with non-obstructive azoospermia and severely impaired spermatogenesis (n = 12). Testicular tissue samples were processed by immunohistochemistry and real time polymerase chain reaction. Ang-(1–7) was strongly expressed in the interstitial compartment, mainly in Leydig cells, with similar intensity in all groups evaluated. The peptide was also detected in the seminiferous tubules, but with much less intensity compared to interstitial cells. The receptor Mas was equally distributed between interstitial and tubular compartments and was found in all layers of the normal seminiferous epithelium. However, neither Ang-(1–7) nor Mas were detected in the seminiferous tubules of samples with impaired spermatogenesis. The testicular samples of infertile men with impaired spermatogenesis (non-obstructive azoospermia) expressed Mas and ACE2 mRNA at lower concentrations (fold change = 0.06 and 0.04, respectively, P < 0.05) than samples with full spermatogenesis (obstructive azoospermia). This shows, for the first time, the immunolocalization of Ang-(1–7) and its receptor Mas in testes of fertile and infertile men, and suggests that this system may be altered when spermatogenesis is severely impaired.     

Xenogeneic transplantation of human spermatogonia

In the last 3 years, several studies have shown that xenogeneic transplantation of rodent spermatogonia is feasible. The treatment of infertile patients with spermatogenic arrest using the injection of immature germ cells has yielded only poor results. We attempted to establish a complete spermatogenetic line in the testes of mutant aspermatogenic (W/Wv) and severe combined immunodeficient mice (SCID) transplanted with germ cells from azoospermic men. Spermatogenic cells were obtained from testicular biopsy specimens of men (average age of 34.3 +/- 9 years) undergoing infertility treatment because of obstructive and non-obstructive azoospermia. Testicular tissue was digested with collagenase to promote separation of individual spermatogenic cells. The germ cells were injected into mouse testicular seminiferous tubules using a microneedle (40 microm inner diameter) on a 10 ml syringe. To assess the penetration of the cell suspension into the tubules, trypan blue was used as an indicator. Mice were maintained for 50 to 150 days to allow time for germ cell colonisation and development prior to them being killed. Testes were then fixed for histological examination and approximately 100 cross-sectioned tubules were examined for human spermatogenic cells. A total of 26 testicular cell samples, 16 frozen and 10 fresh, were obtained from 24 men. The origin of the azoospermia was obstructive (OA) in 16 patients and non-obstructive (NOA) in 8 patients. The concentration of spermatogenic cells in the OA group was 6.6 x 10(6) cells/ml, and 1.3 x 10(6) cells/ml in the NOA group (p < 0.01). The different spermatogenic cell types were distributed equally in the OA samples, ranging from spermatogenia to fully developed spermatozoa, but in the NOA group the majority of cells were spermatogonia and spermatocytes. A total of 23 testes from 14 W/Wv mice and 24 testes from 12 SCID mice were injected successfully, as judged by the presence of spermatogenic cells in histological sections of testes removed immediately after the injection. However, sections from the remaining testes examined up to 150 days after injection showed tubules lined with Sertoli cells and xenogeneic germ cells were not found. The reason why the two strains of mouse used as recipients did not allow the implantation of human germ cells is probably due to interspecies specificity involving non-compatible cell adhesion molecules and/or immunological rejection.     

Patterns of testicular cytology in men with primary infertility: any change since the Gulf War?

