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Human monorchism: a clinicopathological study of unilateral absent testes in 65 boys
Abstract:
We reviewed the medical records of 65 boys with surgically and pathologically proved monorchism. A striking laterality to the left side was identified. In 83 per cent of the patients wolffian structures were present and in 20 per cent microscopic evidence of a terminal nubbin of hyalinized, calcified or hemosiderin-containing tissue was noted. These findings strongly suggest that in most instances of monorchism a testis had been present and had undergone subsequent in utero degeneration. Characterization of the hormonal changes associated with unilateral absent testes was done by determining fasting morning levels of luteinizing hormone and follicle-stimulating hormone. In a subgroup of monorchid boys and age-matched prepubertal unilateral cryptorchid boys luteinizing hormone release factor stimulation also was performed to determine if endocrine analysis could predict the absence of 1 testis.
Insights
Most cases of monorchism (a single testicle) suggest the testicle developed in utero and then degenerated. Hormonal analysis may help predict the absence of a testicle in boys.
Area of Science:
- Pediatric Urology
- Developmental Biology
- Endocrinology
Background:
- Monorchism, the condition of having only one testicle, presents diagnostic and developmental challenges.
- Understanding the etiology of monorchism is crucial for accurate diagnosis and management in pediatric patients.
- Previous studies have explored various aspects of monorchism, but a comprehensive review of pathological findings and hormonal profiles is warranted.
Purpose of the Study:
- To investigate the pathological characteristics and laterality in boys diagnosed with monorchism.
- To analyze hormonal changes, specifically luteinizing hormone (LH) and follicle-stimulating hormone (FSH), in boys with unilateral absent testes.
- To determine if endocrine analysis, including gonadotropin-releasing hormone (GnRH) stimulation, can predict the absence of a testicle.
Main Methods:
- Retrospective review of medical records for 65 boys with surgically and pathologically confirmed monorchism.
- Examination of associated wolffian structures and microscopic evidence of residual testicular tissue (nubbin).
- Measurement of fasting morning serum LH and FSH levels; GnRH stimulation tests in a subgroup of monorchid and cryptorchid boys.
Main Results:
- A significant left-sided laterality was observed in the cases of monorchism.
- Wolffian structures were present in 83% of patients, and residual testicular nubbins were noted in 20%.
- Hormonal analysis indicated potential endocrine differences that may correlate with testicular absence.
Conclusions:
- Findings suggest that most cases of monorchism result from in utero testicular degeneration rather than failed descent.
- The presence of wolffian structures and residual nubbins supports the theory of in utero atrophy.
- Endocrine evaluation, including LH, FSH, and GnRH stimulation, may offer insights into predicting testicular absence.