Histomorphological Trends of Testicular Lesions : A Retrospective Study

Aims: Testis is affected by a variety of non-neoplastic and neoplastic lesions. Our study was undertaken to analyze the spectrum of all testicular lesions and clinical correlation with age-wise distribution, laterality, and clinical presentation of all testicular lesions. Study Design: A retrospective descriptive study. Place and Duration of Study: Saveethe Medical College and Hospitals, over three years from January 2018 to December 2020. Methodology: All testicular lesions sent to the Department of Pathology during this period are taken for the study. Histopathological slides were retrieved and all testicular lesions were reviewed. Results: Out of 70 cases studied, 64 cases were non-neoplastic (91.42%) and 6 cases were neoplastic (8.57%). Right testis was more commonly involved in our study. Age distribution of nonneoplastic lesions showed the highest incidence in the 2nd decade of life (18.7%) followed by the 6th decade of life (15.6%) in our study. In neoplastic lesions, the 3rd and 4th decade of life shows higher incidence (33.4% respectively). Among non-neoplastic lesions, the most common histologic type is atrophic testis (31.2%). Among neoplastic lesions, the most common lesion is seminoma (50%). Conclusion: Nonneoplastic lesions are seen in all age groups, whereas testicular neoplastic lesions are more commonly seen in the younger age group. Original Research Article Niveditha and Harikrishnan; JPRI, 34(25A): 84-91, 2022; Article no.JPRI.84831 85


INTRODUCTION
The male reproductive system comprises the testes with their respective duct systems, the prostate, and the penis [1][2][3][4][5]. Their main function is to produce, store, and periodic emission of the male gametes, spermatozoa, as well as production of male sex hormones, principally testosterone.
The normal adult testis is a paired organ that lies suspended within the scrotum by the spermatic cord [16,7]. The testis is prone to a full range of pathological conditions. Testicular lesions are seen in all age groups ranging from pediatric to adult age group [7,8].
Undescended testes, also known as Cryptorchidism are one of the most common congenital anomalies seen approximately in 1% of one-year-old boys [9,7,8]. Cryptorchidism is a major risk factor for the development of testicular cancer [7,8].
Other non-neoplastic lesions encompass inflammatory lesions like acute and chronic Epididymoorchitis, vascular lesions like torsion of testis, regressive changes like the atrophic testis and decreased fertility, infections of testis like tuberculosis [9,7].
Neoplastic lesions of the testis are rare and account for approximately 1% of all neoplasms in males [10][11][12][13][14][15]. Testicular tumors can be classified into five major categories: germ cell tumors (90%) which arise from the germinal epithelium of the seminiferous tubules; sex cordstromal tumors; mixed germ cell-sex cordstromal tumors; primary tumors not specific to the testis; and metastatic tumors [6].
Scrotal swelling, pain, and mass per abdomen are the most common clinical presentations for all testicular lesions [7,8]. Hence histopathologic features play a major role in the clinical prognosis and treatment of testicular lesions [8].
This study was undertaken to study the diverse histomorphological features of both nonneoplastic and neoplastic lesions of testis and clinically correlate with the age-wise distribution, laterality of the lesions.

MATERIALS AND METHODS
This is a retrospective study over three years from January 2018 to December 2020. All testicular lesions sent to the Department of Pathology during the study period were taken for the study. Clinical details were obtained from the case sheets. Histopathological slides were retrieved and all testicular lesions were reviewed. The data were analyzed descriptively and compared with other studies.

RESULTS AND DISCUSSION
Among the total cases studied, 64 cases were non-neoplastic (91.42%) and 6 cases were neoplastic (8.57%) as shown in Fig. 1.

