Anormal İnmemiş Testis Tespit Edilen Bir Yetişkin Hasta

Normalde testis abdomende gelişir ve doğum sırasında yada 1 veya 2 yıl içinde skrotal kese içine iner. Farklı faktörler testisin inmesi ile ilişkilendirilir. İnmede meydana gelen hata inmemiş testise veya kriptorşidizme neden olabilir. Sunulan bu vakada, 71 yaşında ki erkek bir kadavrada kısmen abdomende ve inguinal kanalda inmemiş testisini tespit ettik. İlk olarak inen epididimis ve onun büyük parçası yüzeysel inguinal halkanın dışında idi. Derin inguinal halkalar boyunca ilerleyen testiküler damarlar kanal içinde testisin konik kısmının postero-lateral kısmına dahil oldu. Bükülme (torsiyon) veya nekrotik değişimler inmemiş testiste gözlendi. Histolojik inceleme, kanal içinde epididimis kısmında birincil kanal sisteminde ve kanalın dışında olan epididimiste normal görüntüyü ortaya çıkardı ancak; tüm testis incelemeleri, sadece büyük inter-tübüler boşluklar ve hücresel yapılar ile kanalize olmayan küçük seminifer tübülleri ortaya çıkardı. Bunun gibi inmemiş testis ile ilişkili en yaygın problemler fertilite, testiküler kanser, inguinal hernia ve nekroz ile testiküler torsiyondur. Dolayısıyla; bu durumların doğru tespiti, ilişkili sendromların uygun teşhis ve tedavisel stratejileri yukarıda bahsedilen olumsuz sonuçları önlemede oldukça önemlidir.

Anahtar Kelimeler:

İnmemiş testis, epididimis, inguinal kanal, kriptorşizm, testiküler torsiyon.

Abnormally rotated undescended testis arrested in the deep inguinal ring of an adult: A case report with histological study and review of literature

Normally testis is developed in the abdomen and descends in to the designated scrotal sac at the time of birth or within one or two years after birth. Several factors are associated with proper descent of the testis. Failure to descend, may lead to undescended testis or cryptorchidism. In the present case, we found an undescended testis partly in the inguinal canal and partly in the abdomen in a 71-year-old male cadaver. The epididymis descended first and its major portion was outside the superficial inguinal ring. The rest of the flattened epididymis was found inside the canal attached to the upper tapered pole of the testis and the vas deferens was found arising from this portion. The testicular vessels traversing through the deep inguinal ring then entered the postero-lateral portion of the tapered portion of the testis within the canal. No torsion and necrotic changes were observed in the undescended testis. Histological examination revealed a normal pattern in the epididymis which was outside the canal and a primitive duct system in the part of the epididymis within the canal. However, the entire testis showed only non-canalized smaller seminiferous tubules with very few cellular components and large inter-tubular spaces. The most common problems associated with such undescended testes are altered fertility, testicular cancer, inguinal hernia and testicular torsion with necrosis. Therefore, identifying the condition, evaluating the associated syndromes, proper diagnosis and therapeutic strategies are very important to prevent the adverse consequences mentioned above.

Keywords:

Undescended testis, epididymis, inguinal canal, cryptorchidism, testicular torsion,

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Yazışma Adresi / Address for Correspondence: Dr. Kumar MR Bhat Manipal University, Department of Anatomy Kasturba Medical Collage Manipal-576104, INDIA
Email- kumar.mr@manipal.edu G eliş tarihi/Received on: 26.12.2013
Kabul tarihi/Accepted on:03.02.2014