Surgico-pathological analysis of testicular lesions

The primary objective of our study was to identify the different types of histopathological lesions of testes and epididymis occurring in patients admitted in a tertiary care hospital, the objective was also to analyze the spectrum of testicular lesions, our aim was to evaluate the prevalence of testicular malignancies and characterize the tumor based on their histo-morphological features. This was a prospective study of 2 years (October 2018 to October 2020) aggregating a total of 52 cases. The surgical specimens were referred to the pathology department for histopathological analysis. Adetailed preoperative history of every case with regards to age, presenting symptoms, and signs along with personal history were obtained.Also, relevant investigations like serum tumor markers and Ultrasonography findings were analyzed. Postoperatively, the tissue was sent to the histopathology department was studied by proper fixation, gross examination, adequate sampling, and paraffin sections of the same.10% formalin was used to fix the specimen. Some resources suggest the use of Bouin solution for the fixation of testis biopsy specimens. However, the picric acid in the Bouin solution presents challenges for safe handling and disposal due to its explosive potential.Hence, given the available resources in our laboratory setting, formalin was the preferred choice of fixative. We ensured that the specimens came in adequate amount of formalin from the OT with correct labeling.We excluded the autolyzed specimens. The data was noted and quantitative analysis was done.The study was further compared with other previously reported studies. 52 cases were studied and majority of the cases were reported in the age group of 31-40yrs. 65.4% cases were non neoplastic, with testicular torsion being the commonest lesion. Amongthe 23.1% neoplastic cases that were reported, mixed germ cell tumor was the commonest (75%). Non neoplastic lesions are more common than neoplastic lesions. Torsion testis was the commonest indication for orchidectomy in younger age group. Despite newer techniques in imaging and tumor marker assays the diagnosis of testicular lesions is primarily dependent upon histopathological examination.

Are tyrosine kinase inhibitors an effective treatment in testicular metastases from kidney cancer? Case report and review of the literature

Testicular metastases from renal cell carcinoma (RCC) are extremely rare. Tyrosine kinase inhibitors (TKI) are the cornerstone of systemic therapy for metastatic RCC. We report a case of testicular metastasis in a 72-year-old patient with RCC that developed 17 years after nephrectomy and response to TKI treatment, a retrospective literature search on testicular metastases from RCC, and the indirect evidence described in the literature on the efficacy of chemotherapy and target therapy on testicular lesions.

Intratesticular Simple Cyst - Ultrasound and Elastography Appearance

Simple intratesticular cysts are unusual lesions. They are mostly non-palpable and diagnosed incidentally. A fifty year old patient was presented for scrotal sonography due to vague scrotal pain. On examination, a 6.8 x 5.4 mm intratesticular hypoechoic lesion was seen with imperceptible walls and posterior acoustic enhancement which is an indication of cystic lesion. This cyst contained echogenic mobile material indicating benign nature of the lesion (Figure 1). Strain elastography revealed typical blue green red (BGR) sign confirming cystic nature of lesion. (Figure 2) Benign intra testicular lesions are uncommon, but proper diagnosis is important so that unnecessary surgical intervention is prevented. Benign lesions involve tubular ectasia, abscess, intra testicular varicocele, intratesticular simple cysts, epidermoid cyst, tunica albuginea cyst and hemorrhage.1 Gray-scale ultrasonography (USG) along with Color-Doppler ultrasound wherever possible mostly gives accurate diagnosis leading to appropriate treatment.2 Features of simple cyst on USG include an imperceptible wall, an anechoic center and through transmission. Simple cysts are incidental finding most commonly in males of age 40 years and above. Variable in size having diameter of two mili meters to two centimeters. These are commonly single, in some cases multiple cysts have also been found. Simple cysts are commonly found near the mediastinum of testis but can also be found in other parts of testis. Also, these are linked with extra testicular spermatoceles. On local examination, even large simple testicular cysts are generally not palpable as they are not firm. Tunica albuginea cysts are very firm. So, we can easily differentiate between tunica albuginea cyst and simple testicular cyst.3 Sometimes testicular cysts contain echoic material which is mobile with change in position (Figure 2). The mobility of material suggests whether the cyst is benign or if fixed, it can be a cyst of neoplastic etiology. 4 The 3 - layer pattern (blue / green / red layers) visible in smaller cystic areas is known as the BGR sign and is visible in a few elastography systems. This pattern is taken into consideration as beneficial because it highlights the cystic nature of the lesion and has been proven to be true even in cases of cystic lesions with inner echogenic material.

Is ferroptosis involved in ROS-induced testicular lesions in a varicocele rat model?

