Histological evaluation of the testicular nubbins in patients with nonpalpable testis: assessment of etiology and surgical approach

Abstract

There is a controversy in the literature whether testicular nubbins carry malignancy risk and excision of the nubbin is necessary in patients with nonpalpable testis. It is also controversial whether vanishing testis has the same etiopathogenesis and risk with true undescended testis. The aim of this study is to investigate the histological findings of testicular nubbins in patients with nonpalpable testis and to question etiology and surgical indications for vanishing testis. We reviewed the histopathological results of 44 testicular nubbins in 40 patients (mean age: 4.1 years, range 1-13 years) with nonpalpable testis between 1992 and 2004, retrospectively. Exploration revealed 5 intraabdominal and 39 inguinal testicular nubbins. Of 44 specimens only 5 (11.3%) from inquinal testicular nubbins were found to have seminiferous tubules. Two of the five had seminiferous tubule structures with viable germ cells showing maturation correlating with age. The other two with scarce seminiferous tubules were seen on only a single area and one had Sertoli cells only. None of the excised tissue had malignant degeneration. The vas deferens was identified in 23 (52.2%), vessels in 26 (59%), calcification in 14 (31.8%) and hemosiderin in 12 (27.2%) of excised tissue. Presence of calcification in one-third of the nubbins supports vascular accident thesis in the etiopathogenesis of vanishing testis. The possibility for the presence of seminiferous tubules and viable germ cells in the testicular nubbin is low. These facts decrease theoritical risk of malingnancy. Therefore, an inguinal exploration for testicular nubbin in patients with vas deferens and vessels entering into the inquinal canal diagnosed at laparoscopy can be postponed untill testicular prosthesis implantation and the nubbin can be removed at this operation.

Feasible etiology of vanishing testis regarding disturbance of testicular development: Histopathological and immunohistochemical evaluation of testicular nubbins

“…3,15,16 However, it is controversial whether vanishing testis have the same etiology and carry the same malignancy risk as undescended testes. 17 In the present study, we focused on the elucidation of mechanisms underlying regressing or vanishing testes. Clarification of the mechanisms underlying testicular regression will not only contribute to appropriate diagnosis or treatment for non-palpable testes, but will also uncover the mechanisms of testicular development or descent.…”

“…On the basis of these observations, some authors suggest the routine removal of testicular nubbins to prevent malignant transformation, 15 but this indication is not accepted by those who did not detect testicular tissue in testicular nubbins. 17 However, given that Sertoli cells and Leydig cells with gene mutations developed malignancy, 28 early excision at the time of initial surgical treatment is recommended.…”

Intra Abdominal Testis- Role of Laproscopy in Search of Hidden Testis

“…Histopathological examination of testicular remnants in nonpalpable testes demonstrated presence of seminiferous tubules and viable germ cells in 0 to 16% of the reported series [15][16][17]. Based on these observations, some authors suggest routine removal of testicular remnant tissue to prevent malignant transformation, but others did not accept this indication because they could not find testicular tissue in testicular remnants.…”

Testicular nubbins and prosthesis insertion: is it all just in the timing?

“…Secondly, the authors' article implies that insertion of a testicular prosthesis represents routine practice and should therefore be another reason to safely defer exploration and removal of a testicular nubbin late in adolescence [1]. Insertion of such a prosthesis, however, would not represent standard practice at my institution.…”

“…Ó Springer-Verlag 2007 Dear Editor, I was interested to read Emir et al's [1] article on the histological evaluation of testicular nubbins in boys with an impalpable testis. At a mean age of 4.1 years 44 testicular nubbins were examined in 40 boys.…”