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Presented by Dr. Andres Matoso and prepared by Dr. Yembur Ahmad.
53 year old female undergoing bilateral orchiectomy
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1. Question
The images shown below are from a 53 year old female who has undergone a bilateral orchiectomy. What is your diagnosis?
Correct
Correct answer: C
Histology: Testis with atrophic seminiferous tubules with appearance similar to Sertoli-only pattern, marked expansion of the intertubular space with peritubular fibrosis. Leydig cells are diminished in number.
Discussion: As tolerance to gender dysphoria increases in the United States, many more individuals will be opting for gender affirming surgery (GAS) and specimens that were once uncommon will begin to be more frequent in surgical pathology laboratories. The clinical care of persons undergoing GAS is standardized and all persons reaching the stage of the surgical procedure have undergone hormonal therapy aimed to achieve a feminine phenotype. The histologic findings in the testis associated with cross-hormone therapy in persons undergoing GAS. These include: 1) decreased diameter of seminiferous tubules and expansion of the interstitium; 2) marked hypoplasia of germ cells with aspermatogenesis; 3) rare cytomegaly; 4) hypoplasia or absence of Leydig cells; 5) epididymal hyperplasia of the epithelium and periepididymal fibrosis. This spectrum of findings can be summarized in the surgical pathology report as “changes consistent with cross-hormone therapy.”
Reference: Hum Pathol. 2018 Jun;76:91-99.
Incorrect
Correct answer: C
Histology: Testis with atrophic seminiferous tubules with appearance similar to Sertoli-only pattern, marked expansion of the intertubular space with peritubular fibrosis. Leydig cells are diminished in number.
Discussion: As tolerance to gender dysphoria increases in the United States, many more individuals will be opting for gender affirming surgery (GAS) and specimens that were once uncommon will begin to be more frequent in surgical pathology laboratories. The clinical care of persons undergoing GAS is standardized and all persons reaching the stage of the surgical procedure have undergone hormonal therapy aimed to achieve a feminine phenotype. The histologic findings in the testis associated with cross-hormone therapy in persons undergoing GAS. These include: 1) decreased diameter of seminiferous tubules and expansion of the interstitium; 2) marked hypoplasia of germ cells with aspermatogenesis; 3) rare cytomegaly; 4) hypoplasia or absence of Leydig cells; 5) epididymal hyperplasia of the epithelium and periepididymal fibrosis. This spectrum of findings can be summarized in the surgical pathology report as “changes consistent with cross-hormone therapy.”
Reference: Hum Pathol. 2018 Jun;76:91-99.