Background Ferroptosis is an iron-dependent cell death that is distinct from apoptosis. Based on excessive amounts of iron and reactive oxygen species in varicocele (VCL) rats, we hypothesize that ferroptosis might be involved in VCL. In addition, since alpha-lipoic acid (ALA) was shown to have both antioxidant and anti-ferroptotic activity we assessed in the present work the status of ferroptosis in our varicocele model and the protective effect of ALA. To this end, 70 male Wistar rats were divided into 7 groups: control, sham and varicocele groups which were initially sacrificed 2 months after the operation to verify the induction of varicocele. A second batch of the same 3 groups were sacrificed 4 months after varicocele induction to evaluate the effect of ALA supplementation. The parameters measured were chromatin integrity (aniline blue and acridine orange staining), lipid peroxidation (BODIPY staining), testicular morphometry and iron content. In addition, redox (GSH and NADPH) and ferroptosis (Nrf2, Slc7a11, P53 and p-Jnk) markers were evaluated at 2 and 4 months post-operation. Result The alteration of the spermatic parameters made it possible to verify the induction of the varicocele. Iron accumulated well in the testicles during varicocele and decreased significantly following ALA treatment. Ferroptotic molecular markers at the mRNA and protein levels were not significantly altered. ALA supplementation did not alter NADPH values, but increased GSH levels. Conclusion Despite the increased accumulation of iron in the testes 2 and 4 months after surgical induction of varicocele, molecular evidence did not demonstrate the involvement of ferroptosis. This could be explained by the mosaic nature of the varicocele affecting some seminiferous tubules and not others which could mask variations in molecular markers. In parallel, our study confirms that ALA stimulates the NRF2 pathway.

Frozen-section examination in the management of paediatric testicular lesions

Purpose Paediatric testicular and para-testicular lesions have traditionally been managed according to adult protocols. Testis-sparing surgery (TSS) has gained popularity as it has become apparent benign lesions predominate in childhood. Frozen-section examination (FSE) for intra-operative diagnosis has been extensively utilised in adults, though its use in paediatric practice remains limited. We reviewed our experience of FSE in paediatric patients with an aim to identify the utility and efficacy of this tool in the management of testicular and para-testicular pathology. Methods A retrospective, single-centre review of paediatric patients who underwent intra-operative FSE for a range of testicular and para-testicular lesions was performed. FSE results were compared to final pathology. TSS was performed if appropriate, and was utilised in adolescent patients, and in lesions with a diameter greater than 20 mm. Results Nine males underwent FSE from 2013 to 2020. Median age at surgery was 9 years (range 1–15). Eight (89%) patients had benign pathology. FSE result correlated with the final pathological examination in 100% of cases. FSE facilitated TSS in 7/9 cases. Conclusion FSE has 100% diagnostic accuracy for paediatric testicular and para-testicular pathology. We would recommend all lesions be evaluated by FSE to guide intra-operative decision making and facilitate TSS in appropriate cases.

Salmonella enterica subsp. diarizonae Serotype 61:k:1:5:(7) a Host Adapted to Sheep

Salmonella genus is widely distributed in nature and causes a spectrum of diseases in man and animals. Salmonella enterica subsp. diarizonae serotype 61: k: 1,5, (7) (SED) is a host adapted to sheep and its presence as saprophytic bacteria in sheep has been described in different countries. Several studies performed in abattoirs reported the presence of SED in healthy sheep in the intestinal content and also in the respiratory tract. In addition, this microorganism has also been isolated from nostril and faecal samples in healthy live animals. For this reason, this microorganism is considered well adapted to sheep, behaving normally these animals as asymptomatic carriers. However, SED has also been reported causing health disorders such as chronic proliferative rhinitis in adult sheep, abortions, testicular lesions in rams or alimentary tract disorders in young animals. The zoonotic potential of this microorganism is also discussed.

ACE2 Expression in Kidney and Testis May Cause Kidney and Testis Infection in COVID-19 Patients

In December 2019, a new type of pneumonia caused by SARS-Cov-2 (COVID-19) occurred in Wuhan and has been discovered in many countries around the world. ACE2 (angiotensin-converting enzyme 2) has been shown to be one of the major receptors that mediate the entry of SARS-Cov-2 into human cells. Here in this study, we used the online datasets to analyze ACE2 expression in different human organs. The results indicated that ACE2 highly expresses in renal tubular cells, Sertoli cells, Leydig cells, and cells in seminiferous ducts in testis. Recombinant SARS-CoV-2 spike protein (RBD) domain and ACE2 of RPTEC/SerC cell-binding assays confirmed that SARS-Cov-2 can bind to ACE2 on the surface of these cells. Our results suggest that ACE2 expression could contribute to kidney and testis infection after COVID-19 infection. Renal function evaluation and special care should be performed during clinical work. Clinicians should also pay attention to the risk of testicular lesions in patients during hospitalization and later clinical follow-up, especially the assessment and appropriate intervention in young patients' fertility.