Fine-needle aspiration cytology in azoospermic males

Cytological description of testicular cell populations in sexually mature cats with normal spermatogenesis

In cats, assessment of the testicular function is mainly based on sperm evaluation. Whatever the technique used, the volume of collected sperm is often small, which may lead to technical difficulties to achieve the semen evaluation in routine practice. Fine-needle aspiration (FNA) biopsy of the testicular parenchyma is one of the other methods used to assess testicular function. The aim of this study was to explore the relevance of FNA in the assessment of testicular cells in sexually mature cats. Eighteen cats over one year of age were recruited among animals presented for surgical neutering. Semen was collected by electroejaculation before it was evaluated. FNA biopsies of the testicles were taken using a 21-gauge needle. After castration, histological analysis of the testes was performed. Semen evaluation and histological analysis showed no anomalies, which confirmed normal spermatogenesis in all the cats and allowed a proper interpretation of the cytological findings. The cells identified through cytological examination were spermatogonia (1.99 ± 0.17%), primary spermatocytes (10.49 ± 0.74%), round spermatids (34.80 ± 1.57%), elongated spermatids (23.59 ± 2.02%), spermatozoa (21.56 ± 1.86%), Sertoli cells (7.53 ± 1.23%) and Leydig cells (0.04 ± 0.03%). However, spermatocytes II were not identified. This is due to the low proportions of these cells, related to their very short lifespan. Likewise, the very low number of Leydig cells observed is probably due to the damage caused during the aspiration stage. This study showed that fine-needle aspiration is an efficient method to describe cytologically normal testicular populations, a cornerstone for future research aimed to study abnormal spermatogenesis and to correlate it to cytological proportion of germ cells.

Quantitation of spermatogenesis by DNA flow cytometry from fine-needle aspiration cytology material

DNA flow cytometry (FCM) was performed from fine-needle aspiration cytology (FNAC) of testis in 15 cases of male infertility to quantitate spermatogenesis. The results were correlated with FNAC findings. DNA FCM showed a ploidy relationship of haploid (1N) > diploid (2N) > tetraploid (4N) in cases of normal spermatogenesis. A ploidy relation of 2N > 1N > 4N was observed in cases of hypospermatogenesis or maturation arrest. In Sertoli cell-only cases, there were only 2N populations of cells. With the help of DNA FCM, a rapid and objective assessment of spermatogenesis is possible from FNAC of the testis.

Is diagnostic testicular fine needle aspiration necessary in azoospermic men before sperm aspiration/extraction for intracytoplasmic sperm injection cycles?

PURPOSE

To determine whether diagnostic testicular fine needle aspiration (TEFNA) sampling needs to be performed in azoospermic men prior to obtaining testicular sperm cells for IVF-ICSI procedures.

METHODS

Ten azoospermic patients underwent TEFNA in 1993-1996. During 1997, all patients underwent testicular sperm aspiration (TESA) and/or testicular sperm extraction (TESE) to retrieve spermatozoa for IVF-ICSI cycles. The results of the two procedures performed in two separate hospitals were compared.

RESULTS

Diagnostic TEFNA revealed spermatozoa in five patients; identical results in four were found during IVF-ICSI cycles. In three patients, only Sertoli cells were found on TEFNA, in two of them TESA/TESE showed identical results, and in one, two spermatozoa were detected by Cyto-SEM. In the remaining two patients, spermatids or spermatocytes were found on both procedures.

CONCLUSIONS

There was a very good correlation between the diagnostic and therapeutic procedures. We suggest that in azoospermic patients, diagnostic TEFNA is valuable in order to avoid unnecessary controlled ovarian hyperstimulation in the female partner for IVF. In patients in whom spermatozoa are detected, cryopreservation may be performed for later IVF-ICSI cycles.

Azoospermia in two Labrador retrievers

Azoospermia is described in two sibling Labrador Retriever dogs. Clinical investigations following failure to sire pups after normal matings revealed testicular hypoplasia and degeneration. Sperm were absent on repeated ejaculate examination in both dogs. Histopathological examination of testicular needle aspirate biopsy and whole testicle of the first dog displayed an absence of spermatids and spermatocytes. Seminiferous tubules containing Sertoli cells with or without primary spermatogonia were present in the second dog. Peritubular lymphocyte accumulation was also present in both dogs. The dogs had been conceived using frozen-thawed semen.

Testicular fine needle aspiration cytology as a diagnostic tool in dog infertility

The results of testicular aspirate cytology taken from clinical patients with a history of infertility were compared with the clinical and histological findings. Azoospermia was the most common and the most rewarding indication for the examination. Samples were also taken from cases with suspected testicular tumours, orchitis, epididymitis, severe oligo- and teratozoospermia, lack of libido and unilateral testicular atrophy. Histological and cytological findings were found to correlate well. Identification of cell types from normal germinal epithelium was relatively easy. No immediate adverse effects of aspiration were noted. Five normospermic dogs were monitored for two to six months after aspiration, and there were no marked deleterious effects on testicular consistency, testicular histology or semen characteristics. Testicular cytology obtained by fine needle aspiration may, at least to some extent, be used to assist clinical diagnosis, especially in azoospermic dogs and dogs with palpable changes of testicular tissue.

