Journal of pediatric surgery · 2026
Evaluation of the immunohistochemical and histological differences of the human cremaster muscle in retractile and undescended testis.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Florou Maria, Koletsa Triantafyllia, Raptou Georgia, Spyridakis Ioannis, Kaselas Christos
Аннотация
BACKGROUND: Retractile testes have long been considered a normal variant, yet emerging evidence questions this assumption. Given the central role of the cremaster muscle in testicular position, this study aimed to compare the histological and immunohistochemical characteristics of the human cremaster muscle in boys with retractile testes (RT) and undescended testes (UDT), using patients with inguinal hernia (IH) and normally descended testes as controls.
METHODS: Forty boys undergoing surgery between March 2021 and April 2023 were enrolled: 22 with retractile testis, 7 with congenital cryptorchidism, and 11 controls with inguinal hernia. Intraoperative biopsies of the cremaster muscle were evaluated using hematoxylin-eosin staining and digital morphometry. Immunohistochemistry for myosin heavy chain (MyHC)-embryonic and antibody CD34 was performed. Statistical analysis assessed differences in muscle fiber diameters, morphology, MyHC-embryonic expression, and intramuscular capillary density among groups and across age subgroups.
RESULTS: Retractile and undescended testes demonstrated similar muscle fiber morphology, characterized by significantly smaller minimum and maximum muscle fiber diameters compared with controls (p < 0.001). Atrophic fibers were frequent in retractile testes (16/22), less common in cryptorchidism (2/7), and absent in controls. Both the retractile testis and the UDT group exhibited significantly higher MyHC-embryonic expression than controls (p = 0.038 and p = 0.0016 respectively). CD34 staining revealed markedly increased intrafascicular capillary density in retractile testes compared with both other groups (p < 0.001).
CONCLUSIONS: Cremaster muscle in retractile testes demonstrates histological and immunohistochemical patterns closely resembling congenital cryptorchidism - a clearly defined pathological condition-rather than normal controls. At the same time, findings suggest that the retractile testis is a distinct clinical entity, with probable ongoing muscle remodeling and possible regenerative activity, rather than a physiological variant. These results combined advocate for closer monitoring of the young patients with clinical re-evaluations, while raising the question of whether earlier surgical intervention prior to puberty warrant further investigation.
METHODS: Forty boys undergoing surgery between March 2021 and April 2023 were enrolled: 22 with retractile testis, 7 with congenital cryptorchidism, and 11 controls with inguinal hernia. Intraoperative biopsies of the cremaster muscle were evaluated using hematoxylin-eosin staining and digital morphometry. Immunohistochemistry for myosin heavy chain (MyHC)-embryonic and antibody CD34 was performed. Statistical analysis assessed differences in muscle fiber diameters, morphology, MyHC-embryonic expression, and intramuscular capillary density among groups and across age subgroups.
RESULTS: Retractile and undescended testes demonstrated similar muscle fiber morphology, characterized by significantly smaller minimum and maximum muscle fiber diameters compared with controls (p < 0.001). Atrophic fibers were frequent in retractile testes (16/22), less common in cryptorchidism (2/7), and absent in controls. Both the retractile testis and the UDT group exhibited significantly higher MyHC-embryonic expression than controls (p = 0.038 and p = 0.0016 respectively). CD34 staining revealed markedly increased intrafascicular capillary density in retractile testes compared with both other groups (p < 0.001).
CONCLUSIONS: Cremaster muscle in retractile testes demonstrates histological and immunohistochemical patterns closely resembling congenital cryptorchidism - a clearly defined pathological condition-rather than normal controls. At the same time, findings suggest that the retractile testis is a distinct clinical entity, with probable ongoing muscle remodeling and possible regenerative activity, rather than a physiological variant. These results combined advocate for closer monitoring of the young patients with clinical re-evaluations, while raising the question of whether earlier surgical intervention prior to puberty warrant further investigation.