Primary Epithelioid Angiosarcoma of the Adrenal Gland Case Report and Review of the Literature

Primary angiosarcoma of the adrenal gland is extremely rare. Here, we report on a 70-year-old man with an angiosarcoma of the right adrenal gland who died 3 weeks after tumor resection due to intestinal infarction and acute renal failure. No metastases were found at autopsy. Histologically, the tumor showed a predominantly epithelioid differentiation. Immunohistochemical examination revealed positive reactivity for cytokeratin, epithelial membrane antigen, vimentin, factor Vlll-related antigen, CD31, CD34 and Ulex eu-ropaeus agglutinin-l. Features of endothelial origin were also demonstrable by electron microscopy. The differential diagnosis of this uncommon neoplasm is discussed. The present case emphasizes problems in differential diagnosis that arise from its epithelioid differentiation. A review of the literature underlines the poor clinical outcome of adrenal angiosarcoma.

[Clinical pathology in the Hanseatic City of Lübeck from the planning of an institute to the formation of the "Medizinische Hochschule"]

The formation of an university institute of pathology at the Hanseatic city of Lübeck preceded a long, changeful planning, accompanied by a chain of historical events. In the 19th century, Lübeck owned seven different places for clinical or forensic autopsies. Thus, in the first years of the 20th century it was generally called for the formation of a "Central Institute of Pathology" that was completed after all in the year 1927. Two years later, Eberhard von Praun became head of the institute and was immediately confronted with the "Lübeck-disaster". He was followed 1935 by Ernst Jeckeln, who identified the "Enteritis necroticans" which appeared in North Germany in the first years after the "Second World War". He called the disease "Darmbrand", a term that is since then internationally used. Jeckeln became the first "Ordinarius for Pathology" at the "Medical Academy Lübeck", which was associated to the "University of Kiel". His long-time colleague was Alfred Wegener, who identified the "Wegener's granulomatosis". In the year 1972 Alfred Gropp became head of the institute, an all-round scientist and pathologist, e.g. well-known in the field of developmental pathology. During his term, the "Medical Academy" got the university status and was named "Medizinische Hochschule Lübeck".

Increased frequency of X-bearing sperm in males from an infertility clinic: analysis by two-color fluorescence in situ hybridization

Semen samples from 34 men visiting the Lübeck infertility clinic were investigated using a two-color FISH method to determine the ratio of X- and Y-bearing sperm. The overall ratio was significantly shifted to a preponderance of X-containing sperm. A statistical comparison with seven reports from the literature which included 53 normal probands demonstrated in our patients a significant tendency of a preponderance of X-bearing sperm and significantly less Y-bearing sperm. Furthermore, the Lübeck sperm samples are remarkably more heterogeneous in respect to their variability of X- and Y-bearing spermatozoa than in the other mentioned studies with normal probands. These phenomena have to be evaluated in further studies on groups of infertile males showing similar infertility histories.

Megalospermatocytes in the human testis exhibit asynapsis of chromosomes

Testis biopsies of three infertile patients were identified, which showed a predomination of megalospermatocytes in the seminiferous tubules. Megalospermatocytes are very large primary spermatocytes indicating a spermatogenic arrest. Because of the high percentage of these germ cells it was possible to apply a whole-mount spreading technique to investigate the chromosomal pairing behaviour in prophase I of meiosis. It could be shown that most of the megalospermatocytes exhibited extensive chromosomal asynapsis, suggesting that a characteristic meiotic disorder may give rise to reduced fertility, or even infertility.

[Transmission electron microscopy image of wear particles of joint endoprostheses and ultrastructural cell changes]

Wear particles from joint endoprostheses vary considerably in size, and may be detectable in tissue only by electron microscopy. Wear debris plays a central role in the non-infectious late loosening of prostheses, and it has been estimated that the submicron particles induce increased liberation of mediators of osteolysis by activated macrophages. From the types of prostheses currently in use, bone cement and polyethylene particles greatly predominate over metallic and ceramic particles. Since it had formerly not been possible to reliably identify wear particles in the transmission electron microscopy, and descriptions of them in the literature varied considerably, we analysed ultrathin sections obtained from periprosthetic tissue containing wear particles previously identified by laser microprobe mass analysis. Using this method, it proved possible to classify almost all the wear particles detected in the electron microscope, to determine their size range and to represent the cellular alterations caused by them.

