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Thorup J, Hildorf S, Hildorf AE, Baastrup JM, Mamsen LS, Andersen CY, Olsen TE, Cortes D. The fate of germ cells in cryptorchid testis. Front Endocrinol (Lausanne) 2024; 14:1305428. [PMID: 38234428 PMCID: PMC10792029 DOI: 10.3389/fendo.2023.1305428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 11/29/2023] [Indexed: 01/19/2024] Open
Abstract
Cryptorchidism in males constitutes a notable risk factor for both infertility and testicular cancer. Infertility in adulthood is closely linked to the germ cell status in childhood. Furthermore, the significance of germ cell status is important as more than 95% of all reported testicular malignancies are germ cell tumors. The review aims to elucidate the pathogenesis of germ cells in cryptorchid testes concerning their association with infertility and testicular malignancies. Impaired germ cell numbers are evident in cryptorchid testes even during antenatal and neonatal stages. In cryptorchidism there is a rapid decline in germ cell number within the first year of life, partially attributed to physiologic gonocyte apoptosis. Additionally, germ cells fail to differentiate normally during mini-puberty leading to reduced germ cell proliferation and delayed clearance of gonocytes from the seminiferous epithelium. Absence of germ cells in testicular biopsies occurs already 10 months of age and germ cell deterioration progressively worsens with approximately 50% of persisting cryptorchid testes lacking germ cells during puberty. The deficient germ cell maturation and proliferation leads to later infertility. Elevated temperature in the cryptorchid testes and also hormonal deficiency contribute to this phenomenon. Germ cell neoplasia in situ (GCNIS) originating during fetal development may manifest in rare cases associated with disorders of sexual development, chromosomal abnormalities in boys, specific syndromes, and teratomas that include cryptorchidism. In adults, the presence of GCNIS predominantly represents a new histology pattern before invasive germ cell cancer is demonstrated and is neither congenital nor related to abnormal gonocyte transformation.
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Affiliation(s)
- Jorgen Thorup
- Department of Pediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Simone Hildorf
- Department of Pediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Andrea E. Hildorf
- Department of Pediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jonas M. Baastrup
- Department of Pediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Linn Salto Mamsen
- The Laboratory of Reproductive Biology, Rigshospitalet, Copenhagen, Denmark
| | | | - Tina E. Olsen
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Dina Cortes
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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García-Andrade F, Vigueras-Villaseñor RM, Chávez-Saldaña MD, Rojas-Castañeda JC, Bahena-Ocampo IU, Aréchaga-Ocampo E, Flores-Fortis M, Díaz-Chávez J, Herrera LA, Landero-Huerta DA. Molecular Characterization of Patients with Cryptorchidism: Preliminary Search for an Expression Profile Related to That of Testicular Germ-Cell Tumors. Diagnostics (Basel) 2023; 13:3020. [PMID: 37761387 PMCID: PMC10529510 DOI: 10.3390/diagnostics13183020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/30/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
Cryptorchidism (CO) is a risk factor for the development of testicular germ-cell tumors (TGCT). This is supported by reports showing the persistence of gonocytes in CO patients. These cells are proposed to be related to the development of germ-cell neoplasia in situ (GCNIS), which is considered the precursor stage/lesion of TGCT. Therefore, it is proposed that some patients with CO could express some molecular markers related to TGCT. In this study, we analyzed testicular tissue samples from CO, TGCT, and controls. We determined the expression of POU5F1, PLAP, and KIT by immunohistochemistry and that of the hsa-miR-371-373 cluster, hsa-miR-367, and LATS2, PTEN, and IGFR1 genes by RT-qPCR. We then carried out a bioinformatic analysis to identify other possible candidate genes as tumor biomarkers. We found that 16.7% (2/12) of the CO patients presented increased expression of POU5F1, KIT, PLAP, hsa-miR-371-373, and hsa-miR-367 and decreased expression of LATS2 and IGF1R. Finally, the genes ARID4B, GALNT3, and KPNA6 were identified as other possible candidate tumor biomarkers. This is the first report describing the expression of the hsa-miR-371-373 cluster, hsa-miR-367, LATS2, and IGF1R in the testicular tissues of two CO patients with cells immune-positive to POU5F1, PLAP, and KIT, which is similar to what is observed in TGCT.
