Spectrum of Findings in Orchiectomy Specimens of Persons Undergoing Gender Confirmation Surgery

Publication date: Available online 17 March 2018
Source:Human Pathology
Author(s): Andres Matoso, Binny Khandakar, Songyang Yuan, Tony Wu, Li J. Wang, Kara A Lombardo, Shamlal Mangray, Abul Ala Syed Rifat Mannan, Evgeny Yakirevich
Gender confirmation surgery (GCS) is increasingly common in persons with gender dysphoria. We describe changes seen in gonads from individuals seeking male to female physical adaptation. We studied 99 orchiectomies from 50 persons. The average age was 33years (range: 21–63). Eighty six of 99 (86.8%) testes were normal in size with an average size of 3.87cm (range: 3.0–5.5). Thirteen of 99 (13.1%) testes were hypotrophic and measured up to 2.5cm. Seminiferous tubules were reduced in diameter compared to controls (0.237 mm vs. 0.137 mm; P<.001) and showed peritubular fibrosis in 41 of 50 (82%) persons. In 40 of 50 (80%) persons, there was maturation arrest at the spermatogonia level. In 10 of 50 (20%) persons, the seminiferous tubules showed focal spermatids/spermatozoa up to 7 per 10 tubules mixed with partial maturation arrest at primary spermatocytes. Twenty six of 99 (26%) testes showed seminiferous tubules with rare cells with large nuclei (3x size of Sertoli cells nuclei) and degenerative chromatin (cytomegaly). Leydig cells were absent in 25 (50%), markedly reduced in 15 (32%), and similar to controls (mean 33/HPF) in 10 (20%). A subset (20/99, 20%) of testes had epithelial hyperplasia of the proximal epididymis with stratification and micropapillae. There was no germ cell tumor, sex cord stromal tumors or germ cell neoplasia in-situ. In summary, the histologic changes include: 1) decreased diameter of seminiferous tubules and expansion of the interstitium; 2) marked hypoplasia of germ cells; 3) rare cytomegaly; 4) hypoplasia or absence of Leydig cells; 5) epididymal hyperplasia.



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