OBJECTIVE: To evaluate the patterns of testicular cytology in men with primary infertility, to compare the morphologic patterns between the periods 1990-1995, immediately after Gulf War II, and 1997-2001 and to determine whether there is a correlation between hormonal profile, testicular volume and morphologic pattern. STUDY DESIGN: Retrospective study of men with primary infertility. History, complete physical examination, hormonal assay and testicular ultrasound were evaluated. A total of 545 patients had samples for testicular cytology obtained from both testes. The patient's consent was obtained in all cases. Smears were interpreted under light microscopy after treatment with Diff-Quik. A total of 104 healthy, fertile subjects were used for comparison of the hormonal profile and testicular volume. RESULTS: The mean (+/- SD) age was 28.66 +/- 4.36 years and duration of marriage 4.4 +/- 4.36 years. There were 11.2% patients with normal cytology, 55.8% with hypospermatogenesis, 28.4% with testicular atrophy, 2.9% with Sertoli cells only and 1.7% with maturation arrest. A significant increase in hypospermatogenesis and decrease in the Sertoli cell-only pattern were noted in 1997-2001 when compared with 1990-1995. The mean left testicular volume was 10.53 +/- 5.51 mL3 in the infertile group vs. 15.2 +/- 4.97 in the fertile group (p < 0.003); right testicular volume was 10.84 +/- 4.77 vs. 15.15 +/- 5.31 (p < 0.003). The hormonal profile revealed higher luteinizing hormone and follicle-stimulating hormone levels in the infertile group vs. control group (8.53 +/- 9.03 and 16.44 +/- 19.243 vs. 6.98 +/- 4.53 and 7.37 +/- 6.63, respectively [p < 0.001]). Free testosterone was higher in the fertile group (39.69 +/- 12.76 vs. 20.28 +/- 8.5 [p < 0.000]). CONCLUSION: The majority of infertile males in our cohort had hypospermatogenesis; testicular atrophy was the next most common disorder. There was no major change in overall absolute numbers since the Gulf War. Testicular cytology by fine needle aspiration is a safe and well-tolerated complementary investigation for unexplained male infertility.     

Testicular fine needle aspiration cytology in male infertility

OBJECTIVE: To compare the accuracy of testicular fine needle aspiration and biopsy for diagnostic and therapeutic purposes. STUDY DESIGN: A comparison of testicular fine needle aspiration and biopsy was performed on 34 infertile men over a 2-year period. RESULTS: Concordance of the 2 tests was evident in 88% of cases. In discordant cases fine needle aspiration yielded more than biopsy, considering the existence of secondary spermatocytes and spermatids. Charcot-Bottcher crystalloids were frequently seen in the cytoplasm of Sertoli cells in normal and abnormal spermatogenesis. CONCLUSION: Testicular fine needle aspiration is a simple and cost-effective method of evaluating testicular pathology in male factor infertility. It may yield more diagnostic and therapeutic material than does biopsy.     

Ultrastructure of peritubular tissue in association with tubular hyalinization in human testis.

Testicular peritubular tissue, also known as the tunica propria, surrounds the seminiferous tubules and is responsible for contractile, paracrine and transport functions. The aim of the present report is to describe the pathomorphology of peritubular tissue in association with tubular hyalinization in human testis. Twenty-seven testicular biopsies from 21 subfertile and infertile men were studied with the electron microscope. Biopsies from five patients showed complete or nearly complete tubular hyalinization. In addition to changes described earlier, the following new ultrastructural features were observed: 1. loss of polarity and configuration of myoid cells; 2. protrusion of myoid cells towards the tubule and evagination of basal lamina surrounding the tubule towards the interstitial direction leading to 'bridge' formation. These 'bridges' of myoid cells often created completely separated small compartments within the tunica propria; 3. vacuolization and fragmentation of myoid cell nuclei; 4. a balloon-like swelling of myoid cell containing phagolysosomes and lipid droplets. We conclude that disorganization and loss of vital functions of the extracellular matrix and myoid cells contribute to the pathogenesis of tubular hyalinization.     

Feasibility of global gene expression analysis in testicular biopsies from infertile men

Numerous studies have documented the use of microarray analysis to identify patterns of global gene expression that distinguish normal development from that of the diseased state. Yet, there are no reports that compare global gene expression in the fertile and infertile human testis. Here, we report an initial study of global gene expression in testicular biopsies from several men with different infertility phenotypes. We found that microarray analysis of small biopsy samples was suitable for profiling expression of genes known to function in germ cell development and also identified expression of novel genes. Since it is now common for infertile men with spermatogenic failure to use intracytoplasmic sperm injection (ICSI) to achieve biological paternity, we hypothesize that molecular screening of testicular biopsies with microarrays may be suitable: (1) to categorize the molecular phenoytpes of infertile testes in a manner similar to standard morphologic analysis and (2) to initiate larger studies of gene expression in the infertile testes that may identify genetic signatures from biopsies that allow prediction of outcomes.     

