Aberrant epididymal tissue: a significant clinical entity

DES Sons, The Journal of urology, 1987

Abstract

Epididymal anomalies are relatively rare and usually they are associated with an undescended testis. A 33 to 66 per cent incidence of epididymal anomalies has been noted in male subjects with cryptorchidism.

An increased incidence of epididymal anomalies also has been noted in association with cystic fibrosis, von Hippel-Lindau’s syndrome and in male offspring of women treated with diethylstilbestrol.

The frequency and anatomical spectrum of epididymal anomalies among men with normal descended testes are not known. We describe 3 patients with bilaterally descended testes, who were found to have aberrant epididymal tissue at scrotal or inguinal exploration. The variable presentations of aberrant epididymal tissue in these 3 patients can be explained best by understanding the embryology and anatomy of the epididymis and its associated vestigial structures. In all likelihood the structures encountered in our patients were the ductus aberrans inferior and the paradidymis.

These structures, which rarely are included in urological anatomical descriptions of the epididymis, can be significant clinically. Therefore, it is important that the urologist be aware of their existence and their means of presentation.

Sources

  • Aberrant epididymal tissue: a significant clinical entity, The Journal of urology, NCBI PubMed, PMID: 3669178, 1987.
DES DIETHYLSTILBESTROL RESOURCES

Lesions of testis and epididymis associated with prenatal diethylstilbestrol exposure

Environmental health perspectives, 1988

Study Abstract

Cryptorchidism and retention of Müllerian duct structures occur with high frequency among the male offspring of CD-1 mice treated with 100 micrograms diethylstilbestrol/kg body weight on days 9 through 16 of pregnancy. Hyperplasia of the rete testis and Müllerian duct structures were found in many of the DES-treated male mice, as was a low but significant number of reproductive tract neoplasms.

A persistent Mullerian duct syndrome has been described in human males, usually associated with cryptorchidism and Leydig cell hyperplasia. These men may have uteri, oviducts, and the upper one-third of the vagina.

Sources

  • Full text (free access) : Lesions of testis and epididymis associated with prenatal diethylstilbestrol exposure, Journal of obstetric, Environmental health perspectives, NCBI PubMed, PMC1474522, 1988.
DES DIETHYLSTILBESTROL RESOURCES

Effects of in utero exposure to DES on male progeny

Journal of obstetric, gynecologic, and neonatal nursing, 1985

Abstract

Diethylstilbestrol (DES) was prescribed for almost 30 years by physicians who believed the nonsteroidal synthetic estrogen was beneficial in both the treatment of threatened abortions and the prevention of spontaneous abortions.  Toxemia, premature delivery, postmaturity, and stillbirth were said to be significantly reduced in patients who were treated with DES.

The consequences of in utero exposure to DES on female progeny have been widely publicized.

However, male progeny also suffer the effects of in utero exposure to DES. These effects include epididymal cysts, small penile size, and cryptorchidism.

Altered reproductive capacity is suggested by diminished sperm counts and sperm penetration assays.

Sources

  • Effects of in utero exposure to DES on male progeny, Journal of obstetric, gynecologic, and neonatal nursing, NCBI PubMed, PMID: 3851834, 1985 Nov-Dec.
  • Abnormal Physical Findings in the Male Genital Tract featured image credit Bibbo M. Gill WB, Azizi F. et a/, Follow-up study of male and female offspring of DES exposed mothers, 1977.
DES DIETHYLSTILBESTROL RESOURCES

Structural and functional abnormalities in the DES sons sex organs

The in utero effects of DES (Diethylstilbestrol) on the human male genital tract are reported in this follow-up study of male offspring of DES-treated mothers

1976 Study Abstract

Both anatomical and functional abnormalities were significantly greater in the DES-exposed males as compared to control males whose mothers were all participants in a prospective, randomized double blind study of the effects of DES on pregnancy at the Chicago Lying-in Hospital during the early 1950s.

Epididymal cysts, hypotrophic testes and capsular induration of the testes were among the more common genital lesions found in 27% of 134 DES-exposed males as compared to a 7% incidence in 119 control males.

Spermatozoa analyses revealed severely pathologic changes (Eliasson score greater than 10) in 29% of 28 DES-exposed males and 0% of 18 control males (with or without genital i.e., physical abnormalities).

Abnormal findings on physical examination combined with sperm abnormalities (Eliasson score greater than or equal to 5) were found in 29% of DES-exposed males versus 0% of 18 control males. Cytologic examinations did not reveal malignant cells from the following materials: urines before and after prostatic massage or ejaculation, prostatic fluids and aspirates from epididymal cysts.

