停留精巣の研究 第1報: 停留精巣における間細胞の形態学的観察

Abstract

正常成人6名を対照とし, 2～37歳の片側及び両側性停留精巣患者74例についてそれぞれ生検により間細胞を観察した.思春期前の停留精巣では, 成熟型間細胞は殆どなかったが, 思春期後では, 正常精巣におけるよりも過形成が認められ, その過形成を光顕下各対象の全視野の精細管数, 間細胞数, 間細胞塊数, セルトリ細胞数及びそれら相互の関係の面から検討した結果, 間細胞塊数/精細管数が, 過形成の定量的評価に最も有用と考えられた.この評価法でも, 過形成は健側において, より著明であった.正常成人精巣には, 電顕下で, 未熟型並びに成熟型間細胞が区別されたが, 停留精巣においては, 5歳以後でも成熟型間細胞は殆ど見られず, 思春期になってその出現を見たが, 依然として前駆細胞が優位を占め, 成熟型細胞が多くなるのは, その後のことであった.HCGを投与した患児の停留精巣では5歳でも成熟型細胞が出現した反面, 思春期後の停留精巣には, 種々の退行性変化が認められた

A morphological study of the Leydig's cells in the testes of cryptorchid patients was made by light and electron microscopy. Seventy four unilateral and bilateral cryptorchids (aged 2 to 37 years) were selected for light microscopic observation, and 28 of these specimens were also examined by electron microscopy. In 5 cases of pre-pubertal and pubertal cryptorchids, tissue specimens were biopsied after 20, 000 units of HCG had been given and examined similarly. In addition, Leydig's cell density was evaluated quantitatively in the undescended and contralateral scrotal testes of 12 post-pubertal patients. This was based on the determination of the total number of Leydig's cells, Leydig's cell clusters and seminiferous tubules in the entire histologic section of each biopsy and the calculation of the following indices; mean number of Leydig's cells per tubule, mean number of Leydig's cell clusters per tubule and mean number of Leydig's cells per cluster. In addition, the number of Sertoli's cells was counted, and the ratio of Leydig's cells to Sertoli's cells was also calculated. In the undescended testes, almost no mature Leydig's cells were found by light or electron microscopy during pre-pubertal periods; and, even in puberty they were few, while immature precursor Leydig's cells were abundant. In the 5 cases treated preoperatively with HCG, even at 5 years, mature Leydig's cells were observed by light and electron microscopy. On the contrary, after puberty, not only the undescended but also the contralateral scrotal testes of the cryptorchids had more mature Leydig's cells than the normal controls. This Leydig's cell hyperplasia was also confirmed by the quantitative analysis of Leydig's cell density. In the mature Leydig's cells of the undescended testes, however, the electron microscopic observation showed marked regressive changes, in cytology especially prominent depletion of the smooth endoplasmic reticulum and frequent occurrence of specific cytoplasmic inclusion bodies. Such regressive changes as found in the cells of the undescended testes were not observed in the cells of the contralateral scrotal testes. Thus, the morphological alteration of Leydig's cells observed here suggest that the cells are in a dysfunctional condition and that the androgen production is consequently decreased in the undescended testes of cryptorchid patients.