Testicular function in patients with spinal cord damage.

Vaying degrees of testicular dysfunction are found in men with traumatic spinal cord damage. Eighteen paraplegic men have been studied and the gonadotropin response to luteinizing hormone-releasing hormone (LRH) measured. Basal serum testosterone estimations were made and in eight of the patients testicular testosterone reserve was assessed by the testosterone response to human chorionic gonadotropin (HCG). Testicular biopsies were performed in seven cases. In three of these patients, the testicular biopsies were abnormal. Five of the patients had elevated Follicle stimulating hormone levels and abnormalities of Luteinizing hormone kinetics were found in the same five patients. There was no significant difference between the plasma testosterone levels of the paraplegic patients when compared to the control group. In all the patients tested, there was an adequate testosterone reserve, and this included the three patients with the abnormal testicular biopsies. No relationship was found between the level of cord lesion and any of the hormonal parameters measured. This study confirms the primary nature of the seminiferous tubular damage which occurs in some patients with paraplegia.     

Risk of testicular cancer in cohort of boys with cryptorchidism.

OBJECTIVE: To determine the risk of testicular cancer in relation to undescended testis and its treatment based on recorded details of the maldescent, treatment, and biopsy from case notes. DESIGN: Cohort study. SETTING: Hospital for Sick Children, Great Ormond Street, London. SUBJECTS: 1075 boys with cryptorchidism treated by orchidopexy or hormones at the hospital during 1951-64. MAIN OUTCOME MEASURES: Relative risk of testicular cancer in the cohort compared with men in the general population. RESULTS: 12 testicular cancers occurred in 11 of the patients during follow up to mid-1990 (relative risk of cancer in males with cryptorchidism = 7.5 (95% confidence interval 3.9 to 12.8)). The relative risk fell significantly beyond 15 years after orchidopexy but did not decrease with younger age at orchidopexy. Risk was significantly raised in testes that had had biopsy samples removed during orchidopexy (relative risk = 66.7 (23.9 to 143.3) compared with a testis in a man in the general population) and was significantly greater in these testes than in undescended testes that had not had biopsy samples taken at orchidopexy (6.7 (2.7 to 13.5)). No reasons for biopsy or distinguishing clinical aspects of the testes that had had biopsy samples taken and later developed malignancies were evident in the case notes. No histological abnormalities were evident at initial biopsy except in one testis that had features of dysgenesis. CONCLUSIONS: Biopsy seems to be a stronger risk factor for testicular cancer than any factor previously identified. The trauma of open biopsy may contribute substantially to risk of malignancy or the testes may have been selected for biopsy on the basis of clinical factors predictive of malignancy but not mentioned in the case notes.     

Prevalence of carcinoma in situ of the testis in 207 oligozoospermic men from infertile couples: prospective study of testicular biopsies.

OBJECTIVE: To investigate the prevalence of carcinoma in situ of the testis in a group of oligozoospermic men from infertile couples. DESIGN: A consecutive group of oligozoospermic men from infertile couples were offered bilateral testicular biopsy. The observed prevalence of carcinoma in situ was compared with the expected prevalence of testicular cancer in a corresponding age matched population of Danish men, assuming all untreated cases of carcinoma in situ progress to tumour stage. This calculation was based on data from the Danish Cancer Registry. SUBJECTS: 207 men aged 18-50 years who had sperm density below 10 million/ml in two samples within the previous 2 years or sperm density below 20 million/ml in two samples within the previous 2 years and a history of cryptorchidism or one or two atrophic testicles (orchidometer volume less than 15 cm3), or both. INTERVENTIONS: Bilateral testicular biopsies. MAIN OUTCOME MEASURES: Carcinoma in situ in the biopsy specimen. RESULTS: No case of carcinoma in situ was found among the 207 men. The expected number in a normal age matched population of corresponding size was 0.8. CONCLUSIONS: There is no increase in risk of carcinoma in situ of the testis in moderately oligozoospermic men of couples referred because of infertility.     