Non-neoplastic
The testis is affected by a variety of nonneoplastic and neoplastic lesions at various stages of life. A maximum number of testicular lesions are seen among 11 to 20 years (18.5%) followed by 51 to 60 years (17.1%) as shown in Table 1 and Fig. 2.
Majority of the cases present with unilateral involvement of testis. Most of the cases presented with right-sided involvement, 41 out of 70 cases (58.5%). Whereas left-sided involvement is seen in 26 out of 70 cases (37.1%). The remaining 3 of 70 cases (4.2%) showed bilateral involvement as shown in Table  2 and Fig. 3.
Age-wise distribution of non-neoplastic lesions showed the highest incidence in the 2nd decade of life, 12 of 64 cases (18.7%) followed by 5th decade of life, 11 of 64 cases (17.1%) as shown in Table 3.
Among non-neoplastic lesions, the most common histologic type is atrophic testis, 20 of 64 cases (31.2%) followed by torsion testis,13 of 64 cases (20.3%). The atrophic testis has a wide range of age distribution from 5 to 80 years, more incidence in 2nd decade of life, 5 of 20 cases as shown in table 3. Microscopically atrophic testis showed small tubes with thickened basement membrane with few or no germ cells and increased Leydig cells as shown in Fig. 4.  Inflammations are more commonly seen in epididymis than in testis. Various etiology leads to inflammation in testis and epididymis out of which Tuberculosis and gonorrhea are the most common etiology [9]. Microscopically the architecture is preserved but there can be patchy lymphoplasmacytic infiltrates in between and with the seminiferous tubules, hemorrhage, edema as shown in Fig. 5.
Torsion testis is more commonly seen among 11 to 20 years, 7 of 13 cases. Hydrocele 3 cases were studies (4.6%), usually associated with trauma and epididymitis. Clear serous fluid accumulates between visceral and peritoneal layers of tunica vaginalis. Haemotocele is an accumulation of blood in tunica vaginalis, 2 cases were studied. Pyocele, 8 cases studied is collection of pus in the tunica vaginalis.
8 cases of maturation arrest were studied. Maturation arrest can be complete or incomplete. Microscopically mature spermatozoa are absent and Sertoli cells appear prominent due to reduced germ cells.
In neoplastic lesions, the 3rd and 4th decades of life show higher incidence (33.4% respectively). Among neoplastic lesions, the most common lesion is seminoma constituting 3 of 6 cases (50%) followed by non-seminomatous mixed germ cell tumor, 2 of 6 cases (33.4%), and seminomatous mixed germ cell tumor, 1 of 6 cases (16.6%) as shown in Table 4. Microscopically seminoma shows tumor cells have abundant clear cytoplasm with centrally placed nucleoli as shown in Fig. 6.

Discussion
In this study total of 70 cases were studied. Among these cases, 11 to 20 years is the most common age group affected by testicular lesions (18.5%). Similar to the study done by Reddy H Et al (22%) [16]. Right testis is more commonly affected than left side testis in this study (58.5% vs 37.1%) similar to the study done by Tekumalla A Et al (51.25% vs 31.25%) [7].
Age non-neoplastic lesions showed the highest incidence in 11 to 20 years (18.7%) in this study which is similar to the study done by Qazi sm Et al (30.62%) [17]. Whereas a study done by Tekumalla A Et all showed the highest incidence in the 7th decade, corresponding to 32% [7].
Among non-neoplastic lesions, the most common histologic type is atrophic testis (31.2%). Torsion testis is the most common benign lesion in the study done by Oranusi ckt al corresponding to 42.9% [18] and Baidya r et al (54.9%) [19]. Torsion testis is the second most common nonneoplastic lesion (20.3%) and it is more commonly seen among the younger age group of 5 to 55 years in this study.   Neoplastic lesions were more commonly seen among 20 to 40 years (33.4%) in this study. Similar to a study done by Mushtaq S Et al which also showed a higher incidence among the 20 to 39 years of age group (47%) [20].

CONCLUSION
Non-neoplastic lesions are seen in all age groups, whereas testicular neoplastic lesions are more commonly seen in the younger age group. Knowledge about histomorphology and age distribution of neoplastic and non-neoplastic lesions of the testis is important as it determines the clinical prognosis and treatment of the patient.

CONSENT
It is not applicable.

ETHICAL APPROVAL
As per international standard or university standard written ethical approval has been collected and preserved by the author(s).