Sources

  • Structural and functional abnormalities in the sex organs of male offspring of mothers treated with diethylstilbestrol (DES), The Journal of reproductive medicine, NCBI PubMed, PMID: 772199, 1976 April.
DES DIETHYLSTILBESTROL RESOURCES

DES Exposure and Offspring Reproductive Health, 1982 Review

In utero exposure to diethylstilbestrol: Adverse effects on the reproductive tract and reproductive performance in male and female offspring

1982 Study Abstract

Exposure to diethylstilbestrol (DES) in utero is associated with adverse effects on the reproductive tract in male and female progeny.

These effects include epididymal cysts, microphallus, cryptorchidism, and testicular hypoplasia in male subjects and adenosis, clear cell adenocarcinoma, and structural defects of the cervix, vagina, uterus, and fallopian tubes in female subjects.

As these offspring have reached reproductive age, reports of adverse reproductive performance have been published, including still controversial reports of menstrual dysfunction and infertility.

More well established are increased rates of spontaneous abortion, ectopic pregnancy, premature deliveries, and perinatal deaths, all contributing to an increase in overall adverse pregnancy outcome.

Often there is correlation between the DES-associated anatomic abnormalities in the reproductive tract and the adverse reproductive performance. Altered male reproductive capacity is also suggested by diminished semen analyses and sperm penetration assays. A detailed review of these effects of in utero DES exposure is presented.

Sources

  • In utero exposure to diethylstilbestrol: Adverse effects on the reproductive tract and reproductive performance in male and female offspring, American journal of obstetrics and gynecology, NCBI PubMed, PMID: 6121486, 1982 Apr.
  • Featured image credit Callie Gibson.
DES DIETHYLSTILBESTROL RESOURCES

Guidelines for Examination in DES Sons, 1981

Screening of Adolescents Exposed to DES in Utero, 1981

Abstract

… The following genitourinary entities have been reported to occur with increased frequency in men exposed to DES in utero: epididymal cysts, testicular hypoplasia, cryptorchidism, capsular induration of the testis, decreased penile length, hypospadias, urethral stenosis, varicoceles, and abnormal semen (decreased sperm density, decreased sperm mobility, and abnormal sperm morphology).

A careful physical examination of the male genitalia and accessory sexual organs in both the recumbent and standing positions will reveal the presence or absence of structural abnormalities in all but …

continue reading on sciencedirect, Pediatric Clinics of North America, Volume 28, Issue 2, Pages 379-388, May 1981.

DES DIETHYLSTILBESTROL RESOURCES

DES Sons and Cryptorchidism, Testicular Hypoplasia, Semen Abnormalities

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

1979 Study 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.

Sources

  • Association of diethylstilbestrol exposure in utero with cryptorchidism, testicular hypoplasia and semen abnormalities, The Journal of urology, NCBI PubMed, PMID: 37351, 1979 Jul.
  • Featured image credit Ian Espinosa.
DES DIETHYLSTILBESTROL RESOURCES

Follow-up study of male and female offspring of DES-treated mothers, 1975

Bibbo’s 1975 study revealed anatomic abnormalities such as epididymal cysts, undescended and hypoplastic testis in males exposed to DES in utero

Abstract

This is a follow-up study of male and female offspring of mothers who were part of a double-blind placebo controlled investigation during the years 1951-1952, originally aimed at determining the usefulness of DES administration in maintaining pregnancy. So far, 84 DES-exposed females, 43 female controls, 42 DES-exposed males and 37 male controls have been examined.

Circumferential ridges of the vagina and cervix were seen in 39% of the DES-exposed females but in none of the controls. Colposcopy revealed vaginal epitheleal changes in 78% of the DES-exposed females 2% of the female controls. Cytology proved to be reliable as a screening test for vaginal epithelial changes in the DES-exposed female. Urine cytology was negative for tumor cells in all patients.

The main abnormal finding in the DES-exposed males was that cysts in the epididymis were detected in 10%. No cases of cancer were observed in either the male or female offspring.

Population Information Program

The original study conducted 22 years earlier at the Chicago Lying-in Hospital attempted to determine the value of diethylstilbestrol (DES) in maintaining pregnancy. The number completing the course of therapy was 840 in the DES group; there were 860 in a control group. Increasing doses were given beginning during the 7th week of pregnancy. The present study was to determine the level of risk of cancer and other anomalies in the female and male offspring of mothers who participated in the study. So far, 84 DES-exposed females, 43 female controls, 43 DES-exposed males, and 37 male controls have been examined.