Fine needle aspiration of the testis. Correlation between cytology and histology

OBJECTIVE: To determine the diagnostic value, reliability, safety and patient discomfort of testicular fine needle aspiration (FNA) as a cytologic sampling technique. All cases were divided into three groups: group A (control group), 15 patients with normal testes undergoing orchiectomy for prostatic carcinoma treatment; group B, 17 cases who had presented with oligoazoospermia for evaluation of male infertility; group C, 20 cases who had presented mainly with scrotal swelling with or without pain. The patients' ages ranged between 22 and 83 years. Older patients entered group A. Younger patients entered group B. A wide range in age occurred in group C. STUDY DESIGN: Fine needle aspirates from 98 testes in 52 patients, 46 bilaterally punctured, were assessed. RESULTS: All fine needle results on group A and most on B and C were correlated with histologic results of biopsy specimens. In 88.5% of cases an excellent correlation was found between the results of the two methods, and the cytologic diagnosis was absolutely precise. The specificity and sensitivity of the method were 100% in this series. CONCLUSION: The procedure was well tolerated, reliable and simple, with no serious complications. Testicular FNA is a useful and safe investigative modality in the evaluation of testicular function and disease.     

Aspects cliniques et biologiques de l’azoospermie chez l’homme infertile en Tunisie

Objective

It is now very important to investigate azoospermia because the introduction of the intracytoplasmic sperm injection technique during the last decade has allowed many infertile men to achieve their dreams of fatherhood. The purpose of this study was to define the characteristics of infertile men with azoospermia, and to analyse the clinical and laboratory features and the causes of infertility in Tunisia. The authors also discuss various aspects that they consider to be very important in the diagnosis of male fertility.

Material and Methods

This retrospective study analysed the parameters of physical examination, laboratory tests, semen analysis, radiographic examinations, testicular biopsy, karyotype and AZF microdeletions.

Results

Based on the results of endocrinological and cytogenetic examinations, the aetiology of azoospermia was considered to be secretory in 43 cases of azoospermia. Physical examination revealed a high percentage of hypotrophic/atrophic testes (43.9%). Serum follicle stimulating hormone levels were high in 58.5% of cases. The overall incidence of chromosomal abnormalities was 31.4%. The most frequent anomaly was Klinefelter syndrome (9 cases). Seven out of 28 patients (25%) with nonobstructive azoospermia had AZF deletions. None of the patients with excretory azoospermia and severe oligospermia had an abnormal karyotype or AZF microdeletions. 48.8% of patients presented a varicocele, 13.9% had cryptorchidism and 13.0% had a history of genital tract infection.

Conclusion

In line with the literature, genetic abmormalities are the main causes of severe forms of impaired spermatogenesis in the Tunisian population.     

二种寄生蜂寄生对不同虫龄小菜蛾精巢的影响

为探明寄生蜂引起寄主寄生性去势的机制,本文选取携带不同多分DNA病毒(Polydnavirus,PDV)的2种内寄生蜂与共同寄主小菜蛾Plutella xylostella(L.)为寄生体系,研究不同虫龄小菜蛾被寄生后雄性生精细胞、精子束形态和精巢发育体积变化,系统比较寄生性去势程度和分别拥有2类PDV的寄生蜂在寄主精子发生和形成过程中的作用。结果表明:携带Bracovirus PDV的菜蛾盘绒茧蜂Cotesiave stalis(Haliday)或拥有Ichvovirus PDV的半闭弯尾姬蜂Diadegma semiclausum Hellén寄生对不同虫龄小菜蛾的精子发生和形成过程均产生明显的抑制作用,表现为不能产生精子束或精子束数量减少,但抑制程度以寄生低龄寄主时最明显。2种蜂寄生均能抑制小菜蛾精巢体积的增长,但对低龄寄主的抑制程度明显强于高龄寄主,寄生性去势程度取决于寄生时寄主虫龄。相比而言,寄生不同虫龄小菜蛾时,茧蜂引起小菜蛾寄生性去势的程度均强于姬蜂。     

