478 



DAVID M. DAVIS 



Anomalies of Position 



These include the conditions in which the testicle is rotated, inverted, 

 or otherwise changed from the way in which it normally hangs in the 

 scrotum. They are of no interest in connection with endocrinology. 



In all ectopias, the testicle may be fixed or mobile, depending on the 

 presence or absence of adhesions. There may be dislocation of the epididy- 



mis from the testicle, or 

 prolapse of the vas def- 

 erens below the ectopic 

 testicle. 



In infants, the ec- 

 topic testis is, as a rule, 

 slightly smaller than 

 normal, and shows some 

 increase in connective 

 tissue. No epithelial 

 change is evident. The 

 interstitial cells are nor- 

 mal or increased in 

 number. At the time of 

 puberty, spermatogene- 

 sis does not begin. This 

 is an almost universal 

 rule, but in exceptional 

 cases spermatogenesis 

 may be normal, and the 

 individual be fecund. 

 Thus, in a case treated 

 in the Johns Hopkins 

 Hospital, a double cryp- 

 torchid had been the 

 father of four children. 

 The testes examined at 

 autopsy appeared nor- 

 mal, with spermatozoa 



in the tubules. The cause of the usual aspermatogenesis may be the exist- 

 ence of adhesions in the rete region, causing obstruction. Except in these 

 very unusual cases, the spermatogenic cells soon become granular and un- 

 dergo fatty degeneration, the walls of the tubules thicken and become 

 folded, and finally the epithelial elements disappear, leaving only the 

 fibrotic stroma. The interstitial cells usually persist, and as one would ex- 

 pect, the accessory sexual characteristics are developed, and libido is pres- 



Fig. 3. Section of a cryptorchid testicle, showing 

 atrophic tubules, with diminished epithelium, aspermato- 

 genesis, thickened and hyaline tubular walls, fibrosis of 

 the stroma, and marked hypertrophy of the interstitial 

 cells. X 130. (Brady Urological Institute collection.) 



