Vanishing testes: a literature review

Abstract

Vanishing testes syndrome is often referred to as testicular regression syndrome (TRS) in the recent medical literature. The most characteristic histological findings are presence of a fibrovascular nodule with associated hemosiderin-laden macrophages and dystrophic calcification. Residual testicular tubules are found in less than 10% of cases, with prevalence being unrelated to age at surgery. Presence of seminiferous tubules and viable germ cells in testicular remnant tissue has been reported in some series. TRS theoretically carries a potential for malignant degeneration in the long term and therefore removal of any remnant is a common practice to eliminate this risk. However, no case series has reported germinal dysplasia or intratubular germ cell neoplasia in any of the specimens taken from these patients.

Figure 1. A testicular “remnants” located by the scrotal exploration that was removed from the scrotum with the atretic spermatic cord. Atrophic testicular tissue described as a dense matrix of fibrous connective tissue with widely separated atrophic seminiferous tubules (From the authors’ center)

Figure 2. Moderate undervirilization in a 46XY infant presenting with a micropenis with minimal scrotal development and bilateral cryptorchidism (final diagnosis was testicular regression syndrome) (From the authors’ center)