Fertil Steril 2008 Mar 4;89(3):597-601. Epub 2007 Jun 4.
Department of Paediatric Endocrinology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
Objective: To evaluate the histological features of testicular tumors and residual testicular parenchyma in male patients with congenital adrenal hyperplasia (CAH) and longstanding bilateral testicular adrenal rest tumors (TART).
Design: Descriptive study.
Setting: University medical center in the Netherlands.
Patient(s): Seven male patients who had CAH with longstanding bilateral TART and who were treated with testis-sparing surgery.
Intervention(s): Enucleation of TART and taking biopsies of the surrounding testicular parenchyma.
Main Outcome Measure(s): Description of the histological features of TART and residual testicular parenchyma.
Result(s): All tumors had a similar histological appearance, with sheets of polygonal cells separated by dense fibrous tissue with focal lymphocytic infiltrates and without Reinke crystals. All biopsies showed a decrease in tubular diameter with peritubular fibrosis and, in four patients, tubular hyalinization. The germinative layer showed decreased spermatogenesis and reduced Johnsen scores.
Conclusion(s): Testicular adrenal rest tumors can lead to end-stage damage of testicular parenchyma, most probably as a result of longstanding obstruction of the seminiferous tubules. Therefore, treatment at an early stage is advised.