Histologie testiculaire et études méiotiques dans les stérilités de type non obstructif

There has been a renewed interes in testicular biopsy to evaluate infertility since the introduction, in 1993, of ICSI in azoospermic men with testicular sperm extraction (TESE) and intracytoplasmic sperm injection for the treatment of obstructive azoospermia. TESE is now performed for the treatment of nonobstructive azoospermia, and the testicular material sampled for therapeutic purposes can also be used for diagnostic and research purposes. The development of new methods of investigation of spermatogenesis, such as immunocytochemistry and fluorescent in situ hybridization (FISH) have also led to a renewed interest in analysis of spermatogenesis on testicular biopsy. A precise “testicular phenotype” must now be established to propose an aetiological diagnosis, and to determine the mechanisms and risks of nonobstructive azoospermia and severe oligozoospermia for the embryo. We systematically perform testicular histopathology and meiotic study for each patient undergoing testicular biopsy for ICSI. We first describe the histopathological lesions. Examination of the testicular biopsy specimen determines whether the lesion is focal or diffuse. If it is focal, the percentage of altered tubules, evaluated on 50 tubules, should be calculated. Quantitative evaluation of seminiferous epithelium and a qualitative study of cell morphology must also be performed. There are four frequent lesion patterns: 1-Sertoli-cell-only syndrome; 2-tubular hyalinisation; 3-diffuse lesions in spermatogenesis; 4-mixed atrophy. However, the reliability of interpretation of testicular histology presents certain limitations, as no standard method of analysis of testicular biopsies has been defined and there is a marked variability in the histologist’s capacity to recognize the various histological patterns. Meiotic study is performed on the cell suspension remaining after ICSI, which contains immature germ cells. New methods using immunocytochemistry have replaced older methods. The panel of antibodies which detect individual protein components at different stages of meiosis provides a valuable tool for the detection and interpretation of abnormal meiotic profiles. We performed meiotic studies on 41 patients and 13 controls after Giemsa staining, and synaptonemal complexes (SC) from nine of these patients and one control were immunostained with a polyclonal antibody which recognizes the COR1/SCP3 protein of the lateral element of the SC. Nineteen of the patients presented obstructive infertility (O) and 22 presented nonobstructive infertility (NO). We showed that the rate of asynaptic nuclei from the NO group (25.4%) was significantly higher than that of the O group (9.8%) and the controls (9.8%). Two patients of the NO group had a high percentage of asynaptic nuclei (86% and 91.8%), which could arise from a primary meiotic defect. One of these patients had an AZFc microdeletion. The meiotic study in a patient with classical complete AZFb microdeletion revealed a high prevalence of early meiotic stages: leptotene, zygotene and early pachytene stages and marked impairment of the synaptic process in most spermatocytes. In the light of these findings, we conclude that the pachytene checkpoint is localized at the mid-pachytene stage in humans.     

Biopsies testiculaires percutanees dans l’exploration des infertilites masculines

Between February 1989 and March 1991, eight patients (mean age 32 years) presenting with azoospermia or severe oligozoospermia underwent a testicular biopsy to investigate their secretory or excretory origin. A bilaterial testicular biopsy was performed percutaneously using an automatic biopsy gun with a Tru-cut 14 gauge needle. General anaesthesia was used for seven patients although one man had a painless biopsy following spermatic cord anaesthesia. Satisfactory specimens were obtained in seven patients (more than 30 spermatogenic tubules visible in each biopsy), and the differential diagnosis of excretory (three cases) or secretory origin (four cases) of the infertility was possible. In six patients a testicular ultrasonographic examination was performed after the biopsy. Results were normal in five men while the sixth showed a haematocoele, although the fluid was removed percutaneously. In 7/8 patients no haemorrhagic or infectious complications were noted. To investigate possible immediate complications of this type of procedure, 25 patients presenting with prostatic carcinoma underwent percutaneous testicular biopsy just before their orchidectomy. In all patients a haematic infiltration of the testicular parenchyma along the needle’s path was observed. Among these 25 men, eight biopsies were performed under local spermatic cord anaesthesia: the procedure was painless in six cases but slightly painful in two. Consequently, percunateous testicular biopsy using an automatic gun is an interesting option compared to the traditional open surgical approach used to investigate spermatogenesis in certain types of male sterility. Furthermore, this procedure can be performed under local anaesthesia in the consulting room, making this altermative approach even more attractive     