[Severe 46,XY virilization deficit due to 17beta-hydroxysteroid dehydrogenase deficiency]

BACKGROUND

17beta hydroxysteroid dehydrogenase deficiency is a presumable rare cause for a severe virilization disorder in children with 46,XY karyotype due to a defect in the testicular testosterone biosynthesis from androstenedione.

PATIENT

We report on a 14 year old child with 46,XY karyotype with a predominantly female phenotype.

RESULTS

Hormonal analysis showed low values for androstenedione and testosterone before and after stimulation with human chorionic gonadotropin, however, the androstenedione/testosterone ratio was elevated. Molecular genetic analysis proved the diagnosis of 17beta-hydroxysteroid dehydrogenase deficiency due to a homozygous mutation (325+4 A-T) in the HSD17B3-gene, which leads to an aberrant splicing process.

CONCLUSIONS

This case demonstrates that in addition to a meticulous steroid analysis a direct molecular genetic analysis can be helpful in the diagnosis of 17beta-hydroxysteroid dehydrogenase deficiency.

High deletion frequency of the complete AZFa sequence in men with Sertoli-cell-only syndrome

We have developed a rapid screening protocol for deletion analysis of the complete AZFa sequence (i.e. 792 kb) on the Y chromosome of patients with idiopathic Sertoli-cell-only (SCO) syndrome. This Y deletion was mapped earlier in proximal Yq11 and first found in the Y chromosome of the SCO patient JOLAR, now designated as the AZFa reference patient. We now show that similar AZFa deletions occur with a frequency of 9% in the SCO patient group. In two multiplex polymerase chain reaction experiments, deletions of the complete AZFa sequence were identified by a typical deletion pattern of four new sequence-tagged sites (STS): AZFa-prox1, positive; AZFa-prox2, negative; AZFa-dist1, negative; AZFa-dist2, positive. The STS were established in the proximal and distal neighbourhoods of the two retroviral sequence blocks (HERV15yq1 and HERV15yq2) which encompass the break-point sites for AZFa deletions of the human Y chromosome. We have found deletions of the complete AZFa sequence always associated with a uniform SCO pattern on testicular biopsies. Patients with other testicular histologies as described in the literature and in this paper have only partial AZFa deletions. The current AZFa screening protocols can therefore be improved by analysing the extension of AZFa deletions. This may provide a valuable prognostic tool for infertility clinics performing testicular sperm extraction, as it would enable the exclusion of AZFa patients with a complete SCO syndrome.

[Identification of wear particles of joint prostheses in tissues using laser microprobe mass analysis (LAMMA)]

The definite identification of wear particles from joint prostheses is of great importance for the development of joint replacement, as the type and quantity of different wear particles gives information on the wear resistance of implant materials. From the types of prostheses nowadays in use polyethylene wear of the sockets, bone cement wear, metallic and ceramic wear can be generated. Whereas polyethylene wear can be easily identified by its bright luminescence in polarized light and its characteristic configuration, the distinction of the small granular wear particles of the bone cement, metal and ceramic by light microscope is difficult. The laser microprobe mass analysis (LAMMA) is a method, which allows the analysis of single light microscopically detectable wear particles in tissues. Not only contrast medium particles of the bone cements (zirconium oxide or barium sulfate) but also metallic and aluminum oxide particles could be definitely identified within the pseudocapsules as well as in regional lymph nodes by LAMMA-analysis, whereby the bone cement wear predominated. In addition, the distinction between organic substances (as blood degradation products), which may appear similar to wear particles in configuration and colour, and the foreign material is also possible with this method.

Use of frozen-thawed testicular sperm for intracytoplasmic sperm injection

OBJECTIVE

To determine the feasibility of using frozen-thawed testicular spermatozoa for intracytoplasmic sperm injection.

DESIGN

Prospective clinical study.

SETTING

A university hospital.

PATIENT(S)

One hundred seventy-five azoospermic men participating in a routine intracytoplasmic sperm injection program.

INTERVENTION(S)

The men underwent testicular biopsy for cryopreservation of tissue to be used in consecutive intracytoplasmic sperm injection treatment cycles. Their female partners underwent controlled ovarian hyperstimulation for conventional IVF treatment.

MAIN OUTCOME MEASURE(S)

Fertilization and pregnancy rates.

