|Year : 2022 | Volume
| Issue : 1 | Page : 76-77
Cribriform hyperplasia of epididymis: A diagnostic pitfall for surgical pathologists
Savithri Ravindra, CP Manjula
Department of Pathology, KIMS, Bengaluru, Karnataka, India
|Date of Submission||04-Nov-2021|
|Date of Decision||10-Dec-2021|
|Date of Acceptance||12-Dec-2021|
|Date of Web Publication||23-Jun-2022|
Dr. Savithri Ravindra
Department of Pathology, KIMS, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
Epididymal tubules are lined by tall columnar ciliated cells with central round lumina. Epididymis exhibits wide variations in histology, having very little clinical significance. However, they pose a diagnostic challenge for the reporting pathologists. Cribriform hyperplasia of the epididymis is reported in animals such as rats, cats, dogs, mice, and bulls, in addition to men. We report an incidental finding of cribriform hyperplasia of the epididymis in a specimen of torsion testis.
Keywords: Cribriform hyperplasia, epididymis, torsion testis
|How to cite this article:|
Ravindra S, Manjula C P. Cribriform hyperplasia of epididymis: A diagnostic pitfall for surgical pathologists. Arch Med Health Sci 2022;10:76-7
| Introduction|| |
Epididymis is a highly coiled tubular structure that plays an important role in sperm transport, maturation, concentration, and storage. The lining epithelium consists of tall columnar ciliated cells, basal cells, clear cells, and apical mitochondria-rich cells. The lumens are round and regular. Epididymis exhibits wide variations in histology; cribriform hyperplasia is one of them which may be misinterpreted as carcinoma in situ.
| Case Report|| |
A 25-year-old male presented to the surgery outpatient department, with acute pain in the right scrotum. It was diagnosed as torsion testis, and the patient underwent right-sided orchidectomy. The specimen was sent for histopathological examination. Grossly, testis measured 3.5 cm × 3.0 cm × 2.5 cm, epididymis measured 2.5 cm × 1.2 cm, and the cut surface of both had hemorrhagic areas.
Microscopy of the testis showed coagulative necrosis of the seminiferous tubules, large areas of hemorrhage, and many congested blood vessels. Epididymis showed epithelial hyperplasia of the tubules with cribriform appearance and florid filling of the lumen at places. The cells were cuboidal, having round nuclei and moderate-to-abundant cytoplasm; however, no atypia or mitosis was noted [Figure 1]. A diagnosis of torsion testis and cribriform hyperplasia of the epididymis was rendered.
|Figure 1: Dilated epididymal tubules with florid epithelial proliferations and cribriform architecture (H and E, ×400)|
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| Discussion|| |
Epididymis exhibits wide variations in its histology. The common patterns reported by Shah et al., from 167 orchidectomy specimens, include intranuclear eosinophilic inclusions in 72.5% of patients, cribriform hyperplasia in 41.9% of patients, lipofuscin pigment in 32.9% of patients, Paneth cell-like metaplasia in 8.3% of patients, and focal nuclear atypia in 13.8% of patients. Cribriform hyperplasia was associated with varied pathologic changes in 33 testes while only one testis was normal.
We observed cribriform hyperplasia of the epididymis in a 25-year-old male who underwent right orchidectomy for torsion testis, which showed hemorrhagic necrosis. There was no evidence of tumor or malignancy after extensive sampling. This was only a microscopic finding and no gross abnormalities were noted.
The epididymal cribriform hyperplasia (ECH) occurs in a broad age range, with a mean age of 40 years. It is similar to the patterns of cribriform ductal carcinoma in situ of the female breast. Sharp et al. have described dilated epididymal lumina which are filled with epithelial proliferations forming complex arcades and cellular bridges. The cells lining these interconnecting arches may have hyperchromatic nuclei, but without significant atypia or mitotic activity.
The hyperplastic epithelium is exuberant, and it often folds on itself forming pseudoglandular structures. ECH has been associated with testicular toxicities in rats. It may be a secondary response to lack of sperm cells, lack of testicular fluid, or epididymal atrophy, leading to a disruption of the epididymal microenvironment. Some authors opine that it is an age-related change and is also seen in association with testicular atrophy, cryptorchidism, germ cell tumors, and androgen depletion. A study by Butterworth and Bisset showed simultaneous occurrence of ECH and adenomatous hyperplasia of rete in an atrophic testis, thereby suggesting the putative role of hormonal disturbances in its etiology. However, the definite cause is still unknown.
La Perle et al. have reported ECH not only in men but also in rats, mice, dogs, cats, and bulls. Various authors have suggested that this entity should not be mistaken for neoplasia, either intra-epididymal spread from testicular germ cell tumor or primary epididymal carcinoma. Focal nature of the lesion, absence of mitosis, and prominent nucleoli are useful in distinguishing it from a neoplastic process.,,
| Conclusion|| |
Histologic variations in epididymis pose a diagnostic challenge. Thorough sampling of epididymis is important to rule out any neoplastic process. Knowledge and awareness about variations in histology and a cautious approach will prevent misinterpretations.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Thomas D. Trainer, testis and excretory duct system. In: Stacey E, editor. Mills Histology for Pathologists. Vol. 3. Philadelphia: Lippincott Williams and Wilkins; 2007. p. 955.
De Grava Kempinas W, Klinefelter GR. Interpreting histopathology in the epididymis. Spermatogenesis 2014;4:e979114.
Shah VI, Ro JY, Amin MB, Mullick S, Nazeer T, Ayala AG. Histologic variations in the epididymis: Findings in 167 orchiectomy specimens. Am J Surg Pathol 1998;22:990-6.
Sharp SC, Batt MA, Lennington WJ. Epididymal cribriform hyperplasia. A variant of normal epididymal histology. Arch Pathol Lab Med 1994;118:1020-2.
Butterworth DM, Bisset DL. Cribriform intra-tubular epididymal change and adenomatous hyperplasia of the rete testis – A consequence of testicular atrophy? Histopathology 1992;21:435-8.
La Perle KM, Blomme EA, Sagartz JE, Capen CC. Epididymal cribriform hyperplasia with nuclear atypia in p53 homozygous knockout mice on a mixed 129/Sv-FVB/N background. Comp Med 2002;52:568-71.