Association of diethylstilbestrol exposure in utero with cryptorchidism, testicular hypoplasia and semen abnormalities

Abstract

Epididymal cysts and/or hypoplastic testes have been found in 31.5 per cent of 308 men exposed to diethylstilbestrol in utero, compared to 7.8 per cent of 307 placebo-exposed controls. Analyses of the spermatozoa have revealed severe pathological changes (Eliasson score greater than 10) in 134 diethylstilbestrol-exposed men (18 per cent) and 87 placebo-exposed men (8 per cent). Further investigation of the 26 diethylstilbestrol-exposed men with testicular hypoplasia has revealed that 65 per cent had a history of cryptorchidism. Only 1 of the 6 placebo-exposed controls with testicular hypoplasia had a history of testicular maldescent. Although none of our Diekmann's lying-in study group has had carcinoma to date one must keep in mind the reported increased risk of testicular carcinoma in testes that are or were cryptorchid. A 25-year-old man who was not part of the study group was treated recently by us for a testicular carcinoma ( mixed anaplastic seminoma plus embryonal cell carcinoma) and he had a history of diethylstilbestrol exposure in utero and cryptorchidism.

PIP: 31.5% of 308 men exposed to diethylstilbestrol (DES) in utero had epididymal cysts and/or hypoplastic testes compared with 7.8% of 307 placebo-exposed controls. Analyses of the sperm revealed severe pathological changes (Eliasson score 10) in 134 DES-exposed men (18%) and 87 placebo-exposed men (8%). 26 DES-exposed men with testicular hypoplasia were further investigated, and 65% had a history of cryptorchidism. Only 1/6 placebo-exposed controls with testicular hypoplasia had a history of testicular maldescent. Although none of the 300 men exposed to DES in this 2-decade-old double-blind prospective study has had carcinoma to date, the reported increased risk of testicular carcinoma in testes that are or were cryptorchid must be remembered. A 25-year-old man who was not part of the prospective study group was treated recently by the authors for a testicular carcinoma (a mixed anaplastic seminoma plus embryonal cell carcinoma) and he had a history of DES exposure in utero and cryptorchidism.