No cases of cancer have been found. The average age was 22 years. For female patients the medical history, a general physical examination, a gynecological examination, a colposcopic study, and laboratory tests were made. Laboratory tests consisted of cervical, endocervical, and 4 vaginal wall Pap smears, urine cytology, and follicle stimulating hormone and luteinizing hormone determinations. Biopsies were performed when indicated. Progesterone and total estrogens were determined only in patients with irregular menstrual cycles. In male patients, a general physical examination, urologic studies, and laboratory work-up were done. Medical records of all the newborn infants were surveyed and pediatric records examined. No cases of congenital malformations were recorded. Minor differences in menstrual histories and in ability to conceive were noted.

The differences appeared mainly at vaginal examinations. Circumferential ridges in the vagina and cervix were seen in 39% of the exposed females but in none of the controls. Erythroplakia of the cervix was seen in 67% of the exposed and in 53% of the controls. Colposcopic findings in the vagina revealed vaginal epithelial changes in 78% of the DES-exposed females and 2% of female controls. Iodine negative areas in the vagina were noted in 78% of the exposed females compared with 2% of the unexposed females. Iodine negative areas on the cervix were seen in 74% of the exposed and 58% of the unexposed. All dysplastic lesions were confirmed by histology. The cytology was negative in all.

In the males abnormal findings were noted mainly in the DES-exposed group. An undersized penis was noted in 2, small testes in 2, varicocele in 1, and epididymal cysts in 4. Urine cy tology and prostatic fluid cytology did not reveal unusual findings. A more detailed analysis of findings will follow when material is larger and older.

Sources

  • Follow-up study of male and female offspring of DES-treated mothers a preliminary report, The Journal of reproductive medicine, NCBI PubMed, PMID: 1171234, 1975 Jul.
  • Featured image credit Oli Metcalfe.
DES DIETHYLSTILBESTROL RESOURCES

Transplacental effects of diethylstilbestrol in mice

Lower reproductive capacities observed in both females and males

Abstract

The effect of prenatal exposure to DES on the postnatal development of male and female genital tract function was studied. We investigated the placental transfer of [3H]- or [14C]-radiolabeled DES in pregnant mice.

DES-associated radioactivity in the fetal plasma approximated maternal plasma one-half hour after iv administration of [3H]DES; [3H]-acitivity associated with DES in the fetal genital tract was about threefold higher.

The decrease in reproductive capacity of female offspring from mice treated with DES during gestation was dose related; a low incidence (10% or less) of cancer of the vagina, cervix, and/or uterus was also observed in these mice.

Male offspring exposed prenatally to the highest dose (100 micrograms/kg) of DES in this study also had lower reproductive capacities. Lesions in the genital tract of these mice included epididymal cysts, inflammation, cryptorchidism, and nodular masses in the seminal vesicles and/or prostate gland. Such lesions and sterility were not observed at the lower DES doses.

Histologic studies with neonatal mice raise the possibility that müllerian duct tissue may represent a site for the transplacental toxicity of DES in both the male and female fetus.

Sources

  • Transplacental effects of diethylstilbestrol in mice, National Cancer Institute monograph, NCBI PubMed, PMID: 481582, 1979 May.
DES DIETHYLSTILBESTROL RESOURCES

Health effects : pregnancy use of diethylstilbestrol

The Journal of the Indiana State Medical Association, 1979

Abstract

The use of DES (diethylstilbestrol) to prevent pregnancy complications and miscarriages has shown effects in women who took DES and their offspring.

A University of Chicago follow-up study indicated that women who had used DES had more breast and gynecological cancers than a control group, although the results were statistically insignificant.

DES daughters have a higher occurrence of a rare malignant vaginal cancer, clear cell adenocarcinoma,

and DES-exposed males showed a history of cryptorchidism, hypoplastic testes, epididymal cysts, and low sperm counts.

A DES Task Force formed by the Office of the Assistant Secretary for Health in 1978 recommends that all persons exposed to DES be informed of health risks and that DES daughters be carefully monitored by using Pap smears, iodine staining, and colposcopy when necessary.

In addition, the Task Force recommends

  • that DES women not use estrogens,
  • that postmenopausal replacement estrogens be prescribed prudently,
  • that DES not be given to suppress lactation,
  • and that women given DES for postcoital contraception be informed of the possible health risks.

Sources

  • Health effects: pregnancy use of diethylstilbestrol, The Journal of the Indiana State Medical Association, NCBI PubMed, PMID: 458172, 1979 May.
DES DIETHYLSTILBESTROL RESOURCES