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Affiliation(s)
- Fabiola García-Andrade
- Laboratorio de Biología de la Reproducción, Instituto Nacional de Pediatría, Ciudad de Mexico 04530, Mexico
- Posgrado en Biología Experimental, Universidad Autónoma Metropolitana, Unidad Iztapalapa, Ciudad de Mexico 09310, Mexico
| | | | | | | | - Ivan Uriel Bahena-Ocampo
- Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana, Unidad Iztapalapa, Ciudad de Mexico 09310, Mexico
| | - Elena Aréchaga-Ocampo
- Departamento de Ciencias Naturales, Universidad Autónoma Metropolitana, Unidad Cuajimalpa, Ciudad de Mexico 05348, Mexico
| | - Mauricio Flores-Fortis
- Posgrado en Ciencias Naturales e Ingeniería, Universidad Autónoma Metropolitana, Unidad Cuajimalpa, Ciudad de Mexico 05348, Mexico
| | - José Díaz-Chávez
- Unidad de Investigación en Cáncer, Instituto de Investigaciones Biomédicas-Universidad Nacional Autónoma de México, Instituto Nacional de Cancerología, Ciudad de Mexico 14080, Mexico
| | - Luis Alonso Herrera
- Unidad de Investigación en Cáncer, Instituto de Investigaciones Biomédicas-Universidad Nacional Autónoma de México, Instituto Nacional de Cancerología, Ciudad de Mexico 14080, Mexico
- Escuela de Medicina y Ciencias de la Salud-Tecnológico de Monterrey, Ciudad de Mexico 14380, Mexico
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Yu H, Feng B, Zhang Y, Lyu J. Development and validation of a nomogram for predicting the overall survival of patients with testicular cancer. Cancer Med 2023; 12:15567-15578. [PMID: 37264772 PMCID: PMC10417196 DOI: 10.1002/cam4.6203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/25/2023] [Accepted: 05/23/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND The purpose of this study was to develop and validate a nomogram to predict survival in testicular cancer patients. METHODS Testicular cancer patients diagnosed between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database were selected for this study. A random sampling method was used to divide patients into training and validation cohorts, which accounted for 30% and 70% of the total sample, respectively. The nomogram was developed using the training cohort and evaluated using the C index, calibration chart, and area under the receiver operating characteristic curve (AUC). RESULTS Seven risk factors that affect the survival of testicular cancer patients (AJCC stage, marital status, age at diagnosis, race, SEER historic stage A, surgery status, and origin) were identified using Cox proportional hazard regression analysis. The nomogram has a higher C index (0.897) and AUC when compared with the AJCC staging system. The results of the calibration chart of the nomogram show that the predicted survival of testicular cancer patients at 3, 5, and 10 years after diagnosis is very close to their actual survival. CONCLUSIONS We developed and validated a nomogram for predicting the survival rate of testicular cancer patients at 3, 5, and 10 years after diagnosis. This nomogram has better discrimination, calibration, and clinical validity than the AJCC staging system. This indicates that the nomogram can be used to predict the survival of testicular cancer patients effectively, and provide a reference for patient treatment strategies.