RESULT(S)

In 77% of the patients, spermatozoa could be harvested from the testis by an open testicular biopsy technique and used for intracytoplasmic sperm injection after freezing and thawing of testicular tissue. Histopathologic evaluation revealed a Sertoli cell-only pattern in 21%, maturation arrest in 60%, and hypospermatogenesis in 19% of the patients. In 2. 9% of the patients, carcinoma in situ or a germ cell tumor was detected. In all patients, viable spermatozoa could be visualized after the tissue samples were thawed. One hundred thirty-five intracytoplasmic sperm injection treatment cycles were performed, with a fertilization rate of 45% and a clinical pregnancy rate of 30% per oocyte retrieved.

CONCLUSION(S)

The use of frozen-thawed testicular tissue allows ovarian stimulation of the female partner to be timed and avoids cancellation of ovum pick-up when spermatozoa cannot be retrieved.

[Malakoplakia of the colon]

We report on a 62-year-old female patient with melena in which polypoid lesions of the cecum were discovered endoscopically. Histological examination of mucosal biopsies revealed an inflammatory process with lots of histiocytes and so-called Michaelis-Gutmann bodies, leading to the diagnosis of a malakoplakia of the colon. No other organs were found affected. In the course of an antibiotic therapy, there was no melena detectable over a period of six months. Malakoplakia, an inflammation usually affecting the urogenital tract, is rarely found in the colon, with only 35 cases published until now. It is frequently associated with other diseases like neoplastic or inflammatory disorders, immune defect syndromes or heroin abuse. This spectrum is expanded by our report in which a long-standing alcohol abuse was found as an attendant disease.

Intracytoplasmic injection of round and elongated spermatids from azoospermic patients: results and review

Microinjection is established as the method of choice in the treatment of severe male factor infertility as well as in azoospermic patients. Recent studies have shown that fertilization and cleavage can be achieved by injection of ejaculated as well as testicular elongated spermatids into oocytes. Here we report on the two first pregnancies worldwide resulting from elongated spermatid injection from frozen-thawed testicular tissue. Four patients with complete Sertoli cell-only syndrome (SCOS) and two with spermatogenetic maturation arrest were included in our microinjection programme. Tissues from open testicular biopsies were cryopreserved until the time of follicle puncture. A total of 67 oocytes were harvested. In the two patients with maturation arrest, cryopreserved elongated spermatids were successfully injected, while in two of the other four SCOS patients only cryopreserved round spermatids were available to be injected into the oocytes. Out of 18 injected oocytes, 10 were fertilized in the first group, while nine out of 49 injected oocytes showed fertilization and cleavage in the second group. Two clinical pregnancies were achieved with elongated spermatids from frozen-thawed testicular tissue, while no pregnancy was established in the case of round spermatids. This study confirms that fertilization, cleavage and pregnancy can be successfully achieved in cases with spermatogenetic maturation arrest by injecting cryopreserved elongated spermatids into oocytes. The literature on pregnancies following spermatid injection, as well as the problems using this technique and possible risks, are discussed.

Pachytene chromosomes in trisomy 19 male mice with Robertsonian translocations

Three male mice with trisomy 19 induced by a Robertsonian translocation system were used for the study of meiotic prophase cells and germ cell differentiation. Present in these males were two Robertsonian chromosomes each with a chromosome 19 arm in common, two acrocentric chromosomes corresponding to the second arms of the two Rbs and one acrocentric chromosome 19. These five chromosomes showed a wide range of meiotic pairing configurations. One particular observation was the formation of a true double synaptonemal complex (SC) with three lateral axes and two central elements, which joined the three chromosomes 19 together. Integration of the acrocentric chromosome 19 in a complex pentavalent configuration was seen in 45% of the pachytene nuclei. The proportion of spermatocytes showing association between a quadrivalent and the acrocentric no. 19 was 26%. In 29% of the nuclei, the acrocentric no. 19 was free, integrated or associated with the XY complex, paired with the X chromosome or associated with a bivalent. Finally, in 57% of pachytene cells, the meiotic multivalents or the free univalent 19 were associated with the proximal part of the X chromosome or integrated in the sex chromatin. Therefore, the question arises with regard to the fate of these spermatocytes. The testicular histology shows an arrest of germ cell development at the spermatocyte stage. Several mechanisms seem to be the cause of germ cell depletion in a sequence of different, impaired developmental processes.

