Granular transformation of Sertoli cells in testicular disorders

Perspectives in Pediatric Pathology, Chapter 14. Natural History of Undescended Testes

Cryptorchidism is one of the most frequent problems encountered in pediatric urology. Its causes, associated lesions, and prognosis in terms of fertility have been a source of interest and discrepancies for pediatric pathologists and urological surgeons.

Ultrastructure of the oviductal mucosa of Leptodactylus chaquensis. Analysis of the preovulatory and postovulatory periods

In the present study we analysed the ultrastructural characteristics of the oviductal mucosa of Leptodactylus chaquensis during the preovulatory period and immediately after ovulation. Epithelial secretory cells, ciliated cells, basal cells and glandular secretory cells are described. During the preovulatory period, the oviduct exhibits its maximum degree of development at both the epithelial and the glandular levels, with numerous secretory cells that contain a large number of secretory granules whose contents are released into the oviductal lumen by apocrine and exocytotic secretory processes. The secretory cells present throughout the oviduct display considerable variability in the characteristics of their secretory granules, which show different shapes, sizes, organization of the material contained and electron density. The different cell types are distributed following a characteristic pattern for each oviductal zone, thus creating an ultrastructural mosaic along the oviduct. During the postovulatory period, the number of secretory cells decreases and the remaining ones exhibit a marked reduction in secretory granules. Ciliated cells show a typical ultrastructural organization that is not modified throughout the reproductive cycle. Basal cells, located at the basal region of the epithelium, are characterized by their heterochromatic nuclei and electron-lucent cytoplasm, while glandular secretory cells exhibit oval, round or polyhedric granules, most of them with a prominent core. Our results, which indicate a high heterogeneity of secretory cell contents, allow us to suggest differential synthesis and secretion of specific products in each oviductal zone.

The death of sertoli cells and the capacity to phagocytize elongated spermatids during testicular regression due to short photoperiod in Syrian hamster (Mesocricetus auratus)

In the Syrian hamster (Mesocricetus auratus), an animal that displays testicular regression due to short photoperiod, germ cells are removed by apoptosis during this process and the apoptotic remains are phagocytized by Sertoli cells. The aim of this work was to investigate morphologically whether the testicular regression process due to short photoperiod leads to the apoptosis of Sertoli cells, and whether, during testicular regression, the elongated spermatids are eliminated through phagocytosis by Sertoli cells. To this end, we studied testis sections during testicular regression in Syrian hamster subjected to short photoperiod by means of several morphological techniques using conventional light microscopy (hematoxylin and eosin [H&E], semi-thin section vimentin, immunohistochemistry, SBA lectin, and TUNEL staining), fluorescence microscopy, and transmission electron microscopy (TEM). H&E and semi-thin sections identified Sertoli cells with a degenerated morphology. Greater portion of Sertoli cells that were positive for TUNEL staining were observed especially during the mild regression (MR) and strong regression (SR) phases. In addition, TEM identified the characteristic apoptotic changes in the nucleus and cytoplasm of Sertoli cells. Moreover, during testicular regression and using light microscopy, some elongated spermatids were seen in basal position next to the Sertoli cell nucleus. This Sertoli phagocytic activity was higher in MR and SR phases. TEM confirmed this to be the result of the phagocytic activity of Sertoli cells. In conclusion, during testicular regression in Syrian hamster due to short photoperiod, when germ cells are known to be lost through apoptosis, there is morphological evidences that Sertoli cells are also lost through apoptosis, while some elongated spermatids are phagocytized and eliminated by the Sertoli cells.

Granular changes in Sertoli cells in children and pubertal patients

OBJECTIVE

To characterize lysosomes and histochemical function of granular Sertoli cells in developmental alterations.

DESIGN

Prospective and retrospective study.

SETTING

University hospital and research centers.

PATIENT(S)

Nineteen infantile and pubertal patients undergoing testicular biopsy; four rat testes for lysosomal study.

INTERVENTION(S)

CD-68, alpha-1-antitrypsin, vimentin, inhibin alpha subunit, and anti-mullerian hormone antibodies were evaluated. Morphometric measures in seminiferous tubules with and without granular Sertoli cells were obtained. Ultrastructural data of lysosomes in human and rat Sertoli cells were compared.

MAIN OUTCOME MEASURE(S)

Quantification of mean diameter of seminiferous tubules, tubular fertility index, and germ and Sertoli cell indexes were obtained in human testis.

