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- 不孕症睾丸活检！
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本帖最后由 于 2010-09-14 07:44:00 编辑
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男性不孕症的睾丸活检病理诊断已有70多年历史。病理诊断名称大多为描述性，诊断性术语较少（如‘支持细胞仅有综合症 Sertoli cell only syndrome’)。 国内睾丸活检开展不普遍，大家相对比较生疏。
睾丸活检中约50%被诊断为精子成熟停滞（Maturation Arrest MA） 和精子生成低下(Hypospermatogenesis )，但各病理医生掌握的诊断标准差异很大。有些病例二者同时存在。还要注意一侧睾丸活检并不能代表另一侧睾丸的情况。
精子成熟停滞形态学上根据径子成熟状态，又分成1）Spermatogenic arrest; 2) Spermatocytic (meiotic) arrest。
正常精子生成受到多种激素调节（下丘脑、垂体、肾上腺网状带、甲状腺等）和基因状态的影响。
男子不孕症病因诊非常复杂，包括遗传、胚胎发育、激素调节、血液循环、感染、药物、物理化学等。
睾丸活检的组织学评估包括生精上皮（精子生成）的质和量、支持细胞、基底膜、间质细胞等。
图1-2 正常成人睾丸；图3-4支持细胞仅有综合症；图5 Spermatocytic （meiotic) arrest; 图6 spermatogenic arrest 。 图7 hypospermatogensis,sole germ cell type。8 hypospermatogenesis，雄激素受体缺陷。
根据图谱（Bostwich DG & Cheng L. Urologic Surgical Pathology, 2ed edition, 2008,p665-677)，您认为符合什么诊断？
- xljin8
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It has been years since i evaluated testical biopsies for infertility under supervison of Dr. Humphery at Washington University. This patient apparently has hypospermatogenesis even aspermatogenesis: each tubular cross section should have about 20 sperms. I see much less than 20 sperms/cross section. Secondly there is maturation arrest. Other than these, i will have to check books and study material.
| 以下是引用mingfuyu在2010-9-14 7:57:00的发言： It has been years since i evaluated testical biopsies for infertility under supervison of Dr. Humphery at Washington University. This patient apparently has hypospermatogenesis even aspermatogenesis: each tubular cross section should have about 20 sperms. I see much less than 20 sperms/cross section. Secondly there is maturation arrest. Other than these, i will have to check books and study material. |
几年前我曾在华盛顿大学Humphery医生指导下对不孕症患者睾丸活检做过评估。显然，此病人有生精低下，甚至为无精症。我看到每个曲细精管的横断面上精子数明显少于20个。 其次还存在精子成熟停滞。除了上述意见外，我还须去查参阅考书和学习资料。
- xljin8
