Testicular biopsy and hormonal study in a male with Noonan's syndrome

The testicular biopsy study of a 17-year-old male with Noonan's syndrome revealed seminiferous tubules of reduced diameter with hypospermatogenesis. Many spermatocytes underwent degeneration and many spermatids developed abnormal. The Sertoli cells were similar to immature Sertoli cells. Fully differentiated Leydig cells were rare while precursor Leydig cells were numerous. Both gonadotropin and testosterone levels were low, and a lack of response to LH-RH as well as to clomiphene was found. The testicular biopsy performed at 20 years of age revealed a certain maturation of the seminiferous tubules which increased the germ cell number. The abnormalities in the spermatogenesis as well as the immature appearance of Sertoli cells continued. Leydig cells were more numerous and showed a certain development without reaching the normal pattern. Gonadotropin levels were normal while testosterone levels low. The response to LH-RH was increased and the absence of response to clomiphene persisted. These features suggest a delayed puberty.

Endocrine profile in patients with chronic renal failure under zinc replacement

The plasma levels of androstenedione (A), testosterone (T), dihydrotestosterone (DHT), follicle stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (PRL) were studied in 15 men (aged 24-50 years) with chronic renal failure under periodic peritoneal dialysis, before and after 50 mg of elemental zinc (Zn) orally, twice a day for three weeks. Before treatment, they were divided into three groups: group I, plasma A above normal and PRL less than 100 ng/ml; group II, low or normal A levels with PRL less than 100 ng/ml; and group III, normal or high A levels with PRL greater than 100 ng/ml. After oral Zn, plasma FSH, LH, and PRL were unchanged in all groups; however, in groups I and II plasma A was within normal T and DHT rose significantly, the A/(T+DHT) ratio decreased to normal, and the T/DHT ratio rose above normal. In group III plasma androgens remained low and androgen ratios were unchanged. Oral Zn seems to improve the conversion of A to T and also uncovered the possibility that plasma PRL levels greater than 100 ng/ml might cause a blockade in the 5 alfa-reductase.

Testicular function in men with chronic renal failure and transplant recipients under bromoergocriptine therapy

Plasma zinc (Zn), follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), and androgens concentrations were determined in 15 male patients with chronic renal failure who were successful recipients of kidney transplant. After 25 +/- 8.5 months of the renal transplant, Zn levels were (88 +/- 4 g/dl) lower than in the control group (116 +/- 5 micrograms/dl). Normal concentrations for androstenedione (A) (0.63 +/- 0.05 ng/ml) and testosterone (T) (3.31 +/- 0.15 ng/ml) were found. Dihydrotestosterone (DHT) levels (0.38 +/- 0.01 ng/ml) were lower than normal (1.11 +/- 0.09 ng/ml), suggesting a blockade in the conversion of T to DHT. Eleven of the 15 patients showed higher PRL levels (9.5 +/- 0.8 ng/ml) in contrast with the normal group (3.6 +/- 0.3 ng/ml). Ten patients received orally 2-alpha-bromoergocriptine (BEC) 2.5 mg/day for ten days. Plasma PRL decreased to 2.6 +/- 1.0 ng/ml (p less than 0.001), but A and T levels did not significantly change; however, DHT increased from 0.38 +/- 0.02 ng/ml to 0.72 +/- 0.04 ng/ml (p less than 0.01). All patients showed an increase in both gonadotropins before BEC without significant changes after treatment. The high PRL levels may be responsible for the impaired conversion of T to DHT, possibly by interference with the enzyme 5 alpha-reductase.

Varicose axons bearing "synaptic" vesicles on the basal lamina of the human seminiferous tubules

Normal (infant and adult) and pathological testes were examined by electron microscopy in order to study testicular innervation. Nerves composed of non-myelinated fibres were abundant in the tunica vasculosa of the tunica albuginea. These nerves penetrated into the testicular septa reaching the interstitial tissue. This showed numerous non-myelinated nerve fibres running among the Leydig cells and blood vessels. Single axons or small groups of them, partially surrounded by Schwann cells, approached: 1) the Leydig cells, 2) the interstitial blood vessels, and 3) the seminiferous tubules. Single naked axons were also observed primarily in the proximity of the seminiferous tubules. These axons showed varicosities containing both small and large "synaptic" vesicles. The latter were less numerous and contained a central dense core. Small vesicles were agranular. Some varicose axons ran across the myofibroblast layer of the tunica propria reaching the basal lamina of the seminiferous tubules at the level of the Sertoli cells but not at the level of the spermatogonia. The intercellular space between Sertoli cell and axon membrane was about 150-200 nm.

