Aleksander Giwercman

Prevalence of Carcinoma in Situ and other Histopathological Abnormalities in Testes of Men with a History of Cryptorchidism

The incidence of invasive testicular cancer is increased in men with a history of cryptorchidism. Previous studies based on relatively small series indicated that the risk of carcinoma in situ of the testis also is increased in these men. In our study 500 consecutive men 20 to 30 years old, who were previously admitted to a department of surgery with the diagnosis of testicular maldescent, were asked to participate in a screening for carcinoma in situ of the testis. Of the men 300 consented to testicular biopsy. The biopsies were evaluated by light microscopy for carcinoma in situ and other histopathological abnormalities. Carcinoma in situ was diagnosed in 5 patients (1.7%, 95% confidence limits 0.5 to 3.9%). However, the true risk of carcinoma in situ might be higher, since 2 men who had been treated for testicular cancer before they were offered biopsy were excluded from the study. Advanced spermatogenesis, including the spermatid stage in all tubules, was found in biopsy specimens from only 37% of the men. In 80% of these specimens even the number of late spermatids was decreased. Thus, our study, based on a large number of testicular biopsies from an unselected group of men with testicular maldescent, provided further evidence that these men have an increased risk for carcinoma in situ of the testis. Our data combined with the results of other Scandinavian studies indicate that the true prevalence of carcinoma in situ in men with a history of cryptorchidism is approximately 2 to 3%. Additionally, we confirmed that spermatogenic function is severely impaired in maldescended gonads. Invasive testicular cancer can be prevented if the neoplasm is detected at the stage of carcinoma in situ. In our opinion the magnitude of prevalence of carcinoma in situ found in men with a history of cryptorchidism justifies that these men should be offered testicular biopsy when they reach adulthood.

Commentary: Importance of empirical evidence

Bromwich et al point out that the distribution of sperm count is skewed to the right and that if a differential selection of skewed distributions is applied over the years this will bias the observed time trends. Both of these assertions are correct; indeed, in all 16 of the 61 publications cited in our original overview for which both median and mean were given the median was smaller than the mean, confirming the skewness.1nnBromwich et …

Falling sperm quality

EDITOR,—Stephen Farrow comments on the quality of the evidence concerning a possible decline in sperm quality,1 focusing attention on our paper published in 1992.2 Farrow also responds to a paper by Peter Bromwich and colleagues, for which we provided the commentary.3nnFarrow questions our systematic search of the databases MEDLINE and Index Medicus. A necessary requirement for a valid overview, however, is that the criteria for including articles in the overview (and for excluding them) are explicit and reproducible to avoid selection bias. Several precautions were taken to avoid any undue influence of papers with small numbers of men in them. …

Evidence for decreasing quality of semen during past 50 years

cytological scrapes of 201 Italian sexually active patients. One hundred twenty-four of these women had normal cytologic and colposcopic examination, while seventy-seven women had normal or abnormal cytology and a cervical lesion detectable by colposcopy. Within this latter group, 25 of 77 women (32.4%) were positive for HPV16 DNA, compared to 11 of 124 samples (8.87%) from women with normal cytology and colposcopy. The present results confirm the high efficiency of the PCR technique in detecting HPV16 DNA from cervical scrapes and suggest that this analysis should become a method of choice in clinical studies.