Fine needle tissue aspiration for accurate localization of histological specimens from complex structures

A procedure is presented for exact, detailed comparison of light and electron microscopic analyses of tissues with complex architecture. Earlier techniques require one to make drawings of tissue pieces to be analyzed by electron microscopy to permit rough localization of the origin of the tissue pieces. Specifically, exact analysis of fetal cartilage and bone is hampered by the complicated arrangement of both tissue components, severely limiting the assessment of electron microscopic analyses. The advantage of the technique described here is that it allows precise localization of the tissue sample in the original tissue area. Punches 1 min in diameter were obtained from femora and coxae with a syringe and embedded for light and electron microscopy. The remaining tissue with its exactly defined punctures is prepared for standard histology. Human fetal cartilage and bone tissue were used to demonstrate this technique, but this procedure may be used for other kinds of tissues.

Cyclophosphamide-induced aberrations of chromosome pairing in pachytene oocytes

The aim of this study was to characterise damage to synaptonemal complexes in oocytes following cyclophosphamide exposure. Pregnant mice were treated with three different doses of cyclophosphamide (10, 30 and 50 mg/kg body weight) at day 13 of gestation, when oogonia and very early meiotic cells in the female fetuses are found. Primary oocytes were analysed by light- and electron microscopy at gestational day 17 to reveal effects of the alkylating agent on the chromosomal pairing behaviour. Our pachytene analysis demonstrated that the fraction of cells with lesions of synaptonemal complexes, partial asynapsis and desynaptic bivalents were significantly increased over the levels in the control group. The frequency of alterations was similar at doses of 30 and 50 mg/kg. In addition, a significant increase in frequency of univalents over the base level became evident, showing the highest incidence on a dose of 50 mg/kg.

Scoliosis and congenital anomalies associated with Klippel-Feil syndrome types I-III

STUDY DESIGN

This investigation was aimed at characterizing anomalies and syndromes associated with Klippel-Feil syndrome in a large group of patients. The authors evaluated the clinical and radiographic features, documented the associated anomalies, and registered the type of treatment.

OBJECTIVE

The anomalies or syndromes and the development of scoliosis were correlated to the type of Klippel-Feil syndrome.

MATERIAL AND METHODS

In a cross-sectional study, the authors reviewed data from 57 patients with Klippel-Feil syndrome treated over 25 years at the Department for Orthopedics of the University of Heidelberg. The patients (17 males and 40 females; average age of the first contact, 12 years) were classified into three types according to the description of Feil in 1919.

RESULTS

Klippel-Feil syndrome Type I (fusion of cervical and upper thoracic vertebra with synostosis) and Type II (isolated cervical spine) corresponded to 40% and 47% of patients, respectively. Type III (cervical vertebra associated with lower thoracic or upper lumbar fusion) was displayed in 13% of the patients only. The authors found a variety of combinations of Klippel-Feil syndrome and other anomalies in the patients examined in this study, with 67% of the patients characterized by an association with other disorders or syndromes. Of the patients, 70% showed scoliosis. Its degree depended on the type of Klippel-Feil syndrome. Scoliosis in Type I correlated with 31 degrees (Cobb angle), in Type III with 23 degrees, and in Type II with 9 degrees only. Thus, Type II, with isolated cervical fusion, shows a low risk for scoliosis.

CONCLUSION

This study increases knowledge of a wide range of anomalies and syndromes identified in association with Klippel-Feil syndrome. A special finding of the study was a correlation between the degree of scoliosis and Klippel-Feil syndrome Types I, II, and III.

[A new punch technique of cartilage-bone tissue for morphological studies in orthopedics]

A new technique is presented for the analysis of tissues which allows an exact, detailed comparison of light and electron microscopy. For this purpose, the previous techniques required the cutting of tissue pieces from the original tissue compound and the preparation of drawings as a rough localisation of the tissue pieces removed for analysis. Due to the processes of cutting and drawing, only an approximate localisation of the tissue investigated by electron microscopy was practicable. Specifically, the exact analysis of fetal cartilage-bone-tissue was mostly not possible due to the complicate arrangement of both tissue components. Therefore, the assessment of electron microscopic analyses was severely limited. The new technique, presented in this study, is characterised by a removal of punches 1 mm in diameter from the original tissue for electron microscopy. The remaining tissue with its exact defined punch-punctures is prepared for standard histology. Thus, the specific advantage of this new method is the precise attribution of the punched tissue to the original tissue group. Human fetal cartilage-bone-tissue has been used to demonstrate this punch-technique and the specific light- and electron microscopic preparations.

