Difference between revisions of "Vas deferens"

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The '''vas deferens''' are often seen as part of a [[prostate gland|prostatectomy]] specimen.<ref>URL: [http://www.upmccancercenters.com/cancer/prostate/radprostretropubic.html http://www.upmccancercenters.com/cancer/prostate/radprostretropubic.html]. Accessed on: 26 September 2011.</ref>  They are the component of the [[spermatic cord]] that carries the sperm. They seldom arrive alone.
The '''vas deferens''' are often seen as part of a [[prostate gland|prostatectomy]] specimen.<ref>URL: [http://www.upmccancercenters.com/cancer/prostate/radprostretropubic.html http://www.upmccancercenters.com/cancer/prostate/radprostretropubic.html]. Accessed on: 26 September 2011.</ref>  They are the component of the [[spermatic cord]] that carries the sperm.  
 
They often arrive alone -- removed for family planning ([[vasectomy]]).


==Normal vas deferens==
==Normal vas deferens==
Line 6: Line 8:
*Seen in the context of ''vasectomy''.
*Seen in the context of ''vasectomy''.


Note:
*Vasectomy is associated with [[testicle|testicular changes]] - increased seminiferous tubule wall thickness and decreased number of Sertoli cells.<ref name=pmid4058505>{{Cite journal  | last1 = Jarow | first1 = JP. | last2 = Budin | first2 = RE. | last3 = Dym | first3 = M. | last4 = Zirkin | first4 = BR. | last5 = Noren | first5 = S. | last6 = Marshall | first6 = FF. | title = Quantitative pathologic changes in the human testis after vasectomy. A controlled study. | journal = N Engl J Med | volume = 313 | issue = 20 | pages = 1252-6 | month = Nov | year = 1985 | doi = 10.1056/NEJM198511143132003 | PMID = 4058505 }}</ref>
===Gross===
*Cylindrical piece of tissue.
Note:
*Surface should be inked.
===Microscopic===
===Microscopic===
Features:
Features:<ref name=pmid19926581/>
*Tubular structure - two muscle layers.
*Tubular structure - three muscle layers.
*Epithelium = simple, columnar, ciliated.
**Inner longitudinal (thin).
**Middle circular (thick).
**Outer longitudinal (thick).
*Epithelium  
**Apical cells = columnar, ciliated.
**Basal cells = cuboidal.
 
Note:
*Muscle layers - like in bowel.
*A complete loop of epithelium should be visualized in the plane of section.


DDx:
DDx:
*Missed vas deferens.
*Missed vas deferens.
*Incomplete vasectomy - only partial lumen.
===IHC===
Features:<ref name=pmid19926581>{{Cite journal  | last1 = Sasaki | first1 = K. | last2 = Bastacky | first2 = SI. | last3 = Zynger | first3 = DL. | last4 = Parwani | first4 = AV. | title = Use of immunohistochemical markers to confirm the presence of vas deferens in vasectomy specimens. | journal = Am J Clin Pathol | volume = 132 | issue = 6 | pages = 893-8 | month = Dec | year = 2009 | doi = 10.1309/AJCPQZX4WS8UPKGG | PMID = 19926581 }}
</ref>
*CD10 +ve (marker of Wolffian differentiation).
*Pankeratin +ve.


===Sign out===
===Sign out===
====Right then left====
<pre>
<pre>
A. VAS DEFERENS, RIGHT, VASECTOMY:
A. VAS DEFERENS, RIGHT, VASECTOMY:
- VAS DEFERENS WITHIN NORMAL LIMITS.
- VAS DEFERENS WITHIN NORMAL LIMITS, LOOP OF EPITHELIUM AND MUSCLE LAYERS PRESENT.


B. VAS DEFERENS, LEFT, VASECTOMY:
B. VAS DEFERENS, LEFT, VASECTOMY:
- VAS DEFERENS WITHIN NORMAL LIMITS.
- VAS DEFERENS WITHIN NORMAL LIMITS, LOOP OF EPITHELIUM AND MUSCLE LAYERS PRESENT.
</pre>
 
====Left then right====
<pre>
A. VAS DEFERENS, LEFT, VASECTOMY:
- VAS DEFERENS WITHIN NORMAL LIMITS, LOOP OF EPITHELIUM AND MUSCLE LAYERS PRESENT.
 
B. VAS DEFERENS, RIGHT, VASECTOMY:
- VAS DEFERENS WITHIN NORMAL LIMITS, LOOP OF EPITHELIUM AND MUSCLE LAYERS PRESENT.
</pre>
 
====Single container====
<pre>
VAS DEFERENS, RIGHT AND LEFT, VASECTOMY:
- VAS DEFERENS WITHIN NORMAL LIMITS, LOOPS OF EPITHELIUM AND MUSCLE LAYERS PRESENT.
</pre>
 
=====Alternate=====
<pre>
VAS DEFERENS, RIGHT AND LEFT, VASECTOMY:
- VAS DEFERENS WITHIN NORMAL LIMITS, LOOPS OF EPITHELIUM AND MUSCLE LAYERS PRESENT
  ON BOTH SLIDE A1-1 AND SLIDE A2-1.
</pre>
 
=====One container is empty=====
<pre>
A. VAS DEFERENS ("LEFT"), VASECTOMY:
- VAS DEFERENS WITHIN NORMAL LIMITS, LOOPS OF EPITHELIUM AND MUSCLE LAYERS PRESENT
  ON BOTH SLIDE A1-1 AND SLIDE A2-1.
- SEE COMMENT.
 