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Affiliation(s)
- Haohui Yu
- Department of Medical AdministrationThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Bin Feng
- Department of Medical AdministrationThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Yunrui Zhang
- Department of Medical AdministrationThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Jun Lyu
- Department of Medical AdministrationThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
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Hildorf SE, Clasen-Linde E, Cortes D, Fossum M, Thorup J. The positive predictive value of using fsh and Inhibin-B serum levels to diagnose gonadotropin insufficiency in bilateral cryptorchid boys is high. J Pediatr Urol 2022; 18:844.e1-844.e7. [PMID: 36404197 DOI: 10.1016/j.jpurol.2022.10.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 10/26/2022] [Accepted: 10/29/2022] [Indexed: 11/11/2022]
Abstract
AIM OF STUDY Despite early surgery, many boys with bilateral cryptorchidism at surgery have a reduced number of germ cells per tubular cross-section (G/T) in testicular biopsies and/or low inhibin-B with no elevated follicle-stimulating hormone (FSH) as expected based on a normal gonadotropin feed-back mechanism. Such boys have a high risk of later infertility because of insufficient gonadotropin stimulation and may benefit from adjuvant hormonal treatment. Testicular biopsies are not always wanted or accepted. The study aim was to investigate the value of a low inhibin-B and normal FSH to identify patients that might benefit from adjuvant hormonal treatment avoiding the need for testicular biopsy. METHODS A series of boys with cryptorchidism were evaluated with serum levels of inhibin-B and FSH in relation to G/T in testicular biopsies, which were compared to previously published age-matched normal control values. RESULTS A total of 365 boys who underwent bilateral orchidopexy between 0.4 and 7.8 (median: 2) years of age were included. Twenty-seven (7%) patients had increased FSH and low G/T, whereas 11 of these also had low inhibin-B indicating hypergonadotropic hypogonadism. Moreover, 85 (23%) patients between 0.75 and 7.5 (median: 2) years of age had both low G/T (median: 0.3) and low inhibin-B (median: 56 pg/ml) but normal FSH (median: 0.6 U/l) indicating a gonadotropin insufficiency. Three patients with normal FSH and low inhibin B had normal G/T. DISCUSSION Our study shows that if surgeons prefer to avoid testicular biopsies and only wish to rely on hormonal parameters (low inhibin-B and normal FSH) in order to diagnose a gonadotropin insufficiency as the cause of hypogonadism, they will identify only about 30% of such cases and overlook about 70% of patients sharing the same endocrinopathy. In addition, if surgeons treat patients for gonadotropin insufficiency only based on low inhibin-B and normal FSH they will solely treat patients with gonadotropin insufficiency and would not overtreat patients. CONCLUSION Adjuvant hormonal treatment was indicated by a gonadotropin insufficiency discerned in 23% of boys with bilateral cryptorchidism. Without histology, the clinicians are left with more difficult clinical judgments to identify patients for adjuvant hormonal treatment. The positive predictive value of low inhibin-B and normal FSH corroborated by low G/T was 0.97 (85/85 + 3), but the sensitivity was low (0.30).
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Affiliation(s)
- Simone E Hildorf
- Department of Paediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Erik Clasen-Linde
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Dina Cortes
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Hvidovre, Denmark
| | - Magdalena Fossum
- Department of Paediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Jorgen Thorup
- Department of Paediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Facer L, Pham T, Rogers D. Lost in descent: Complications of cryptorchidism. Radiol Case Rep 2022; 18:161-168. [PMID: 36345463 PMCID: PMC9636006 DOI: 10.1016/j.radcr.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 10/06/2022] [Indexed: 11/23/2022] Open
Abstract
Cryptorchidism is a relatively common and important clinical entity and can lead to an array of downstream complications if it is not corrected in a timely manner, most notably with the development of testicular germ cell tumors. However, beyond the development of malignancy, there are other rare complications associated with cryptorchid testicular germ cell tumors which are more commonly seen in females with ovarian germ cell tumors, including torsion, rupture, and paraneoplastic syndromes. Presented is an instructive case (with literature review) of a patient who presented with NMDA encephalitis due to a torsed mixed germ cell tumor of an undescended testis, which subsequently ruptured leading to growing teratoma syndrome.
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Affiliation(s)
- Lauren Facer
- Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, 1A081, Salt Lake City, UT 84132, USA
| | - Theresa Pham
- Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, 1A081, Salt Lake City, UT 84132, USA
| | - Douglas Rogers
- Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, 1A081, Salt Lake City, UT 84132, USA,Department of Abdominal Imaging, University of Utah, Salt Lake City, UT, USA,Corresponding author.
