Histological features of the testicular nubbin in the vanishing testis: Is surgical exploration necessary?

Abstract

INTRODUCTION & OBJECTIVES: Vanished testis syndrome is identified in up to 35% of cases of nonpalpable testis. It seems that this syndrome is a common phenomenon; however, the optimal management of this condition remains unclear. We reviewed histopathological studies of the testicular nubbins associated with the vanishing testis syndrome, and determined whether surgical removal is indicated based on the histological findings. MATERIAL & METHODS: Between Jan. 1996 and Dec. 2015, a testicular nubbin consistent with a vanishing testis was excised in 62 patients. We reviewed the medical records, operative summaries, surgical pathology reports and slides. We also noted whether the testis was palpable or nonpalpable and whether laparoscopy had been done before inguinal exploration. The microscopic slides were examined in each cases. RESULTS: The ages of patients ranged from 6 months to 35 years. On physical examination, no palpable testis was found in the scrotum in 48 patients. In 12 patients, there was a small palpable nodule thought to be a testis, 3 of which were within the inguinal canal. The surgical approach was via an inguinal incision in 58 patients. The 4 patients underwent laparoscopy followed by inguinal exploration. Of the explorations, 45 were on the left and 15 on the right, 2 patients underwent bilateral exploration. All 62 cases had fibrosis; calcifications were present in 25 and hemosiderin deposits in 28. An epididymis was present in 4 (6.5%) and vas deferens in 49 (79.1%) cases. Recognizable testicular elements (Seminiferous tubules) were present in 7 (11.2%) nubbin. The 5 (8%) with seminiferous tubules had germ cells identified (Fig. 1). No recognizable Leydig cells were present in the stroma surrounding the seminiferous tubules. In all cases, intratubular germ cell neoplasia (ITGCN) was not present.