A 13-year-old boy is brought to the office for a new patient visit. The patient recently immigrated to the United States with his family. He has no history of significant illness, trauma, or surgery. Physical examination shows Tanner stage IV genitalia but an empty right scrotal sac. A round mass can be palpated in the right inguinal canal. Biopsy of the mass shows marked fibrotic changes with prominent Leydig cells and hypoplastic Sertoli cells. The patient's parents are advised that the mass should be removed. Which of the following is the most likely explanation for the need for surgery in this patient?

Question

A 13-year-old boy is brought to the office for a new patient visit.  The patient recently immigrated to the United States with his family.  He has no history of significant illness, trauma, or surgery.  Physical examination shows Tanner stage IV genitalia but an empty right scrotal sac.  A round mass can be palpated in the right inguinal canal.  Biopsy of the mass shows marked fibrotic changes with prominent Leydig cells and hypoplastic Sertoli cells.  The patient's parents are advised that the mass should be removed.  Which of the following is the most likely explanation for the need for surgery in this patient?

Quizplus · Accepted Answer

11ec160b_399f_5ff6_9249_c3ed5d89b92f_MD0001_00 This patient has an undescended testis, or cryptorchidism. Embryologically, the testes originate within the abdomen and then migrate to the scrotal sac via the inguinal canal. The cause of cryptorchidism is poorly understood in most cases. Undescended testes may be unilateral or bilateral and can lie anywhere along the path from the abdomen to the scrotal sac. The temperature inside the scrotal sac is lower than normal body temperature, creating an ideal environment for sperm production. The seminiferous tubules and the Sertoli cells within them are very temperature-sensitive and prone to heat-induced damage. If uncorrected, cryptorchidism leads to atrophy and necrosis of the seminiferous tubules, resulting in decreased fertility. Patients with cryptorchidism are at increased risk for testicular cancer. Orchiopexy (moving the testes into the scrotal sac) reduces but does not eliminate the risk of malignancy and is most effective when performed between age 6 months and 1 year. (Choice A) In unilateral cryptorchidism, the contralateral testis functions normally and is not at increased risk for malignancy or torsion. (Choice B) Unlike the seminiferous tubules, the testosterone-producing Leydig cells are not very sensitive to temperature. Testosterone levels and virilization are usually normal. (Choice C) No increased risk for testicular or genitourinary tract infection is found with cryptorchidism. (Choice D) Orchiopexy before age 1-2 may provide some advantage to future fertility. Beyond age 2, no evidence demonstrates that orchiopexy can preserve sperm count in the undescended testis. Educational objective: In undescended testes, the seminiferous tubules atrophy if uncorrected due to higher body temperatures, resulting in decreased fertility and increased risk for malignancy. Orchiopexy (surgical placement of the testes in the scrotal sac) can minimize damage and decrease risk for testicular cancer. __________ References: The undescended testis: diagnosis, treatment and long-term consequences. (http://www.ncbi.nlm.nih.gov/pubmed/19738919)

A 13-Year-Old Boy Is Brought to the Office for a New