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6
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Hildorf SE. Clinical aspects of histological and hormonal parameters in boys with cryptorchidism: Thesis for PhD degree. APMIS 2022; 130 Suppl 143:1-58. [PMID: 35822689 PMCID: PMC9542020 DOI: 10.1111/apm.13247] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/09/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Simone Engmann Hildorf
- Department of Pediatric Surgery and Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Hildorf S, Hildorf AE, Clasen-Linde E, Cortes D, Walther-Larsen S, Li R, Hutson JM, Thorup J. The Majority of Boys Having Orchidopexy for Congenital Nonsyndromic Cryptorchidism during Minipuberty Exhibited Normal Reproductive Hormonal Profiles. Eur J Pediatr Surg 2022; 32:26-33. [PMID: 34847578 DOI: 10.1055/s-0041-1739416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The activation of the hypothalamic-pituitary-gonadal axis that occurs in male minipuberty during the first 5 months of life is important for early germ cell development. Orchidopexy during minipuberty may improve fertility potential as the germinative epithelium may benefit from the naturally occurring gonadotropin stimulation. We hypothesize that most boys with congenital nonsyndromic cryptorchidism display normal reproductive hormonal profiles and histological findings during minipuberty. METHODS We included boys with congenital nonsyndromic cryptorchidism who underwent orchidopexy at less than 160 days of age, having no potential for spontaneous resolution clinically. At surgery, testicular biopsies and reproductive hormones were collected and compared with normal reference values. We measured the germ cells (G/T) and type A dark spermatogonia number per tubule. RESULTS Thirty-five boys aged 37 to 159 (median age: 124) days at orchidopexy were included, five were bilateral. G/T was below the normal lower range in 26% (9/35) of the cases. In six of these cases, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were above 97.5 percentile, whereas one case had FSH below 2.5 percentile. Totally, 97% (33/34, one FSH was missing) exhibited a normal LH/FSH ratio. LH was more often above 97.5 percentile than FSH: 34% (12/35) versus 3% (1/34, p < 0.001). Inhibin B was below 2.5 percentile in 17% (6/35) of cases who all proved FSH above normal mean and four had LH above normal mean. CONCLUSION Generally, reproductive hormonal profiles of the cryptorchid boys exhibited normal minipubertal pattern. Thus, 26% of the boys had reduced germ cell number, and transient hypogonadotropic hypogonadism could be suspected in few cases.
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Affiliation(s)
- Simone Hildorf
- Department of Pediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Andrea E Hildorf
- Department of Pediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Erik Clasen-Linde
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Dina Cortes
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Søren Walther-Larsen
- Department of Paediatric Anesthesiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ruili Li
- Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - John M Hutson
- Department of Urology, the Royal Children's Hospital, Melbourne, Australia
| | - Jorgen Thorup
- Department of Pediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Hildorf S, Cortes D, Thorup J, Clasen-Linde E, Hutson J, Li R. During infancy low levels of follicle-stimulating hormone may result in high rate of germ cell apoptosis. J Pediatr Surg 2021; 56:2399-2406. [PMID: 33691939 DOI: 10.1016/j.jpedsurg.2021.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/21/2021] [Accepted: 02/04/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE It has been suggested that follicle-stimulating hormone (FSH) plays a role in preventing germ cell apoptosis. We aimed to compare apoptotic rate of boys with cryptorchidism having different levels of FSH in order to investigate its role in apoptosis. METHODS Hormonal profiles and testicular biopsies from 30 boys with unilateral cryptorchidism (age range: 4-14 months) were included. Based on FSH level, the boys were grouped into three (3 × 10) having high (>97.5percentile), low (<2.5percentile), or within normal range. Sections underwent immunohistochemical staining to analyze the number of germ cells and type A dark spermatogonia per cross-sectional tubule. One section was co-stained with immunofluorescent antibodies against an apoptotic marker (cleaved caspase-3), proliferation marker (Ki67), Sertoli cell marker (anti-Müllerian hormone) and processed by confocal imaging for analysis. Germ cell apoptosis was calculated as the apoptosis index (percentage caspase-3+ germ cells/total germ cell number). RESULTS Fifty percent (5/10) of the boys with low FSH had an apoptosis index above 90% compared with 15% (3/20) of the boys with normal or high FSH (p = 0.04). Caspase-3+ germ cells were most likely to be located on the basement membrane (p<0.05). CONCLUSION Our findings lead to trends proposing that FSH may play a role in preventing apoptosis. TYPE OF STUDY Prognosis Study LEVEL OF EVIDENCE: III.
