PATHOLOGICAL AXATOMY OF THE TESTICLE 479 



ent. A number of observers state that there is regularly a distinct increase 

 in the interstitial cells in cryptorchid testes. Abdominal testicles atrophy 

 earlier than inguinal. It has been suggested that the pathological change 

 in ectopic testes is due to a perivascular interstitial orchitis, since there 

 is a slight round cell infiltration about the vessels. The cause of the change 

 remains in doubt, and degeneration of this kind would naturally be 

 accompanied by some inflammatory reaction. Trauma apparently does 

 not play a part, since abdominal testes atrophy more quickly than inguinal. 

 Obstruction of the efferent ducts, as in epididymitis, ordinarily causes no 

 atrophy of the spermatogenic elements. 



In spite of the persistence, at least for a time, of the interstitial cells in 

 ectopic testes, bicryptorchids usually show a deficiency in their accessory 

 sexual characteristics, being often small, adipose and of retarded develop- 

 ment. Manifestations of puberty may be absent. In later life they may 

 assume a habitus marking sexual indifference. If descent of the testicles 

 occurs late, a change to the normal male status may take place in a short 

 time. In some exceptional cases, less rare however than those in which 

 testicular atrophy does not occur, sterile bicryptorchids may have male 

 characteristics and practice coitus. In all such cases interstitial cells are 

 found in the atrophic testes. It may be stated, therefore, that there is 

 always a direct relationship between the persisting interstitial cells and 

 the accessory sexual characteristics. It is a rule, but not a general one, 

 that abdominal cryptorchid testes are more likely to lose their interstitial 

 cells than those lying in the inguinal canal. 



Experimental studies show that when the vas deferens is ligated in 

 young individuals, the spermatogenic apparatus atrophies, while the inter- 

 stitial cells persist for a varying time. They may disappear at once, they 

 may remain indefinitely, or they may degenerate at some intermediate 

 period. When double castration is performed before the age of puberty, 

 the individual becomes a eunuch', being sterile and impotent, and showing 

 lack of sex differentiation in the habitus. If, on the contrary, both 

 testes are removed from an adult, the result is more uncertain. He be- 

 comes sterile at once, but potency, libido, and the male habitus may 

 persist for a variable time or permanently. In some cases, however, 

 secondary changes appear at once, the voice becoming high and the char- 

 acter effeminate. 



Ectopic testes are subject to the same inflammations as normal organs; 

 indeed, it is stated that, for example, in a monocryptorchid who contracts 

 gonorrhea, the retained organ is more apt to become the seat of an epididy- 

 mitis than the normal one. If the vaginal process remains patent, an 

 epididymitis may set up, by extension, a local or general peritonitis. 



It is commonly stated that ectopic testicles are especially apt to be- 

 come the seat of malignant changes. Bland-Sutton, in England, found 

 that among fifty-seven testicular tumors, forty-eight (eighty-four per cent) 





