Malformations

One or both testicles may be absent or hypoplastic. Cryptorchia is a condition in which one or both testicles instead of descending into the scrotum remain within the abdominal cavity or in the inguinal canal. Occasionally the testicles may not descend till puberty. The undescended testicles are usually small and imperfectly developed, and are not uncommonly the seat of a sarcomatous proliferation.

Atrophy of the testicle occurs in senility and after chronic inflammations. The organ is small and dense, is dark in color, and is incapable of spermatogenesis, the epithelium having undergone a fatty degeneration.

Hypertrophy has been noticed as a compensatory change following the removal of one testis and is characterized by an increase in size of the seminiferous tubules.

Fatty degeneration is quite frequently observed as a result of pressure from tumors or from other pathologic conditions within the testicle.

Inflammation of the testes - orchitis - and of the epididymis - epididymitis - are commonly encountered. The two may occur together or alone. If the surrounding tunica albuginea is involved the condition is called periorchitis.

The inflammation may be due to traumatism or to infection, the latter usually resulting from the extension of a gonorrhea. In typhoid fever, scarlet fever, syphilis, smallpox, and mumps the testicles are occasionally the seat of inflammatory changes, as a result of hematogenous infection. The traumatic and gonorrheal processes generally involve the epididymis only.

Orchitis may be acute or chronic. In the acute form the testicle is swollen, hard, and very painful on account of the organ being inclosed within the fibrous tunica albuginea. Microscopically there is seen a marked round-cell infiltration between the tubules. The epithelial cells degenerate and desquamate. The condition may terminate in suppuration; and if the tunica is broken through, the testicular substance may protrude and form a fungous condition. The organ may, on the other hand, entirely recover.

Chronic orchitis usually follows the acute variety or as a complication of syphilis. In it there is a great hyperplasia of the intertubular connective tissue with subsequent contraction, atrophy, and degeneration, the testicle becoming very dense.

In epididymitis that structure becomes much swollen and painful and is usually associated with a serous exudation into the tunica vaginalis.

Tuberculosis generally is primary in the epididymis and secondarily involves the testicles. The infecting organisms may gain entrance either through the circulation or from the urethra through the vas deferens. In the latter form there has generally been a pre-existing tuberculosis of the seminal vesicles, prostate, or bladder.

The condition is, as a rule, secondary to pulmonary tuberculosis, small tubercles develop, these increase in size, coalesce, and form quite large caseous masses which may break down and rupture externally. The interstitial tissue may be more or less densely and diffusely infiltrated by small round cells. The epithelium lining the tubules may be fatty and degenerated. The walls of the tubules may be much thickened by a round cell infiltration.

Syphilis, either acquired or congenital, may give rise to changes in testicles and epididymis; the testicle usually being involved secondarily. There is generally an intertubular round-cell infiltration with induration and degeneration of the tubular epithelium. Gummata sometimes form and undergo a caseous degeneration with subsequent cicatrization.

Leprosy of the testicle in the form of nodular formations, with degeneration and atrophy of the tubules, has been noted.

Tumors

Fibroma, lipoma, and myxoma are sometimes encountered. Chondroma and rhabdomyoma have been described. Sarcoma in all varieties occurs in the testicle, less commonly in the epididymis. Secondary changes frequently occur, and cysts of various sizes may form as a result of the obstruction of the seminiferous tubules. Combinations of the sarcoma with chondroma, lipoma, fibroma, etc., are quite common.

There have also been described tumors of the testicle that contain areas resembling the chorioepitheliomata that are found in women. Typical syncytial, Langhan's, and wandering chorionic cells being found in some cases:

Adenoma is rare; when present it is generally associated with carcinomatous proliferation of the epithelium. Carcinoma is not unusual, and though usually medullary in type, may be scirrhus. Is frequently associated with cystic dilatations of the tubules. Various degenerations, as mucoid and colloid, are quite commonly seen. Although the tumor originates within the cells of the seminiferous tubules of the testicle the epididymis and vas are soon involved, the entire organ being transformed into carcinomatous tissue. The inguinal and lumbar lymph nodes are involved frequently and distant metastasis may occur.

Cysts

Spermatocele is the term applied to a cystic dilatation of a seminal tubule, usually at the head of the epididymis. It may be quite large, containing up to. 350 c.c. of a watery, slightly turbid fluid in which spermatozoa, either active or dead, may be found. Retention cysts may occur as a result of inflammatory changes, or to obstruction of the tubules by some new growth. Dermoid cysts are rarely found.

Vaginitis testis, or periorchitis, is an inflammation of the tunica vaginalis. It occurs as a result of inflammation of the testicle or epididymis, in the course of various infectious diseases or in consequence of traumatism. The most common form is the serofibrinous variety in which there is an accumulation of serous fluid within the tunica vaginalis, giving rise to a hydrocele, usually unilateral. The process may continue slowly and the tunica be tremendously distended by a clear straw-colored fluid. In acute cases the fluid may be purulent or hemorrhagic.

If the hydrocele has continued a long time the tunica vaginalis becomes much thickened and the testicle and epididymis frequently atrophic.