Synaptonemal complex damage in fetal mouse oocytes induced by ionizing irradiation

Fetal female mice were exposed to ionizing irradiation of 2 Gy in a single dose at days 14, 16, and 17 of gestation. Synaptonemal complexes of primary oocytes were analyzed on day 17. It has been demonstrated that electron beam irradiation of early oocytes on day 14 with 2 Gy is accompanied by a duplication of atretic cells. A significant increase in fragmentations of the synaptonemal complexes over the base level became evident when mice were exposed to irradiation on days 16 and 17 of gestation. Frequencies of multivalent formation and univalents were not increased over the levels in the control group. Reduction of fertility and malsegregation of chromosomes may be a reflection of the consequences of the observed nuclear lesions.

Synaptonemal complexes of chains and rings in mice heterozygous for multiple Robertsonian translocations

Complex Robertsonian translocation heterozygosities in the mouse have been used to test different hypotheses regarding the correlation between male hybrid sterility and chromosomal abnormality. Synaptonemal complexes of meiotic super-chains and super-rings involving 15 to 18 metacentric chromosomes were studied in relation to spermatogenic histology. Both types of multivalents showed a characteristic pachytene pattern of alternating paired and non-paired segments. The amount of unpaired segments in rings was about 18% and in chains about 23% of the total length of multivalent chromosomes. The meiotic chains were associated with the proximal part of the X chromosomes in more than 60% of pachytene cells; a similar tight proximity of rings with X or Y chromosomes was never found. Complete arrest of germ cell maturation correlated with super-chains and inconspicuous testicular histology with super-rings. This demonstrates that an excessive amount of unpaired chromosomal axes does not lead per se to male infertility through gametogenic breakdown. On the contrary, the results clearly indicate spermatogenic impairment in this system of multimetacentric heterozygosity as a reflection of X chromosome super-chain interference.

The effect of 13;14 Robertsonian translocations on germ-cell differentiation in infertile males

Two infertile men heterozygous for a 13;14 Robertsonian (Rb) translocation were investigated by means of synaptonemal complex studies, testicular histology, and semen analysis. In both individuals interaction between the Rb trivalent and the XY pair was observed. Twenty percent of pachytene cells analyzed in one patient showed XY-trivalent association which correlated with malformed spermatids; the higher rate of XY-trivalent association (approximately 47%) in the second proband corresponded with complete spermatogenic arrest. The data presented indicate a positive correlation between increased frequency of XY trivalent association and the degree of germ-cell impairment.

Electron microscopic study of paired helical filaments and cerebral amyloid using a novel en bloc silver staining method

A one step en bloc silver staining method which was originally established to study nucleolar organizer regions has been applied for the demonstration of both paired helical filaments (PHF) and extracellular cerebral amyloids in semi-thin sections and at the electron microscopic level. The three forms of PHF can be visualized: (1) neurofibrillary tangles are shown in all stages from first appearance in form of intracellular patches of PHF to severely degenerated shadow-like "ghost" tangles; (2) neuropil threads are distinctly stained in great numbers; and (3) PHF are easily detected as neuritic components in amyloid plaques. All forms of fibrillar extracellular amyloid structures, i.e. "diffuse", "classical" and "burnt out" plaques, are well demonstrated; congophilic angiopathy reveals amyloid preferentially in arteries and arterioles of the leptomeninges and cortex ranging from small circumscribed patches to large circumferential amounts with occasional plaque-like condensations or broad loose accumulations of amyloid; perivascular cuffs and laminar subpial deposits of amyloid are stained as well. At the electron microscopic level all lesions are clearly visible in non uranyl/lead-stained specimens, characterized by varying numbers of silver grains on a pale background. The detailed demonstration of structures in archival material, which had been stored in paraffin and re-embedded for electron microscopy, is due to the demonstration of argyrophilic structures by the protective colloidal developer of gelatin and formic acid and to the proteolytic resistance of insoluble PHF and extracellular amyloids in plaques and congophilic angiopathy.

