CONGENITAL TESTICULAR DEFICIENCY. II. DEFECTIVE SERTOLI CELL DIFFERENTIATION IN HYPOGONADISM OF SO-CALLED “OBSCURE ORIGIN”

Abstract

This report calls attention to certain histologic criteria which enable the observer to segregate patients with hypogonadism due to defective gonadogenesis from the all too frequent category of hypogonadism of "obscure origin". The clue to the recognition of the testicular developmental defect in this 58_yr. old hypogonad lay in the presence of large numbers of immature seminiferous tubules. These are characterized by their cellular contents which consist of undifferentiated cells and spermatogonia. The former are normally present in prepuberal immature tubules. With adolescence they undergo differentiation into Sertoli cells. Since this patient had primary hypogonadism with increased urinary gonadotropins, it is evident that defective Sertoli cell differentiation constitutes the principal congenital lesion. The presence of an associated spinal anomaly, presumably developmental, is consistent with the frequent observation of multiple congenital lesions in the same individual. Leydig cells were absent but this could not be ascribed definitely to a developmental cause.