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Affiliation(s)
- Simone Hildorf
- Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Paediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark.
| | - Dina Cortes
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Jørgen Thorup
- Department of Paediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Erik Clasen-Linde
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - John Hutson
- Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Urology, The Royal Children's Hospital, Melbourne, Australia
| | - Ruili Li
- Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Vigueras-Villaseñor RM, Ramírez Cuevas Z, Chávez-Saldaña M, Landero-Huerta DA, Cuevas Alpuche JO, Arceo Olaiz RA, Rojas-Castañeda JC. Disorders in the function of Sertoli cells and arrest in the differentiation of gonocytes in patients with cryptochidism and microlithiasis. J Pediatr Surg 2021; 56:1886-1893. [PMID: 33461744 DOI: 10.1016/j.jpedsurg.2020.12.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE This study aimed to correlate the presence of microlithiasis (ML) in cryptorchidism (CO) patients with the functionality of Sertoli cells and the arrest of gonocyte differentiation. METHODS Testicular biopsies were obtained from 21 inguinal CO pediatric patients and were classified in two groups as follows: patients with ML and those without ML. In both groups, the number of Sertoli cells/seminiferous cords and their functionality were determined, considering the concentrations of inhibin B. In addition, the area and the histological alterations of seminiferous epithelium were evaluated. The arrest of gonocyte differentiation was determined by immunoreactivity to SALL4, AP2ɣ, PLAP and POU5F1. RESULTS We found a statistical correlation between the presence of ML with the alterations in the functionality of Sertoli cells without reflecting in the differentiation of the gonocytes. CONCLUSION The study of this population suggests that the association between CO and ML shows a malfunction of the Sertoli cells without necessarily causing arrest in the differentiation of gonocytes in these patients.
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Affiliation(s)
| | - Zayra Ramírez Cuevas
- Laboratorio de Biología de la Reproducción, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - Margarita Chávez-Saldaña
- Laboratorio de Biología de la Reproducción, Instituto Nacional de Pediatría, Mexico City, Mexico
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de la Calle CM, Kim S, Baskin LS. Diagnosis and treatment of the intra-abdominal gonad in the pediatric population: Testes, ovaries, dysgenetic gonads, streaks, and ovotestes. J Pediatr Surg 2020; 55:2480-2491. [PMID: 32164982 DOI: 10.1016/j.jpedsurg.2020.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/14/2020] [Accepted: 02/16/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND/PURPOSE Pediatric surgical specialists are often confronted with the difficult task of identifying, diagnosing and managing intra-abdominal gonads in children. Ranging from the intra-abdominal cryptorchid testis to normal or pathologic ovaries and gonads in disorders of sexual development, all intra-abdominal gonads in the pediatric population pose different diagnosis and management challenges. Understanding the hormonal and fertility potential of the gonad and knowing its potential cancer risk is essential when deciding how to manage these patients. In addition, the ideal surgical management for each one of these patients is often debated. METHODS Descriptive literature review. RESULTS/CONCLUSION Herein, we reviewed gonadal formation, common etiologies, diagnosis and management of intra-abdominal testes, pathologic ovaries and gonads in disorders of sexual development. Fertility potential and cancer risk for each were also reviewed and how both affect surgical management of the gonad. TYPE OF STUDY/LEVEL OF EVIDENCE Review Article, Level V.
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Affiliation(s)
- Claire M de la Calle
- Department of Urology, University of California San Francisco, San Francisco, CA, USA.
| | - Sunghoon Kim
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
| | - Laurence S Baskin
- Department of Urology, University of California San Francisco, San Francisco, CA, USA.