Meiotic and sperm chromosome analysis in a male carrier of an inverted insertion (3;10)(q13.2;p14p13)

A phenotypically normal male who fathered a son with the karyotype 46,XY,del(10)(p13) was found to be a balanced carrier of an inverted insertion (3;10) (q13.2;p14p13). Karyotyping five later pregnancies showed four to be unbalanced with respect to the insertion, one of which was also trisomic for chromosome 18. The latest pregnancy was balanced with respect to insertion but had the additional complexity of 47,XXY. In the light of six out of six chromosomally abnormal pregnancies, two of which potentially exhibit an interchromosomal effect, it was decided to investigate the gametic output of the father. Testicular biopsy and semen samples were obtained permitting both meiotic and sperm chromosome analysis. Information was thus obtained at three levels of gamete production, that is, prophase I pairing, chiasma frequency distribution at metaphase I, and sperm karyotypes. Electron microscope studies of synaptonemal complexes showed the rearranged chromosomes to pair fully in meiotic prophase I with no indication of the presence of an insertion. This non-homologous pairing of the inserted region was accompanied by an abnormal frequency distribution of pachytene substages. There was also a reduction in chiasma frequency throughout the genome. However, this did not lead to detectable autosomal univalence or abnormally high X/Y univalence. Thus, the trisomy 18 and XXY pregnancies are unlikely to reflect increased non-disjunctional rates either before or during the first meiotic division. Sperm karyotyping showed that the proportion of chromosomally balanced:unbalanced gametes did not differ from the theoretically expected 1:1. There was no evidence of any increase of unrelated abnormalities in the sperm, further indicating that the overall rate of meiotic non-disjunction was not increased above normal.

Comparative investigations of regional lymph nodes and pseudocapsules after implantation of joint endoprostheses

Morphological alterations of pseudocapsules and regional lymph nodes were studied by light and electron microscopy and by Laser Microprobe Mass Analysis (LAMMA). The tissue specimens originated from 32 autopsies of patients with hip joint endoprostheses (time in situ: 3 weeks - 15 years, average: 6 years) and two cases with knee joint endoprostheses. Characteristic changes of the lymph nodes as well as of the pseudocapsules consisted in an infiltration by monocytic histiocytes with various intracytoplasmatic wear particles. The foreign material consisted mainly of the components of bone cement: polymethylmethacrylate (PMMA) and zirconium oxide, to a lesser degree of polyethylene from the articulating surfaces. In two cases with special types of prostheses ceramic or metallic wear particles could be detected too. Most of the wear particles were found in the ipsilateral parailiac lymph nodes and in the paraaortic lymph nodes bilaterally. In the cases with mostly stable prostheses small amounts of wear particles were found in the lymph nodes as soon as 1.5 years after insertion and their number increased in all groups of lymph nodes after longer duration of the implant. The phagocytosing histiocytes showed degenerative changes. At present it is not clear, if the cell damage is caused by the amount of phagocytosed wear particles alone or if specific toxic effects of certain substances are of importance.

[The cause of loosening in cemented hip joint prostheses. Light and electron microscopy study and laser microprobe mass analysis]

Aseptic loosening of joint prostheses is a quantitatively increasing problem. For evaluation of the pathogenesis of prosthesis loosening joint capsules and tissue membranes taken from the femoral and acetabular bone-cement-interface of 23 hips revised for aseptic loosening were examined. In all cases we found an excessive inflammatory histiocytic reaction with intracytoplasmatic incorporation of a small granular foreign material. This could be identified to be zirconium oxide by LAMMA-analysis. Zirconium oxide and polymethylmethacrylate (PMMA) wear particles could be shown in the cytoplasm of histiocytes by transmission electron microscopy. By quantitative grading of the histiocytic reaction and the intracellular granular wear particles we found that both were evenly distributed around the loosened prosthesis. Chronic inflammation due to bone cement abrasion is regarded as a leading cause of aseptic prosthesis loosening.

The influence of the Robertsonian translocation Rb(X.2)2Ad on anaphase I non-disjunction in male laboratory mice

