Question

A 25 year old male patient is evaluated for primary infertility. Semen analysis shows azoospermia. A testicular biopsy is done and the image is shown below. The shown finding is consistent with

• A. Sertoli cell only syndrome
• B. Testicular atrophy
• C. Benign testicular neoplasm
• D. Orchitis

Answer 1

The Correct Option is A

A 25-year-old male patient presents with primary infertility, and his semen analysis indicates azoospermia. Azoospermia is the absence of sperm in the ejaculate. To further investigate, a testicular biopsy is performed. The biopsy is crucial in determining the underlying pathology causing the lack of sperm production.

The biopsy shows specific findings consistent with a condition known as "Sertoli cell only syndrome."

Explanation:

The findings of the testicular biopsy in Sertoli cell only syndrome reveal the following:

1. The seminiferous tubules are predominantly lined by Sertoli cells without the presence of germ cells. This lack of germ cells is the reason for azoospermia because spermatozoa are derived from germ cells.
2. Usually, this condition is associated with normal or small-sized testes and normal levels of testosterone, as Leydig cells function normally.
3. Sertoli cell only syndrome can be idiopathic or associated with genetic abnormalities like Klinefelter syndrome.

Given these findings from the testicular biopsy, the correct diagnosis is Sertoli cell only syndrome.

Condition	Biopsy Findings
Sertoli cell only syndrome	Only Sertoli cells present, no germ cells
Testicular atrophy	Reduction in the size of seminiferous tubules and germ cell depletion
Benign testicular neoplasm	Presence of a mass or abnormal growth
Orchitis	Inflammatory infiltrates, possible destruction of testicular architecture

Other options are less consistent with the image findings and clinical scenario:

• Testicular atrophy: Typically involves reduction and scarring of the seminiferous tubules, sometimes secondary to external factors such as hormonal imbalance but not limited to Sertoli cells alone.
• Benign testicular neoplasm: Would likely show a mass or tumor, distinct from normal testicular tissue.
• Orchitis: Inflammation usually due to infection, often showing inflammatory cells, edema, and possible damage to the testicular tissue.

Thus, the evaluation of this patient's condition, supported by the testicular biopsy findings, confirms the diagnosis of Sertoli cell only syndrome.