Zinc, prolactin, gonadotropins, and androgen levels in uremic men

This study correlates plasma levels of Zinc (Zn) and some pituitary and testicular hormones in 20 uremic men (aged 17-58 years) on a weekly peritoneal dialysis program. Patients were compared to 12 healthy male volunteers (aged 28-40 years). In uremic men, plasma androstenedione (A) was elevated, while testosterone (T), dihydrotestosterone (DHT), and Zn were low. On a group basis, plasma follicle stimulating hormone (FSH) and luteinizing hormone (LH) were normal while prolactin was increased. A negative correlation was observed between plasma A and LH levels, as well as between the A/T+DHT ratio and plasma Zn concentrations. Our results suggest a diminished A-to-T conversion and point to the possible role of Zn in the enzyme activity of the 17 beta-hydroxysteroid dehydrogenase.

Morphological and histometric study on the human Sertoli cell from birth to the onset of puberty

In order to evaluate the changes in the number and form of the Sertoli cell from birth to the onset of puberty, a histometric and ultrastructural study was carried out in normal children. Ultrastructural findings revealed that immature Sertoli cells, present from birth to puberty, show round to elliptical nuclei, with regular outlines and small nucleoli. The cytoplasm exhibits well developed rough endoplasmic reticulum, prominent supranuclear Golgi complexes and vesicles at the luminal face; smooth endoplasmic reticulum was scarce. Histometric study revealed a progressive decrease in the Sertoli cell number per transverse tubular section as well as per unit area of testicular parenchyma, mainly from 3 years onwards. However, this decrease seemed to be the result of the progressive increase in the testicular volume as well as in the length and width of the seminiferous tubules, without change in the total Sertoli cell number per testis. This number may be considered constant, not only for adult testes but also for postnatal developing testes.

Hyperplasia and the immature appearance of Sertoli cells in primary testicular disorders

Testicular biopsy specimens from adult patients affected with cryptorchidism, Klinefelter's syndrome, and Del Castillo's syndrome were examined by light and electron microscopy. The study revealed a high proportion of testes showing seminiferous tubules with hyperplasia of Sertoli cells (from 25 to 45 cells per transverse tubular section). These cells had an immature appearance and showed a pseudostratified distribution. The nucleus was round to ovoid and regular in outline, with a smaller nucleolus than that of mature Sertoli cells. The cytoplasm showed less development of the endoplasmic reticulum as well as of the secondary lysosomes and lipid droplets than that in mature Sertoli cells. Characteristic features of these immature Sertoli cells were abundant cytoplasmic microfilaments, elaborate interdigitations between adjacent cells, and extensive tight junctions, from basement membrane to lumen. In the cryptorchid testes, a more immature Sertoli cell was found to constitute the majority of the cells in hypoplastic zones. In Klinefelter's and Del Castillo's syndromes as well as in cryptorchid testes to a lesser degree, a transitional type of cell-from immature to mature-was also observed. These observations suggest that Sertoli cells in these primary testicular disorders reflect a congenital deficiency producing abnormal development.

Multi-vacuolated leydig cells in human adult cryptorchid testes

A histological study of 23 testicular biopsies or surgical specimens from adult cryptorchid testes revealed the presence of multi-vacuolated Leydig cells in 12 cases. These cells showed abundant lipid inclusions and scarce secondary lysosomes as well as liprofuchsin pigment granules. Some of these cells contained crystals of Reinke but others had only microcristalline inclusions. This Leydig cell alteration may be related either to heat or to congenital lesions.