A Robertsonian translocation in the mouse between the X chromosome and chromosome 2 is described. The male and female carriers of the Rb(X.2)2Ad were fertile. A homozygous/hemizygous line was maintained. The influence of the X-autosomal Robertsonian translocation on anaphase I non-disjunction in male mice was studied by chromosome counts in cells at metaphase II of meiosis and by assessment of aneuploid progeny. The results conclusively show that the inclusion of Rb2Ad in the male genome induces non-disjunction at the first meoitic division. In second metaphase cells the frequency of sex-chromosomal aneuploidy was 10.8%, and secondary spermatocytes containing two or no sex chromosome were equally frequent. The Rb2Ad males sired 3.9% sex-chromosome aneuploid progeny. The difference in aneuploidy frequencies in the germ cells and among the progeny suggests that the viability of XO and XXY individuals is reduced. The pairing configurations of chromosomes 2, Rb2Ad and Y were studied during meiotic prophase by light and electron microscopy. Trivalent pairing was seen in all well spread nuclei. Complete pairing of the acrocentric autosome 2 with the corresponding segment of the Rb2Ad chromosome was only seen in 3.2% of the cells analysed in the electron microscope. The pairing between the X and Y chromosome in the Rb2Ad males corresponded to that in males with normal karyotype. Reasons for sex-chromosomal non-disjunction despite the normal pairing pattern between the sex chromosomes may be seen in the terminal chiasma location coupled with the asynchronous separation of the sex chromosomes and the autosomes.(ABSTRACT TRUNCATED AT 250 WORDS)

Spermatogenesis in two patients with the fragile X syndrome. II. First meiosis: light and electron microscopy

Chromosomes at first meiosis from two males with the fra(X) form of mental retardation were studied using pachytene surface spreads and air-dried preparations. The pachytene sex bivalents showed no discontinuation of the synaptonemal complex in the terminal part of Xq corresponding to band Xq27-28 of the mitotic chromosomes. In both cases the frequency of a secondary association of Xq and Yq appeared to be increased compared with controls. The pairing behavior of autosomal bivalents in pachytene and the frequency and distribution of chiasmata in diakinesis were normal. The impairment of spermatogenesis found in these males may not be caused by a meiotic disorder, but could be related to peritubular or intratubular pressure effects on germ cells.

Pachytene analysis in males heterozygous for a familial translocation (9;12;13) (q22; q22; q32) ascertained through a child with partial trisomy 9

A family with four male and three female heterozygotes for a three-way translocation (9;12;13) (q22; q22; q32) in three generations was ascertained through a chromosomally imbalanced newborn with an additional derivative chromosome 9 resulting from nondisjunction. Three heterozygous males from two generations with apparent differences in their fertility status were investigated using pachytene spreads and testicular histology. Pachytene analysis in all three individuals, the fertile (II-2) as well as the subfertile (III-7) and infertile (III-9), showed a hexavalent with central nonpairing around the translocation breakpoints in nearly all spermatocytes. Thus, the observed hexavalent configurations in pachytene do not seem to have caused impaired fertility. This rather may have been the result of sperm carrying unbalanced chromosome sets. However, the observed difference in fertility between the heterozygous fertile male in generation II and his two heterozygous sons remains unexplained.

Spermatogenesis in two patients with the fragile X syndrome. I. Histology: light and electron microscopy

Light and electron microscopic studies on testicular biopsies were carried out in two men, 40 and 44 year old, with the fra(X) form of mental retardation and macroorchidism. Distinct interstitial edema, an increased amount of lysosomal inclusions in Sertoli cells, and disturbance of spermatid differentiation were found in both probands. Additionally, some extent of tubular atrophy was demonstrated in one patient. The impairment of spermatogenesis is discussed with respect to pressure effects on the germinal epithelium due to the edema.

Two different XY-quadrivalent associations and impairment of fertility in men

One sterile and one subfertile man with balanced reciprocal autosomal translocations, a t(9;15), and a t(14;21), were analyzed using whole mount pachytene spreads, histology, and semen analyses. In both probands with different types of quadrivalent complexes lack of pairing near the translocation breakpoints and significant associations with XY bivalents were found. Variability in the frequency of XY-quadrivalent contacts and an increase in late pachytene to 52% in t(9;15) and 90% in t(14;21) could be observed. The lower rate was associated with reduced postmeiotic spermatogenesis and the higher rate with complete spermatogenic arrest. In both translocation carriers the XY-quadrivalent association is considered to be the main cause for testicular malfunction rather than nonpaired segments in the multivalent complexes.

