Beitrag zu den sogenannten hypoplastischen Zonen und den Ringtubuli der menschlichen Hoden

Zusammenfassung Verff. berichten in Verbindung mit 2 eigenen Fällen über die sogenannten hypoplastischen Zonen und die Ringtubuli der Hoden und geben eine kurze Übersicht über die in der Literatur mitgeteilten Beobachtungen. Summary The authors report two cases with the so called hypoplastic zones and the so called ring‐like tubules in testicular biopsies. Hypoplastic zones were found in a patient with bilateral cryptorchidism, ring‐like tubules in a patient with hypogonadotropic hypogonadism. Both histologic changes are documented by photographic plates, their etiology and significance is discussed in connection with a short review of the literature. Hypoplastic zones may be defined as isolated lesions of the testis, consisting of tubules with prepuberal features. They were originally attributed to a delayed maturation of the seminiferous epithelium as a consequence of the abnormal position of the undescended testis. More recently, they were considered to indicate congenital, intrinsic defectiveness. This theory, however, has not remained unchallenged, since hypoplastic zones can be found with some frequency in descended and apparently normal testes as well. The appreciation of intratubular bodies in ring‐like tubules has been even more inconsistent. Other names for intratubular bodies include stones, concrements and calco‐spherules. Their origin has been traced to displaced spermatogonia, to a secretory product of Sertoli cells, or to oocytes. Even their intratubular location has been disputed. Two morphologic types of bodies may be distinguished: homogeneous and laminated bodies. The latter are usually associated with typical changes of the corresponding tubules, featuring two distinct layers of cells which lie against the basement membrane and closely around the central body, respectively. While several authors have taken intratubular bodies as evidence of testicular dysgenesis, others feel that they may have no serious implications. Our demonstration of intratubular bodies in a patient with hypogonadotropic hypogonadism and thus secondary testicular failure seems to support the latter opinion. Resumen Los autores aportan dos biopsias testiculares pertenecientes a un paciente criptor‐quidico y a un hipogonadismo hipogonadotrófico en las que encuentran «zonas hipoplásicas» y «túbulos como anillos». «Zonas hipoplásicas» se pueden definir como lesiones aisladas del testiculo, consistentes en túbulos con imágen prepuberal. Originariamente, se atribuyeron a alteración de la maduración del epitelio germinal secundaria a la posición anormal del testiculo no descendido. Recientemente, se considera como defecto intrinseco, congénita. Estas «zonas hipoplásicas», no obstante, se han encontrado también en testiculos descendidos y aparentemente normales. La apreciación de cuerpos intratubulares, ha sido mäs inconstante. Su origen se ha atribuído a espermatogonias alteradas, a producto de la célula de Sertoli o a oocitos. Su lo calización intratubular ha sido discutida. Se pueden distinguir dos tipos morfológicos de cuerpos: cuerpos homogéneos y laminados, los últimos son generalmente asociados con cambios típicos de los tubulos correspondientes que forman dos capas distintas de células que se apoyan contra la membrana basal y rodean estrechamente el cuerpo central respectivamente. Miemtras que unos autores han considerado los cuerpos intratubulares como evidencia de disgenesia testicular, otros creen que no significan complicaciones serias. Nuestra demostracion, comentan los autores, de cuerpos intratubulares en un paciente con hipogonadismo hipogonadotrófico y por tanto fallo testicular secundario, parece apoyar la última opinión.