Answer: Severe testicular atrophy with intrabular germ cell neoplasm unclassified (IGCNU)

Histology: none provided

Discussion: The testis shows many seminiferous tubules with complete atrophy and hyalinization. Leydig cell hyperplasia is associated. The IGCNU lesion is demonstrate a “seminomatous” cytologic morphology showing basaly located cells with distinct cytoplasmic clearing, nuclear enlargement and atypia with one or more prominent nucleoli. Seminiferous tubules involved by IGCNU usually lack evidence of normal spermatogenesis.

The incidence of cryptorchidism is estimated to be 1-2% Although some have suggested a biopsy to be routinely done at time of orchiopexy, Currently such biopsies are recommended only if karyotypic abnormalities or other urogenital malformations are present. IGCNU is encountered in 0.4 % of cryptorchid testis biopsied during pexy procedures. Cryptorchid testes are at 3-5% life time risk (4-7 folds increased relative risk) for developing a germ cell malignancy. Patients also have an additional 2-3 folds increased relative risk of malignancy in the contralateral normally descended testis. The latter is in line with the evidence suggesting a link between the increased risk of IGCNU in crytorchidism and presumed in-utero hormonal environment changes rather than the abnormal location of the testis. The majority of germ cell tumors developing in association with cryporchidism (80 %) are seminomatous in type.