Features of impaired seminiferous tubule differentiation are associated with germ cell neoplasia in adult men surgically treated in childhood because of cryptorchidism

Seminiferous tubule differentiation was related to the occurrence of germ cell neoplasia in 38 men, aged 17-47, treated surgically in childhood for cryptorchidism. Tissues from 46 testes obtained from biopsies taken as a neoplastic preventive procedure or whole testes removed because of GCT were evaluated quantitatively. Paraffin sections were treated with antibodies against placental like alkaline phosphatase (PLAP), a marker of germ cell neoplasia, and cytokeratin 18 (CK-18), a marker of immature Sertoli cells. Quality of spermatogenesis and number Leydig cells were assessed with a score count. Seminiferous tubules diameter, thickness of basal membrane and size of intertubular spaces were measured with image analysis software. In 17.4% of testes spermatogenesis was normal (9.9 points) (N) and neoplasia was not found there. In the other 38 specimens (83%) spermatogenesis was abnormal (A). When spermatogenesis was arrested or when germ cells were absent (3.7+/-1.8 points), neoplastic lesions were found in 13.1% of the specimens. In A group 5.1+/-7.1% of tubules contained immature Sertoli cells, while in N they were not found. Tubular diameter was significantly lower in A (161.5+/-31.8 microm) than in N (184.6+/-24.3 microm) and the percentage of seminiferous tubules with the thickening of tubular basal membrane was also greater in A. Intertubular spaces were significantly larger in A (49.9+/-18.6%) in comparison to N group (32.6+/-12.5%). Mean number of Leydig cells was similar in both groups. To conclude, in most of the formerly cryptorchid testes, despite surgical treatment, impaired seminiferous tubules differentiation is predominant. Germ cell neoplasia is present in testes with retarded seminiferous tubules differentiation. Retardation of seminiferous tubule differentiation consists of inhibited spermatogenesis, presence of tubules with immature Sertoli cells, decreased tubular diameter, increased thickness of basal membrane and enlarged intertubular spaces. Examination of testicular biopsy with respect to the state of seminiferous tubule differentiation may be helpful to predict the appearance of germ cell neoplasia in adult men with cryptorchidism in anamnesis. Orchiopexy of cryptorchid testes may not prevent the occurrence of features of testicular dysgenesis and the associated germ cell neoplasia.     

Gonadal function in young adults after surgical treatment of cryptorchidism.

In a follow-up study of 48 young men who had been surgically treated for cryptorchidism before puberty testicular function was assessed by examining the genitalia, testicular volume, secondary sex characteristics, semen, plasma luteinising hormone (LH) and follicle-stimulating hormone (FSH) concentrations after luteinising hormone-releasing hormone stimulation, and plasma testosterone concentrations. Clinical androgen effects were normal. The mean testicular volume of both testes was in the low normal range in those who had had unilateral cryptorchidism and below normal in those who had had bilateral cryptorchidism. Of 37 patients whose sperm counts were recorded (14 bilateral) six showed azoospermia (all bilateral), five had severe oligospermia (four bilateral), and 10 had moderate oligospermia (one bilateral). In nearly all those who had had bilateral cryptorchidism and most of those who had had unilateral cryptorchidism plasma gonadotrophin levels were increased. Four cases of possible partial LH deficiency were identified. Plasma testosterone concentrations were normal in all except two patients.     