RESULT(S)

Granular changes in Sertoli cells are due to the accumulation of large amounts of lysosomes. Vimentin immunoexpression in infantile and pubertal granular Sertoli cells was lower than in adjacent nongranular Sertoli cells. Inhibin was negative in granular cells. Anti-mullerian hormone-positive and -negative granular Sertoli cells were present within the same tubules.

CONCLUSION(S)

The presence of early granular changes in Sertoli cells in childhood and pubertal cryptorchidic patients, associated with other developmental alterations, suggests an intense and irreversible dysfunction of phagocytosis in the granular Sertoli cells. These alterations might be considered primary and irreversible anomalies of Sertoli cells, which might be contributing factors in the infertility seen in these patients.

Focal orchitis in undescended testes: discussion of pathogenetic mechanisms of tubular atrophy

OBJECTIVE

To evaluate seminiferous epithelium lesions in adult cryptorchid testes showing lymphoid infiltrates in seminiferous tubules and interstitium (i.e., focal orchitis). Also, to consider the possible role of this lesion in the etiology of tubular atrophy.

METHODS

We performed a histopathologic study of the cryptorchid testes and adjacent epididymides removed from 50 adult men who had not been previously treated for cryptorchidism. The study included morphologic and semiquantitative evaluation of seminiferous tubule pathology (according to germ cell numbers), Sertoli cell morphology, tubular lumen dilation, rete testis pattern (normal, hypoplastic, or cystic), and epididymal pattern (normal or epididymal duct hypoplasia). The study also included immunohistochemical evaluation of immune cell markers. The results were compared with clinical and laboratory findings.

RESULTS

Focal lymphoid infiltrates (mainly lymphocytes) in seminiferous tubules and interstitium were found in 22 patients (44%), all of whom had unilateral cryptorchidism. The course of orchitis was asymptomatic, and laboratory data were normal. According to the seminiferous tubule pathology, a variety of histopathologic diagnoses, were made: (1) mixed atrophy consisting of Sertoli cell-only tubules intermingled with tubules showing maturation arrest of spermatogonia (11 testes, 4 of which also showed hyalinized tubules); (2) Sertoli cell-only tubules plus hyalinized tubules (4 testes); (3) Sertoli cell-only tubules (3 testes); (4) intratubular germ cell neoplasia (2 testes, 1 of which also showed hyalinized tubules); (5) complete tubular hyalinization (1 testis); and (6) tubular hyalinization plus some groups of tubules with hypospermatogenesis (all germ cell types were present although in lower numbers, 1 testis). Dysgenetic Sertoli cells, that is, Sertoli cells that had undergone anomalous, incomplete maturation, were observed in all nonhyalinized seminiferous tubules with inflammatory infiltrates. Tubular ectasia was observed in 13 cases. The rete testis was hypoplastic and showed cystic transformation in 18 testes, and the epididymis was hypoplastic in 15 testes.

CONCLUSIONS

The causes of these focal inflammatory infiltrates are unknown. It is possible that tubular ectasia and Sertoli cell dysgenesis are involved and that these alterations cause a disruption of the blood-testis barrier and allow antigens to enter the testicular interstitium, giving rise to an autoimmune process.

Testicular biopsy. Contemporary interpretation

Biopsy of the testis is not universally accepted in contrast with biopsies of other organs. The pathologist studies and reports on the pathophysiology of the testicular biopsy specimen. Methodology requires the inclusion of qualitative and quantitative studies, the evaluation of the lesion's evolution (prognosis), and, often, therapeutic advice regarding treatment. Cooperation between pathologists and clinicians optimizes the utility of the biopsy for the patient.

Androgen insensitivity syndrome: an immunohistochemical, ultrastructural, and morphometric study

OBJECTIVE

To evaluate the morphometric, immunohistochemical, and ultrastructural lesions of the testes in prepubertal and adult patients with androgen insensitivity syndrome.

METHODS

We examined the testicular biopsy using immunohistochemistry for vimentin, smooth muscle actin, and collagen IV antigens. Quantification of seminiferous tubules and testicular interstitium was performed in prepubertal and adult patients with androgen insensitivity syndrome and results were compared with normal testes from both infants and adults.

RESULTS

The adult testes presented nodular and diffuse lesions that consisted of Sertoli-cell-only seminiferous tubules. Two types of Sertoli cells could be distinguished, namely, immature vimentin-positive Sertoli cells and nearly mature Sertoli cells. In the nodules, the lamina propria was thin and contained a scant number of actin-positive peritubular cells. Leydig cells were hyperplastic. The prepubertal patients showed only diffuse lesions characterized by Sertoli cell hyperplasia, decreased germ cell numbers, and a discontinuous immunoreaction to collagen IV.