Histological, histochemical and ultrastructural variations along the length of the human vas deferens before and after puberty

Vasa deferentia of 20 human adult males and 8 children were divided into four portions (proximal, middle, distal and terminal) for histological, histochemical and ultrastructural studies. The epithelium of the adult vas deferens was formed of columnar and basal cells. Three types of columnar cells were observed: (1) principal cells with PAS-positive cytoplasmic granules (lysosomes); (2) dark or pencil cells with a dark cytoplasm and nucleoplasm and cytoplasmic lipid vacuoles, and (3) mitochondrion-rich cells with numerous mitochondria similar to those of principal cells. All these cell types showed stereocilia and irregular convoluted nuclei, some of them containing granular, PAS-positive intranuclear inclusions. Principal cells were the most frequent cell type in the proximal portion but their number gradually decreased along the length of the vas deferens, while the proportion of both pencil cells and mitochondrion-rich cells increased. The muscular coat comprised three muscular layers: (1) inner longitudinal, (2) middle oblique (circular in the distal and terminal portions), and (3) outer longitudinal. The functional significance of regional variations is discussed. The infant vas deferens showed a columnar cell type only. However, cells either with numerous lysosomes or with numerous mitochondria were occasionally found. No regional variations were observed in the infant vas.

Renal function in protein-energy malnutrition

So far, most studies on renal function in children with advanced protein-energy malnutrition have shown an impairment of glomerular filtration rate and renal plasma flow, as well as diminished ability to excrete an acid load and a concentrated urine. Investigation of these functions in eight marasmic infants and eight children with kwashiorkor once they were free of obvious infections and acute electrolyte disturbances has shown a practically normal renal performance.

Histologic classification of undescended testes

On the basis of testicular biopsy study in 203 patients and study of a second biopsy specimen from 27 of these patients, prepubertal undescended testes were classified into four categories according to the mean tubular diameter, the tubular fertility index, and the Sertoli cell index. Type I cases (testes with minimal lesions) were characterized by a normal mean tubular diameter and normal tubular fertility and Sertoli cell indexes or slight tubular hypoplasia. This group represented 26 per cent of the undescended testes. The corresponding lesions can be observed from two years of age onward and are probably acquired. After puberty normal spermatogenesis occurs. Type II cases (24 per cent of the undescended testes) included testes with marked germinal hypoplasia as well as slight or marked tubular hypoplasia and a normal Sertoli cell index. After puberty these testes develop a degree of marked hypospermatogenesis, maturation arrest, or Sertoli cells with only isolated spermatogonia and primary spermatocytes. In type III cases (testes with diffuse tubular hypoplasia) the mean tubular diameter and the tubular fertility and Sertoli cell index values were severely reduced. This group represented 33 per cent of the undescended testes, and after puberty most of them showed seminiferous tubules with exclusively adult Sertoli cells. Type IV testes (diffuse Sertoli cell hyperplasia) were associated with a nearly normal mean tubular diameter and variable tubular fertility index values and represented 17 per cent of all the undescended testes. After puberty Sertoli cells do not mature completely, and therefore in spite of the earlier tubular fertility index, the germinal cell line does not reach adult development. Although early orchiopexy prevents tubular fertility index and mean tubular diameter deterioration due to the noxious effects of temperature in type I testes, we believe that there is no such benefit in the other types. These patients may present only slight modifications in these indexes.

47,XXY Klinefelter's syndrome with low FSH and LH levels and absence of Leydig cells

Examination of testicular biopsy from a patient with 47,XXY Klinefelter's syndrome revealed a diffuse hyalinization of seminiferous tubules as well as absence of mature Leydig cells. Ultrastructural findings showed some immature Leydig cells in the testicular interstitium. Hormone assays revealed low serum FSH and LH levels. The association of both, hormone assays and testicular morphologic pattern, suggests the presence of a Klinefelter's syndrome with hypogonadotropic hypogonadism.