Detection of low-grade mosaicism and its correlation with hormonal profile,testicular volume,and semen quality in a cohort of Egyptian Klinefelter and Klinefelter-like patients

Klinefelter syndrome (KS) is the most common chromosomal syndrome, causing infertility in men and leading to non-obstructive azoospermia. Previous studies on mosaicism have shown contradictory results on its correlation with both serum hormone levels and the presence of spermatozoa in the ejaculate of KS, KS-like, and non-KS-like infertile patients. So, the present study was designed to detect low-grade mosaicism in the peripheral blood lymphocytes and buccal mucosa cells of 14 KS and 8 KS-like patients by using fluorescence in situ hybridization (FISH) and to investigate its correlation with luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone (T) levels, testicular volume, and semen analysis compared with 10 normal healthy fertile men. Our results indicated that mosaicism was only found in 42.9 % of the KS patients and completely absent in all KS-like patients. Moreover, mosaicism has led to complete azoospermia and non-significant differences in both hormone levels and testicular volume between mosaic and non-mosaic KS patients. All KS patients demonstrated significant differences in both hormone levels and testicular volume compared with normal men. Conversely, they revealed non-significant differences in hormone levels and significant differences in testicular volume compared with KS-like patients. Additionally, the KS-like patients exhibited non-significant variations in both LH and FSH levels and significant variations in T level and testicular volume compared with normal men. Moreover, all KS-like patients had azoospermia, except for one patient who showed oligozoospermia. Therefore, no correlations were found either between mosaicism and serum hormone levels or with testicular volume and semen analysis.     

Fine needle aspiration biopsy of azoospermic testes. Could it replace histologic biopsy?

OBJECTIVE: To evaluate the possibility of replacing histologic biopsy of azoospermic testes by fine needle aspiration (FNA) for diagnostic and management purposes. STUDY DESIGN: Twenty-seven patients were examined under general anesthesia, and 53 testes were biopsied by FNA. Fifty-four testes were biopsied for histologic examination. Histology and cytology of each testis were compared to assess the discrepancy or concordance between the diagnoses. RESULTS: Twenty-seven testes showed complete concordance of cytology and histology, and 13 testes showed a mild degree of discrepancy. A severe degree of discrepancy was seen in 13 testes. In the majority of discrepant cases, FNA biopsy diagnosis was more sensitive in detecting evidence of full or advanced maturation. In one case of discrepancy, the histologic finding was Sertoli cells only, and cytology revealed focal full maturation. In vitro fertilization using sperm from this case was successful. CONCLUSION: FNA biopsy of testes in azoospermia is a fast, reliable and minimally traumatic method. The prospects for utilizing FNA biopsy material in assisted and microassisted fertilization are promising.     

Male pseudohermaphroditism: diagnosis in cell culture.

Testicular feminization is a classic form of complete male pseudohermaphroditism. The individuals have a normal XY karyotype but unambiguously female external genitalia. They have congenital complete insensitivity to androgen due to an X-linked mutation. In four patients (from tow families with several affected members) with the typical phenotype of testicular feminization, a severe deficit of specific androgen-binding activity was detected in cultured fibroblasts from labium majus skin. Measurement of this activity in genital skin fibroblasts improves the differential diagnosis in patients with complete or imcomplete male pseudohermaphroditism before puberty.     

Testicular atrophy in captive gorillas (Gorilla g. gorilla)

Testes were obtained at post mortem from three Western lowland gorillas, two Bornean orang-utans and one Chimpanzee. All specimens were adults which had died in captivity. Histological examination revealed that two gorillas exhibited complete degeneration of the seminiferous tubules and that the testes contained large amounts of interstitial tissue. Some, less obvious, signs of degeneration were noted in the third specimen but poor preservation of the material hampered interpretation of these features. The testes of the Orang-utans and Chimpanzee were structurally normal. Testicular atrophy in captive gorillas may be more common than is generally realized and there is a need for research on fertility and reproductive endocrinology of male specimens. At the moment it is not possible to identify the causes of testicular dysfunction in captive gorillas.