CONCLUSIONS

The testicular lesions in androgen insensitivity syndrome are probably caused by primary alterations that begin during gestation. These lesions become progressively more pronounced at puberty, when the nodular lesion pattern (adenomas) is completely developed.

Expression of CD15 in normal and metaplastic Paneth cells of the digestive tract

AIMS

To substantiate that incubation with monoclonal antibody CD15 (C3D-1) elicits a distinctive immunoreaction in normal small intestinal Paneth cells, normal and metaplastic Paneth cells along the digestive tract were assessed to determine whether they are also immunoreactive to CD15.

METHODS

Paneth cells in paraffin wax embedded specimens of normal small intestine, appendix and proximal ascending colon, and from cases of chronic gastritis and ulcerative colitis were investigated immunohistochemically for lysozyme and CD15 antigen expression by means of the avidin-biotin peroxidase complex method.

RESULTS

CD15 antibody reacted with a high proportion of both normal and metaplastic Paneth cells. Paneth cell immunoreactivity to CD15, however, was less intense and less extensive than to antilysozyme antibody, though the latter also stained many other cell types and was more commonly associated with nonspecific background staining.

CONCLUSIONS

CD15 seems to be a valuable adjuvant for the study of Paneth cells in the normal and diseased digestive tract. Furthermore, as CD15 has been shown to be involved in activation of phagocytes, its expression in Paneth cells reinforces their proposed role as antimicrobial agents and regulators of the intestinal flora.

Large cell calcifying Sertoli cell tumour of the testis

Five cases of large cell calcifying Sertoli cell tumour of the testis not associated with complex dysplastic syndromes are reported. The age of the patients ranged from 13 to 34 years and all the tumours were histologically similar, having large, isomorphic, non-mitotic, eosinophilic Sertoli cells with foci of calcification. Flow cytometry demonstrated the cells to be diploid or hypodiploid. All cases were positive for vimentin and focally positive for low molecular weight keratin. The present cases, together with a review of the 22 previously reported tumours, demonstrate that there are two clear cut types of large cell calcifying Sertoli cell tumour; those which are associated with complex dysplastic syndromes and which are bilateral and multifocal, and those which are not associated and are unilateral and focal. Prognosis in all of our cases was uniformly good despite invasion of the rete testis in two cases. It is considered that conservative resection of the tumour is the treatment of choice in cases not associated with complex dysplastic syndromes, since the malignancy rate is low.

Paneth cell-like change in prostatic adenocarcinoma represents neuroendocrine differentiation: report of 30 cases

Paneth cell-like change (PCLC) of the prostatic epithelium is considered to be a distinct form of neuroendocrine differentiation characterized by isolated cells or small groups of cells with prominent eosinophilic cytoplasmic granules. We evaluated 300 serially sectioned radical prostatectomy specimens from patients with prostatic adenocarcinoma who had not received prior adjuvant therapy (pathologic stages T2NOMO [177 patients], T3NOMO [100 patients], and TxN1MO [23 patients]). Paneth cell-like change was identified in 30 cases (10%), ranging from 1 to 20 high-power fields/positive case (mean, 4.1 high-power fields/case). There was no correlation of PCLC with prostate volume, prostate weight, Gleason grade, nuclear grade, lymph node metastases, serum prostate-specific antigen levels, cancer volume, area or presence of capsular perforation, seminal vesicle invasion, or glandular mucin (all P > .05), although a positive correlation was seen with cribriform pattern (r = 0.50, P = .0015). Immunohistochemistry revealed cytoplasmic immunoreactivity within cells of PCLC for chromogranin (seven of seven cases), neuron-specific enolase (seven of seven cases), serotonin (six of seven cases), prostate-specific antigen (five of seven cases), and prostatic acid phosphatase (four of seven cases); lysozyme was negative (seven cases). Our findings indicate that PCLC is more common than previously reported, but that it is not associated with tumor grade, serum PSA levels, or pathologic stage. This study also shows that PCLC represents neuroendocrine differentiation, suggesting that the term "Paneth cell-like change" be deleted from the pathologist's lexicon in relation to prostatic adenocarcinoma; a more appropriate term might be "neuroendocrine cells with large eosinophilic granules."