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Kvist K, Hildorf S, Clasen-Linde E, Cortes D, Thorup J. Germ cells positive for PLAP and c-Kit in 11-16 year old normal boys with ongoing spermatogenesis. Pediatr Surg Int 2020; 36:1249-54. [PMID: 32772137 DOI: 10.1007/s00383-020-04725-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Positive staining of testicular germ cells for PLAP and c-Kit beyond infancy may be associated with the presence of GCNIS (Germ Cell Neoplasia In Situ). We recently reported our findings of positive staining of normal, infantile germ cells for PLAP, and c-Kit up to 2 years of age, contrary to previous studies. The present study aims to elucidate whether otherwise normal testes of boys undergoing puberty express PLAP, c-Kit, Oct3/4, or D2-40. MATERIALS AND METHODS Biopsies were taken from 31 boys (11.5-16.5 years of age, mean and median of 13.5 years), who underwent surgery either for torsion of the testis (15) or a history suspicious of intermittent torsion of the testis (16). 21 were biopsied on both sides, making a total of 52 biopsies. Four testes were necrotic. The biopsies were fixed in Stieve's medium, cut into 2 μm sections, and mounted on coated slides. One slide was processed for H-E, and the others incubated with primary antibody for PLAP, c-Kit, D2-40, and Oct3/4. RESULTS 87% of the boys stained positive for both PLAP and c-Kit. None were positive for either D2-40 or Oct3/4. None had any histological features characteristic of GCNIS. Only two boys showed no signs of having initiated spermatogenesis. Those positive for PLAP were likewise for c-Kit, and vice versa, except 2; one boy, 13 years, was positive for PLAP, but negative for c-KIT, another, 16 years, was negative for PLAP and positive for c-Kit. Three boys stained positive for PLAP and c-Kit on the right side, and negative on the left. One boy was negative for c-Kit on the right side, positive on the left, and positive for PLAP bilaterally. CONCLUSION Positive staining of testicular germ cells for PLAP and c-Kit seems to be a normal finding in boys not having completed puberty. Rather than indicating pre-malignant transformation, the positivity is indicative of an ongoing maturational process of the germ cells.
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Loebenstein M, Thorup J, Cortes D, Clasen-Linde E, Hutson JM, Li R. Cryptorchidism, gonocyte development, and the risks of germ cell malignancy and infertility: A systematic review. J Pediatr Surg 2020; 55:1201-1210. [PMID: 31327540 DOI: 10.1016/j.jpedsurg.2019.06.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/18/2019] [Accepted: 06/28/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM Cryptorchidism, or undescended testis (UDT) occurs in 1%-4% of newborn males and leads to a risk of infertility and testicular malignancy. Recent research suggests that infertility and malignancy in UDT may be caused by abnormal development of the neonatal germ cells, or gonocytes, which normally transform into spermatogonial stem cells (SSC) or undergo apoptosis during minipuberty at 2-6 months in humans (2-6 days in mice). We aimed to identify the current knowledge on how UDT is linked to infertility and malignancy. METHODS Here we review the literature from 1995 to the present to assess the possible causes of infertility and malignancy in UDT, from both human studies and animal models. RESULTS Both the morphological steps and many of the genes involved in germ cell development are now characterized, but the factors involved in gonocyte transformation and apoptosis in both normal and cryptorchid testes are not fully identified. During minipuberty there is evidence for the hypothalamic-pituitary axis stimulating gonocyte transformation, but without known direct control by LH and androgen, although FSH may have a role. An arrested gonocyte maybe the origin of later malignancy at least in syndromic cryptorchid testes in humans, which is consistent with the recent finding that gonocytes are normally absent in a rodent model of congenital cryptorchidism, where malignancy has not been reported. CONCLUSION The results of this review strengthen the view that malignancy and infertility in men with previous UDT may be caused by abnormalities in germ cell development during minipuberty. TYPE OF STUDY Systematic review (secondary, filtered) LEVEL OF EVIDENCE: Level I.
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Affiliation(s)
- Moshe Loebenstein
- Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia
| | - Jorgen Thorup
- Department of Paediatric Surgery, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dina Cortes
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Section of Endocrinology, Department of Pediatrics, Copenhagen University Hospital Hvidovre, Denmark
| | - Erik Clasen-Linde
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - John M Hutson
- Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia; Department of Urology, The Royal Children's Hospital, Melbourne, Australia
| | - Ruili Li
- Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia.
