Presented at the 1999 APIII Conference Return to 1999 Abstract Index
COMPUTER-ASSISTED IMAGE RECONSTRUCTION OF TESTES, DUCTS AND UTERUS IN AN XY MALE WITH PERSISTENT MUELLERIAN DUCT SYNDROME
State University of New York
(SUNY) Downstate
King's County Hospital
Brooklyn, New York
Virginia
Anderson MD
A phenotypic male with cryptorchidism underwent surgery
for maldescent of the testes. A bicornuate uterus with testes
attached to the upper poles of each horn was identified.
Serial histologic sections of the entire specimen were photographed
with a digital camera. Images were aligned and pasted. Electronic
enhancement generated a high-resolution panoramic view at
low magnification that exceeds ordinary microscopic images
in quality and size.
On the lateral side of each uterine cavity, a bilaterally symmetric tubular structure terminated in a male testis. The left testis contained numerous Sertoli cells and a few germ cells. Leydig cells were not apparent. The adjacent epididymis had normal glands and stercocilia. The contralateral gonad had an epididymis with hemorrhagic infarction of the testis (vanishing testis). The tubes that paralleled the uterine cavity exhibited unique muellerian (fallopian tube) and wolffian (vas deferens) structures. The epithelial lining and muscle coats made a morphologic switch as the sections ascended in a direction towards the testes. Classic embryology theory cites no observed homology between fallopian tube and vas deferens. Our computer generated images challenge this and clearly illustrate that morphologic alterations may mirror the hormonal milieu. The persistent muellerian duct syndrome is thought to result from a lack of production of muellerian-inhibiting substance (MIS) by Sertoli cells during the eighth week embryonic life or a MIS receptor defect. In normal male development, MIS is responsible for the regression of the uterus, fallopian tubes and descent of the testis into the scrotum.
An application of digitized images appeared to be an essential factor to be able to appreciate homology of malformed structure present in numerous histologic sections.