Diffuse intratubular undifferentiated germ cell tumor in both testes of a male subject with a uterus and ipsilateral testicular dysgenesis

A case of müllerian pseudohermaphroditism in a male subject with a uterus is described. The patient showed normal secondary sex characteristics as well as normal external genitalia, except for right cryptorchidism and a painful tumoral mass in the left testis. Examination of surgical specimens revealed a uterus attached to the left ductus deferens. Areas of seminoma and embryonal carcinoma were present in the left testis. In addition, there was a thin insufficiently collagenized albuginea that contained a cellular connective tissue resembling the ovarian stroma, as well as hypoplastic and atrophic seminiferous tubules. In the testicular parenchyma most of the seminiferous tubules located far away from the tumor possessed the atypical malignant germ cells characteristic of intratubular undifferentiated germ cell tumors. No spermatogenesis was seen. The right abdominal testis was atrophic and showed a normal albuginea. However, there was an undifferentiated germ cell tumor similar to that observed in the left testis. We describe the first case of a tumor in a scrotal testis of a male subject with a uterus. The occurrence of this tumor is discussed with regard to tubular dysgenesis present in both testes and supported by the intrinsically abnormal germ cells as well as by the immature Sertoli cells found in both testes.

Ruthenium Red Staining of Chromatin in Epon Sections

After staining with a 50% ethanol solution of ruthenium red, chromatin from onion and mouse cells showed red color and high contrast in the light and electron micro­scope, respectively. When applied to glutaraldehyde-fixed, Epon-embedded tissues, this selective staining technique proved to be dependent on the DNA content of chromatin.

Development of the endoplasmic reticulum during human spermatogenesis

Human primary spermatocytes show a special development of the endoplasmic reticulum (ER). During the leptotene-zygotene stages a cisterna of ER surrounds a third or half of the nucleus closely associated with the nuclear envelope and connected with it. In the following stages of the first meiotic prophase, stacks of these cisternae appear closely related to the nucleus and show connections with other cytoplasmic cisternae which are free in the cytoplasm. In the secondary spermatocytes and spermatids, the number of ER cisternae joined to the nucleus decreases; in contrast, the number of free ER cisternae increases. Another peculiar differentiation of the ER, such as the annulate lamellae (AL), appears in the late stages of the first meiotic prophase in relation with the nuclear envelope. AL are conspicuous in secondary spermatocytes and spermatids. In spermatids, AL appear either joined to the nucleus or free in the cytoplasm, in close proximity to the Golgi complex. Finally, AL and other membranes of the ER are released in the cytoplasmic droplets of the maturing spermatids.

Ultrastructure of testicular biopsy from an XX male

Ultrastructural study of testicular biopsy specimens from an XX male showed hyalinized seminiferous tubules and tubules containing only mature Sertoli cells. These cells possessed large lipid inclusions as well as microfilament bundles which were perpendicular to the basement membrane and parallel to one another. The basal lamina was thickened and composed of several parallel layers with myofibroblast layers between them. The interstitium showed nodular to diffuse Leydig cell hyperplasia. Four types of Leydig cells were found: 1) normal Leydig cells with crystals of Reinke; 2) cells with abundant microcrystalline inclusions as well as microfilaments and concentric cisternae of smooth endoplasmic reticulum; 3) vacuolated cells containing numerous large lipid droplets; 4) immature Leydig cells. The different ultrastructural abnormalities found in the Sertoli and Leydig cells might be considered as the histological expression of a tubular-interstitial dysgenesis which is reflected in the high levels of gonadotropins and low levels of testosterone.

Leydig cell differentiation induced by stimulation with HCG and HMG in two patients affected with hypogonadotropic hypogonadism

In order to elucidate the ultrastructural characteristics of the precursor cell of Leydig cells and its subsequent differentiation, testicular biopsies from two patients with hypogonadotropic hypogonadism, obtained prior to and after treatment with HCG and HMG, were studied in comparison with those of prepubertal, pubertal and postpubertal testes. Prior to HCG and HMG stimulation, the testicular interstitium of both patients showed the following spindle-cell-types: Fibroblasts, myofibroblasts and a cell-type similar to the myofibroblast but differing from it by the arrangement of microfilaments and the development of the smooth endoplasmic reticulum as well as lipid droplets. It may be considered the precursor of Leydig cells. In the following stages of differentiation observed in the biopsies after treatment, there is a progressive involution of microfilaments and rough endoplasmic reticulum, a transient period of hyperplasia of the Golgi complex, and the definitive development of cell components involved in steroid biosynthesis, such as the smooth endoplasmic reticulum, polymorphic mitochondria with tubular cristae, lipid droplets and diverse lysosomal bodies. From early stages of differentiation, gap junctions occurred between the cells. Numerous axon profiles were also present among the cells. Only in a small percentage of cells did vesicle-bearing axons closely appose the Leydig cell membrane.