The chromosomes of Micromys minutus (Rodentia, Murinae). II. Pairing pattern of X and Y chromosomes in meiotic prophase

Both light and electron microscopy were used to study the pairing behavior of the sex chromosomes of the harvest mouse, Micromys minutus, in surface-spread pachytene spermatocytes. The XY pairing pattern is very exceptional in that the site of synaptic initiation is located interstitially in the short arms of the X and the Y, next to their centromeric regions. From this tiny euchromatic site, synapsis proceeds unidirectionally along the homologous heterochromatic short arms of the X and the Y toward the ends of the chromosomes. After pairing of the short arm is concluded, synapsis begins between the nonhomologous long arms of the X and the Y in the immediate vicinity of the centromeres and progresses unidirectionally toward the end of the long arm of the Y. A synaptic complex develops between the constitutive heterochromatin of the long arm of the Y and the euchromatin of the long arm of the X. Analysis of C-banded and distamycin A/DAPI-stained diakineses revealed a trefoil-like XY bivalent, which was interpreted to be the result of an interstitial chiasma occurring in the paired short arms of the X and the Y. A conspicuous, electron-dense body, about 1 micron in diameter, was found closely associated with the centromeres of the X and the Y in numerous pachytene spermatocytes. A review of the literature showed that comparable XY-associated bodies have been found in only eight other mammals to date.

Morphologic alterations in the long Q-T syndrome. Light and electron microscopic observations in the conduction system and in sympathetic trunks

Post-mortem examinations of 2 patients with long Q-T syndrome revealed marked focal fibrosis and lipomatosis of the conduction system as well as focal round cell ganglionitis of both sympathetic trunks. The patients, young women of different nationality displaying syncopal attacks and a long Q-T interval in the ECG died suddenly of ventricular arrhythmias. A family study of one of them revealed Q-T prolongation in 4 generations. The ultrastructure of the conductive tissue and the ventricular myocardium showed no specific alterations indicative of a primary metabolic defect. Ganglionitis of the sympathetic trunks has not yet been reported in the long Q-T syndrome. Although the etiology of the inflammatory changes is uncertain a chronic viral infection, noninfectious toxic alterations or an autoimmunopathy are among the plausible causes discussed.

Quantitative histology of human fetal testes in chromosomal disease

Morphometric studies on male gonads were performed in 35 midterm fetuses aborted after prenatal diagnosis of a chromosome anomaly and in 11 chromosomally normal controls. A significant reduction of the number and volume percentage of premeiotic germ cells was observed in the chromosomally abnormal cases. Germ cell depletion was correlated with the severity of the chromosomal disease. It was least expressed in the XYY condition. In trisomy 13 and 18, depletion lead to values of less than a half or even a fourth the values of controls. Complex anomalies with XXY or XYY in addition to an autosomal disorder showed a moderate effect on germ cell reduction. No morphological differences were observed in germ cells or in Sertoli cells in a comparative electron microscopic study. Paucity of fetal germ cells can result from impaired colonization of the gonadal ridge, from low mitotic activity, or from increased premeiotic cell loss. All three factors seem to contribute to the above findings.

Down's syndrome in the male. Reproductive pathology and meiotic studies

Studies on testicular histology and meiosis were carried out by the use of light and electron microscopy in an 18-year-old Down's syndrome male in an attempt to follow the fate of the extra chromosome 21 and to evaluate the effects of this condition on spermatogenesis and the reproductive functions. The histological changes in the testes corresponded to spermatogenic arrest. Electron microscopic whole-mount spreadings of meiotic cells in the pachytene stage showed that in most nuclei an extra chromosome 21 was not detectable. Only in a small number of nuclei, univalents or trivalents with segmental pairing structures of an extra chromosome could be discovered. In contrast, the great majority of (C-banded) diakinesis figures showed the presence of a supernumerary G (no. 21) chromosome. The absence of a traceable extra chromosome 21 in most pachytene cells is explained by the assumption that it is intimately connected with and hidden in the sex vesicle, whose complex structure does not allow the identification of single elements. Strong support for this assumption is seen (a) in the general tendency of narrow spatial association of unpaired segments with the XY complex and (b) in close structural similarities occurring between univalents or nonsynapsed segments of trivalents and the nonpaired segments of the sex chromosomes. It is suggested that the association or connection of an extra chromosome with the XY complex during pachytene interferes with the phenomenon of X inactivation. In animal systems such abnormal interference is related with spermatogenic breakdown and, in a general way, with male hybrid type sterility. So far, the range of sterility vs. fertility in cases of male Down's syndrome is not yet fully clear, but it appears that impairment of fertility, and sterility are most frequent. If so, it is proposed that the effect of the trisomy 21 condition on spermatogenesis (and fertility) is a consequence of the behavior of the extra chromosome in the meiotic prophase.