Endocrinology of testicular neoplasms

Autophagy: A Double-Edged Sword in Male Reproduction

Autophagy, an evolutionarily conserved cell reprogramming mechanism, exists in all eukaryotic organisms. It is a fundamental and vital degradation/recycling pathway that removes undesirable components, such as cytoplasmic organelles, misfolded proteins, viruses, and intracellular bacteria, to provide energy and essential materials for organisms. The success of male reproduction depends on healthy testes, which are mainly composed of seminiferous tubules and mesenchyme. Seminiferous tubules are composed of Sertoli cells (SCs) and various germ cells, and the main functional part of mesenchyme are Leydig cells (LCs). In recent years, a large amount of evidence has confirmed that autophagy is active in many cellular events associated with the testes. Autophagy is not only important for testicular spermatogenesis, but is also an essential regulatory mechanism for the ectoplasmic specialization (ES) integrity of SCs, as well as for the normal function of the blood-testes barrier (BTB). At the same time, it is active in LCs and is crucial for steroid production and for maintaining testosterone levels. In this review, we expanded upon the narration regarding the composition of the testes; summarized the regulation and molecular mechanism of autophagy in SCs, germ cells, and LCs; and concluded the roles of autophagy in the process of spermatogenesis and testicular endocrinology. Through integrating the latest summaries and advances, we discuss how the role of autophagy is a double-edged sword in the testes and may provide insight for future studies and explorations on autophagy in male reproduction.

Chronic Immune-Mediated Orchitis Is the Major Cause of Acquired Non-obstructive Azoospermia in Dogs

Azoospermia, the lack of spermatozoa in the ejaculate, is the most common finding in infertile but otherwise healthy male dogs and represents an increasing reproductive health issue in men, too. The diagnosis can be further classified as non-obstructive azoospermia and obstructive azoospermia due to an obstruction of the deferent ducts. Although non-obstructive azoospermia comprises more than half of azoospermic cases in men and is a common cause of infertility in the male dog, knowledge of the underlying etiology and pathophysiology is still strongly limited, and much uncertainty exists about the true incidence and possible treatment options. Therefore, this study aims to investigate and characterize infertile canine patients in detail by combining results of andrological examinations (clinical parameters, semen analysis, bacterial examination of semen, and Brucella canis serology), endocrine analysis (luteinizing hormone, testosterone, estradiol-17ß, and thyroid function), analysis of the alkaline phosphatase in seminal plasma, and histological assessment of testicular biopsies of 10 azoospermic dogs. Our results not only verify non-obstructive etiology for 9/10 cases of canine azoospermia but also further identified significant histopathological changes of the testicular tissue with severely disrupted spermatogenesis, including fibrotic remodeling, vacuolization, Sertoli-cell-only syndrome, tubular shadows, and an increase of the interstitial and vascular area. In addition, three dogs showed local and six dogs generalized immune-cell infiltration, indicating chronic immune-mediated orchitis. Only in one case (no. 1) that no immune cells were found, and obstructive azoospermia was suspected due to low alkaline phosphatase activity. Furthermore, the detection of anti-thyroideal antibodies in two dogs indicates an autoimmune thyroid disease and a correlation between the occurrence of thyroidal disorders and azoospermia. Our results confirm previous findings and contribute additional evidence suggesting that chronic immune-mediated orchitis is the major cause of infertility in dogs. Further studies should focus on uncovering underlying inflammatory processes behind spermatogenic failure in these cases and identify possible treatment options to (re-)initialize spermatogenesis.

Two distinct localization patterns of testis-specific serine protease 1 (TESSP1) in the seminiferous tubules of the mouse testis

Mouse Tesspl has been shown to be a testis-specific gene that may contribute to spermatogenesis. In this report, we raised a specific antibody against TESSP1 to assess its biological role. Western blotting detected testicular TESSP1 in all postnatal developmental stages of the mouse. Experiments using the testes of W/W(V) mice, which lack germ cells, indicated TESSP1 expression in Sertoli cells and Leydig cells. In immunofluorescence staining of the wild-type mouse testis, dot-like signals for TESSP1 were observed in the adluminal compartment of the seminiferous tubules, while diffused signals were found in the basal compartment. Generally, the dot-like and diffused signals overlapped with the trans-Golgi network marker RAB6 and the transmembrane protein CADHERIN 2, respectively. Some TESSP1 staining was also observed in association with interstitial Leydig cells of the testis. The results of this study suggest that TESSP1 is predominantly localized in the plasma membrane of spermatogonia and Sertoli cells in the basal compartment, but exhibits an intracellular localization, presumably in the Golgi apparatus, of spermatocytes and spermatids in the adluminal compartment of the seminiferous tubules. The expression of TESSP1 in both germ cells and somatic cells and alteration in its cellular localization in the germ cells during spermatogenesis indicate that it may have a unique role in the testis.

Male gynecomastia and risk for malignant tumours--a cohort study

BACKGROUND

Men with gynecomastia may suffer from absolute or relative estrogen excess and their risk of different malignancies may be increased. We tested whether men with gynecomastia were at greater risk of developing cancer.

METHODS

A cohort was formed of all the men having a histopathological diagnosis of gynecomastia at the Department of Pathology, University of Lund, following an operation for either uni- or bilateral breast enlargement between 1970-1979. All possible causes of gynecomastia were accepted, such as endogenous or exogenous hormonal exposure as well as cases of unknown etiology. Prior to diagnosis of gynecomastia eight men had a diagnosis of prostate carcinoma, two men a diagnosis of unilateral breast cancer and one had Hodgkin's disease. These patients were included in the analyses. The final cohort of 446 men was matched to the Swedish Cancer Registry, Death Registry and General Population Registry.

RESULTS

At the end of the follow up in December 1999, the cohort constituted 8375.2 person years of follow-up time. A total of 68 malignancies versus 66.07 expected were observed; SIR = 1.03 (95% CI 0.80-1.30). A significantly increased risk for testicular cancer; SIR = 5.82 (95% CI 1.20-17.00) and squamous cell carcinoma of the skin; SIR = 3.21 (95% CI 1.71-5.48) were noted. The increased risk appeared after 2 years of follow-up. A non-significantly increased risk for esophageal cancer was also seen while no new cases of male breast cancer were observed. However, in the prospective cohort, diagnostic operations for gynecomastia may substantially have reduced this risk

CONCLUSIONS

There is a significant increased risk of testicular cancer and squamous cell carcinoma of the skin in men who have been operated on for gynecomastia.

Sexual and marital relationships after radiotherapy for seminoma

Questionnaires on sexual function, marital status, and fertility were returned by 84 men who received radiotherapy for seminoma (Stage I, II, or III). The mean length of follow-up was ten years. Although 93 per cent were married, 19 per cent had low rates of sexual activity, 12 per cent reported low sexual desire, 15 per cent had erectile dysfunction, 10 per cent had difficulty reaching orgasm, and 14 per cent had premature ejaculation. The most common problems were reduced intensity of orgasm (33%) and reduced semen volume (49%). Twenty-one men remained childless, and 30 per cent of men worried at least occasionally about infertility. Thirteen children were conceived after cancer therapy. The data suggest that sexual dysfunction and infertility are important concerns for a subgroup of men treated for seminoma.