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Li R, Azzollini D, Shen R, Thorup J, Clasen-Linde E, Cortes D, Hutson JM. Postnatal germ cell development during first 18 months of life in testes from boys with non-syndromic cryptorchidism and complete or partial androgen insensitivity syndrome. J Pediatr Surg 2019; 54:1654-1659. [PMID: 30739749 DOI: 10.1016/j.jpedsurg.2018.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 11/28/2018] [Accepted: 12/18/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Neonatal testicular germ cells/gonocytes, transform into stem cells for spermatogenesis during 'minipuberty', driving change in timing of surgery. This study examined gonocyte transformation in cryptorchid testes in children ≤18 months of age with unilateral, bilateral undescended testes (UDT), complete or partial androgen insensitivity syndrome (CAIS, PAIS) [3,4]. MATERIAL AND METHODS Testicular biopsies were taken from patients with unilateral or bilateral UDT, PAIS or CAIS, aged 10 days-18 months. These testicular sections underwent immunohistochemistry with antibodies (Oct4, Ki67, C-Kit, Sox9) followed by confocal imaging, cell counting and statistical analysis. RESULTS Both Sertoli cells/tubule and germ cells (GC)/tubule decreased with age, and % empty tubules (no GC) increased with age but with no significant differences between patient groups. Oct4+ germ cells/tubule decreased with age. There are some GCs and Sertoli cells proliferating during the first year and most proliferating Oct4+ germ cells (Oct4+/Ki67+) were located off tubular basement membrane. CONCLUSION Our study showed that Oct4 expression gradually decreased after minipuberty and transformation into spermatogonia. Germ cells and Sertoli cells undergo mitosis during the first 12 months although not abundantly. We propose that Oct4+ gonocyte transformation into spermatogonia via proliferation and migration to the basement membrane may be delayed in UDT.
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Affiliation(s)
- Ruili Li
- Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia.
| | - Damian Azzollini
- Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Ruidong Shen
- Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jorgen Thorup
- Department of Paediatric Surgery, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Dina Cortes
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Pediatrics, Hvidovre University Hospital and University of Copenhagen, Denmark
| | - John M Hutson
- Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia; Department of Urology, The Royal Children's Hospital, Melbourne, Australia
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Abstract
Around 1.4-3.8% of boys in the Western world are operated because of cryptorchidism. This means that orchidopexy remains one of the most common surgical procedures performed in boys. As a consequence, several consensus reports, guidelines, and reviews dealing with the management of cryptorchidism have been published recently. Based on our research and 30 years' experience with the management of cryptorchidism, the intention of the present publication is to advise on the surgical management and comment on the expected outcome, especially with focus on the controversies related to guidelines and reviews. Except for late referral and waiting lists, which may be practical problems, there is no reason to postpone orchidopexy for nonsyndromic congenital cryptorchid testes beyond 6 months. There is good evidence that such strategy improves the fertility potential and decreases the risk of testicular cancer. In cases with genuine gonadotropin insufficiency, early surgical correction is not enough and adjuvant LH-RH treatment should be implemented to improve the fertility potential. Cryopreservation may be an option in case of treatment failure of adjuvant LH-RH. A prerequisite for such management includes serum hormone assessment and evaluation of testicular biopsies at orchidopexy. Ascended testes contribute to 20-60% of operative cases and should be treated when diagnosed.