Testicular microlithiasis in 2 children with bilateral cryptorchidism

Testicular microlithiasis, associated with bilateral cryptorchidism, is studied in 2, 6-year-old children. In case 1 autopsy revealed that 60 per cent of the seminiferous tubules contained completely calcified microliths. Similar mineralized concretions also were found in different areas of the cerebrum and cerebellum. In the testicular biopsy obtained from case 2, 30 per cent of the seminiferous tubules contained microliths showing different degrees of calcification. The study of such calcifications supports the hypothesis that the mineralization process occurs according to the following stages: 1) accumulation of cellular debris in the tubular lumen, 2) deposit of concentric rings of glycoprotein material surrounding the central core and 3) calcification of the glycoprotein lamellar material. The presence of similar concretion in the nervous system as well as the lung in other reported cases suggests that microlithiasis could be a systemic disease.

Histogenesis of human extraparenchymal Leydig cells

From 64 consecutive autopsies of patients with neither testicular nor hormonal pathology, 26 showed extraparenchymal Leydig cells, located mainly in the epididymis and in the spermatic cord. The ultrastructural study of these specimens plus those obtained from 2 patients affected with functional testicular tumors leads to the following conclusions: (1) The origin of ectopic Leydig cells is not interstitial Leydig cells having infiltrated the testicular nerves and migrated along them towards ectopic locations. (2) The ectopic Leydig cells are considered to develop from undifferentiated precursor cells, located extraparenchymally, mainly inside and beside the testicular nerves. These precursor cells are similar to those observed in the testicular interstitium and have an ovoid shape and some cytoplasmic projections. The cytoplasm contains vesicles of smooth endoplasmic reticulum, lysosomes, lipid droplets and abundant microfilament bundles. The transformation from these cells into mature Leydig cells implies a progressive differentiation of the cytoplasmic components involved in steroid biosynthesis.

[Lack of the central pair of axial filaments in a case of short-tailed spermatozoa human teratospermia (author's transl)]

A case of short-tailed human spermatozoa is presented in a patient with severe teratospermia. The middle piece was generally short, showing abundant cytoplasmic droplets, disruption of the mitochondrial sheath and absence of some coarsed fibers. The majority of spermatozoa showed enlargement of the principal piece, reduplication of proliferation of the fibrous sheath, and disorganization as well of the axial filament complex as of the coarsed fibers. An abnormal great number of microtubules and coarsed fibers were frequently randomly scattered throughout the cytoplasmic droplet. A further abnormality, consisting in the lack of the central pair of axial filaments was relevant in a 70 p. 100 of spermatozoa. This latter abnormality could be or not associated with the former alterations.

[Excretion in basommatophora and stylommatophora pulmonata (author's transl)]

A comparative study on the kidney of Pulmonata living on land (Stylommatophora) and in fresh water (Basommatophora) was made. The sections performed in three different planes allowed us to know the 3-dimensional pattern of its components: renopericardial duct, kidney sac and ureter. Renopericardial duct runs far into the kidney sac. The duct of Basommatophora is longer and bears also longer cilia than that of Stylommatophora. Kidney sac is similar in both groups and is made up of a wall from which a complex lamellar system spreads into the cavity. Lamellae are longer and more numerous at the dorsal wall, being the lumen of the organ eccentric. The cavity is lined by columnar epithelial cells (nefrocytes) with brush border. Characteristic of the nefrocytes is the presence of a large apical vacuole containing an excretion granule. In Lymnaea there are also lamella lined by cubic epithelium without excretion granule. The union between kidney sac and ureter is different from one another in the three species studied. In Lymnaea the kidney sac narrows and forms the ureter; the connexion in Cryptomphalus is achieved through a 200 micrometer window; and in Helicella there is a duct between both parts. The ureter has a columnar epithelium with very deep infoldings of the basal cell membrane, according to its osmotic regulative function. In Stylommatophora there are primary and secondary ureters, while in Basommatophora there is only one type.