Functional and cytologic features of the contralateral testis in cryptorchidism

OBJECTIVE

To characterize the testicular cytologic pictures in cryptorchild and contralateral testis related to seminal pattern.

DESIGN

Controlled clinical study.

SETTING

Andrological and urologic academic setting.

PATIENTS

One hundred nine patients orchidopexied because of unilateral cryptorchidism compared with 35 normospermic subjects.

INTERVENTIONS

Bilateral testicular fine-needle aspiration cytology.

MAIN OUTCOME MEASURES

Seminal parameters; testicular cytologic features; plasma levels of FSH, LH, and T; and ultrasound testicular examination.

RESULTS

The cytologic analysis revealed an important quantitative and qualitative impairment of spermatogenic line in all the excryptorchid testes. These alterations are present in the contralateral testes only when azoospermia or severe oligozoospermia were observed, whereas in moderate oligozoospermic subjects a normal tubular status was evident. A compensatory activity in normally descended testis of normozoospermic patients was present.

CONCLUSIONS

In unilateral cryptorchidism, a frequent testicular damage in the orchidopexied and in the contralateral descended testis suggests that this condition is the end point of different pathological conditions, including testicular intrinsic (congenital) and extrinsic (anatomical) causes. Fine-needle aspiration cytology of both testes represents a tool in the assessment of the tubular status in excryptorchid subjects.

The Contralateral Testis in Cryptorchid Patients

We performed bilateral testicular Fine Needle Aspiration Cytology (FNAC) in a large group of unilateral cryptorchid subjects to characterize the tubular status related to the seminal pattern. In azoospermic and in severe oligozoospermic subjects the cytological picture of the contralateral testis showed similar lesions to those observed in the cryptorchid testis, while in moderate oligozoospermic subjects this analysis revealed the presence of a normal spermatogenic line and in normospermic subjects the presence of a compensatory activity of the tubular function. In conclusion, in unilateral cryptorchidism a frequent testicular damage in the orchidopexied testis and a concomitant tubular alteration in the contralateral scrotal testis exist, suggesting that cryptorchidism is the end point of different pathological conditions, including intrinsic (congenital) and extrinsic (anatomical) causes. FNAC of both testes could represent a tool for the clinician in the assessment of the tubular status in cryptorchid subjects, above all in presence of azoospermia or severe oligozoospermia. In these cases the existence of intratesticular spermatids or mature spermatozoa allows new assisted reproduction techniques using intratesticular germ cells to be used.

Is one testicular specimen sufficient for quantitative evaluation of spermatogenesis?

OBJECTIVE

To investigate whether quantitative analysis performed on one testicular specimen is adequate for quantitative evaluation of spermatogenic process.

DESIGN

Comparison of quantitative analysis of spermatogenic cell types in testicular cytologic aspirates of various sites of each testis.

SETTING

In each aspirate, a total of 500 Sertoli cells and cells at each of the spermatogenic stages were identified, counted, and grouped according to cell type. A quantitative cell type index was calculated for each type of cell in each aspirate. Mean cell type indexes then were calculated for each of the cell types in the three aspirates of each patient, and variations of a given sample from its mean were compared.

PATIENTS

Azoospermic or severely oligospermic infertile men.

INTERVENTIONS

Fine needle aspiration performed on the upper, middle, and lower poles of each testis.

RESULTS

Each of the aspirates showed wide deviations from the mean of the three aspirates for that patient. The deviation ranges of the cell type indexes of each of the spermatogenic stages were as follows: spermatogonia, 0.8% to 200%; spermatocytes, 1.4% to 94.3%; spermatids, 2.9% to 200%; and spermatozoa, 0.7% to 128%. In the majority of the patients, at least one of the three aspirates showed a cell type index score that was statistically different from the others.

CONCLUSIONS

These results suggest that more than one testicular specimen is needed to evaluate quantitatively the spermatogenic process.

Quantitative analysis of mast cells in testicular aspiration cytology smears in azoospermic males

Quantitative estimation of mast cells was done in testicular aspiration cytology smears of 90 azoospermic males. Cases included normal spermatogenesis (32), Sertoli cell only (38), late maturation arrest (16), and early maturation arrest (4). The pooled number of mast cells in 20 standard fields in Sertoli cell only and late maturation arrest cases were significantly higher than that of normal spermatogenesis (P < .001 and P < .01 respectively). Aggregates of mast cells were found around the seminiferous tubules in Sertoli cell only cases. The findings suggest that increased number of mast cells may be the cause or effect of testicular damage in idiopathic male infertility.

Testicular cytology in azoospermia

Two hundred-seventy-five azoospermic males were subjected to fine-needle aspiration (FNA) cytologic study of testis with the aim of determining the cause of azoospermia; 534 aspirates from these patients were classified as follows: normal spermatogenesis (162), hypospermatogenesis (mild, moderate, or severe, 226), absence of spermatogenesis (130), maturation arrest (36), Sertoli-cell-only syndrome (14), and Leydig-cell hyperplasia (3). The morphology of cells was excellent in the cytologic preparations and various spermatogenic cells and Sertoli cells were easily recognized. Leydig cells were uncommonly seen, except in cases of Leydig-cell hyperplasia. Degenerative changes, possibly due to obstruction, were seen in 104 cases. The procedure was well tolerated by the patients. We conclude that FNA cytology is a useful investigative modality in the evaluation of azoospermic males.