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Assisi L, Pelagalli A, Squillacioti C, Liguori G, Annunziata C, Mirabella N. Orexin A-Mediated Modulation of Reproductive Activities in Testis of Normal and Cryptorchid Dogs: Possible Model for Studying Relationships Between Energy Metabolism and Reproductive Control. Front Endocrinol (Lausanne) 2019; 10:816. [PMID: 31824429 PMCID: PMC6882921 DOI: 10.3389/fendo.2019.00816] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 11/07/2019] [Indexed: 12/25/2022] Open
Abstract
Orexin A (OxA) is a neuropeptide produced in the lateral hypothalamus that performs pleiotropic functions in different tissues, including involvement in energy homeostasis and reproductive neuroendocrine functions. The role of OxA is particularly important given the well-studied relationships between physiological mechanisms controlling energy balance and reproduction. The enzyme P450 aromatase (ARO) helps convert androgens to estrogens and has roles in steroidogenesis, spermatogenesis, and energy metabolism in several organs. The goal of this study was thus to investigate the role of OxA in ARO activity and the effects of this regulation on reproductive homeostasis in male gonads from healthy and cryptorchid dogs. The cryptorchidism is a specific condition characterized by altered reproductive and metabolic activities, the latter of which emerge from impaired glycolysis. OxA helps to stimulate testosterone (T) synthesis in the dog testis. We aimed to investigate OxA-mediated modulation of 17β-estradiol (17β-E) synthesis, ARO expression and metabolic indicators in testis of normal and cryptorchid dogs. Our results indicate putative effects of OxA on estrogen biosynthesis and ARO activity based on western blotting analysis and immunohistochemistry for ARO detection and in vitro tests. OxA triggered decrease in estrogen production and ARO activity inhibition; reduced ARO activity thus prevented the conversion of T to estrogens and increasing OxA-mediated synthesis of T. Furthermore, we characterized some metabolic and oxidative modulations in normal and cryptorchid dog's testis. The steroidogenic regulation by OxA and its modulation of ARO activity led us to hypothesize that OxA is a potential therapeutic target in pathological conditions associated with steroidogenic alterations and OxA possible involvement in metabolic processes in the male gonad.
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Affiliation(s)
- Loredana Assisi
- Department of Biological Sciences, University of Naples Federico II, Naples, Italy
| | - Alessandra Pelagalli
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
- Institute of Biostructures and Bioimages, National Research Council, Naples, Italy
| | - Caterina Squillacioti
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, Naples, Italy
- *Correspondence: Caterina Squillacioti
| | - Giovanna Liguori
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, Naples, Italy
| | - Chiara Annunziata
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Nicola Mirabella
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, Naples, Italy
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Kvist K, Clasen-Linde E, Langballe O, Hansen SH, Cortes D, Thorup J. The Expression of Markers for Intratubular Germ Cell Neoplasia in Normal Infantile Testes. Front Endocrinol (Lausanne) 2018; 9:286. [PMID: 29910774 PMCID: PMC5992279 DOI: 10.3389/fendo.2018.00286] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/14/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Positive immunohistochemical expression of testicular cancer markers is often reported beyond 12 months of age in cryptorchid testes, which is assumed to indicate delayed maturation of the fetal germ cells, or neoplastic changes. These findings allowed for questions as to the extent of positive reaction in normal testes. The aim of the study was to clarify the expression of these markers in a normal material up to 2 years. METHODS Testicular material from 69 boys aged 1-690 days, who died of causes with no association of testicular pathology. Histology sections were incubated with primary antibodies including anti-placental-like alkaline phosphatase (PLAP), anti-C-Kit, anti-D2-40, and anti-Oct3/4. The mean germ cell number per tubular transverse section (G/T) was calculated based on the G/T of both testes of every boy. RESULTS The mean G/T declined through the 690 days. PLAP appeared stably expressed throughout the ages studied. The likelihood of a positive reaction for C-Kit waned with increasing age within the study period. Positive staining for D2-40 and Oct3/4 was demonstrated up to 6 and 9 months respectively. CONCLUSION Up to 1 or 2 years of age, normal infantile testes contain germ cells positive for the immunohistochemical markers commonly utilized to aid in the detection of testicular cancer. This finding supports the concept of germ cells undergoing a continuous maturational process in a heterogeneous fashion, and that this process is not complete by 2 years of age.
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Affiliation(s)
- Kolja Kvist
- The Department of Pediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Erik Clasen-Linde
- The Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Oline Langballe
- The Department of Pediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Steen Holger Hansen
- Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Dina Cortes
- Department of Pediatrics, Section of Endocrinology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jorgen Thorup
- The Department of Pediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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