B. VAS DEFERENS ("RIGHT"), VASECTOMY:
- NO TISSUE IDENTIFIED, SEE COMMENT.
 
COMMENT:
Both specimens (left vas deferens and right vas deferens) may have been placed in
container A. See 'gross' section of report. Clinical correlation is essential.
</pre>
</pre>


==Vasitis nodosa==
====Incomplete loop====
===General===
<pre>
*Classically develops post-vasovasostomy ([[vasectomy]] reversal).<ref name=pmid3366928>{{Cite journal  | last1 = Hirschowitz | first1 = L. | last2 = Rode | first2 = J. | last3 = Guillebaud | first3 = J. | last4 = Bounds | first4 = W. | last5 = Moss | first5 = E. | title = Vasitis nodosa and associated clinical findings. | journal = J Clin Pathol | volume = 41 | issue = 4 | pages = 419-23 | month = Apr | year = 1988 | doi =  | PMID = 3366928 | PMC=1141468 }}</ref>
A. VAS DEFERENS, RIGHT, VASECTOMY:
**Seen in association with other surgical procedures.
- VAS DEFERENS WITHOUT SIGNIFICANT PATHOLOGY - INCOMPLETE LOOP OF EPITHELIUM, SEE COMMENT.
**May be seen in the context of infertility (without prior vasectomy).
 
*Some similarity to [[salpingitis isthmica nodosa]].<ref name=pmid3366928/>
B. VAS DEFERENS, LEFT, VASECTOMY:
- VAS DEFERENS WITHIN NORMAL LIMITS, LOOP OF EPITHELIUM AND MUSCLE LAYERS PRESENT.


===Gross===
COMMENT:
*Mass.
Clinical correlation is suggested.
</pre>


===Microscopic===
====Oblique cut====
Features:<ref name=pmid3366928/>
<pre>
*Tubules in wall of vas deferens.
A. VAS DEFERENS, RIGHT, VASECTOMY:
**Lined by columnar/cuboidal epithelium.
- VAS DEFERENS WITHOUT SIGNIFICANT PATHOLOGY - OBLIQUE SECTION WITH COMPRESSED
***May have mitotic activity.
  LOOP OF EPITHELIUM, SEE COMMENT.
***Nucleoli.
***Contain sperm - small, dark staining, teardrop-shaped (~1 micrometer) - '''key feature'''.
*+/-[[Sperm granuloma]]s.
**Histocytes - abundant foamy cytoplasm.
**Sperm - small, dark staining, teardrop-shaped (~1 micrometer).


DDx:
B. VAS DEFERENS, LEFT, VASECTOMY:
*Metastatic (prostate) carcinoma.
- VAS DEFERENS WITHIN NORMAL LIMITS, LOOP OF EPITHELIUM AND MUSCLE LAYERS PRESENT.


COMMENT:
Clinical correlation is suggested.
</pre>
Notes:
Notes:
*Can be confused with [[prostatic adenocarcinoma]]:<ref name=pmid3984936>{{Cite journal  | last1 = Balogh | first1 = K. | last2 = Travis | first2 = WD. | title = Benign vascular invasion in vasitis nodosa. | journal = Am J Clin Pathol | volume = 83 | issue = 4 | pages = 426-30 | month = Apr | year = 1985 | doi = | PMID = 3984936 }}</ref>
*The word ''loop'' is preferred over the words ''cross section'' as:
**May "invade" vascular spaces - associated with elastosis (breakdown of elastic fibres<ref>URL: [http://medical-dictionary.thefreedictionary.com/elastosis http://medical-dictionary.thefreedictionary.com/elastosis]. Accessed on: 26 September 2011.</ref>).
*#The words ''cross section'' imply the cut is perpendicular to the axis.
*#It is possible that a section with a loop of epithelium is the result of a non-transecting cut that generates an ovoid defect in the wall of the vas deferens.
 
====No definite epithelium====
<pre>
A. VAS DEFERENS, LEFT, VASECTOMY:
- VAS DEFERENS WITHIN NORMAL LIMITS, LOOP OF EPITHELIUM AND MUSCLE LAYERS PRESENT.
 
B. VAS DEFERENS, RIGHT, VASECTOMY:
- COMPATIBLE WITH VAS DEFERENS, WITHOUT COMPLETE LOOP OF EPITHELIUM, SEE COMMENT.
 
COMMENT - PART B:
Definite vas deferens epithelium is not identified; however, the muscle layering seen is
compatible with a vas deferens. Levels were cut (x4).
 
Clinical correlation is suggested.
</pre>
 
====No vas deferens identified====
<pre>
A. CONNECTIVE TISSUE, RIGHT, "VASECTOMY":
- NO VAS DEFERENS IDENTIFIED.
- BENIGN FIBROMUSCULAR TISSUE WITH INTERMEDIATE BLOOD VESSELS.
 
B. CONNECTIVE TISSUE, LEFT, "VASECTOMY":
- NO VAS DEFERENS IDENTIFIED.
- BENIGN FIBROMUSCULAR TISSUE WITH INTERMEDIATE BLOOD VESSELS.


Image:
COMMENT:
*[http://www.webpathology.com/image.asp?n=11&Case=40 Vasitis nodosa (webpathology.com)].
Levels were cut (x3). Clinical correlation is suggested.
</pre>


===IHC===
==Vasitis nodosa==
*PSA -ve.
{{Main|Vasitis nodosa}}
*PSAP -ve.


==Bilateral absence of the vas deferens==
==Bilateral absence of the vas deferens==
Line 66: Line 156:
*[[Prostate gland]].
*[[Prostate gland]].
*[[Testis]].
*[[Testis]].
*[[Male infertility]].
*[[Epididymis]].


==References==
==References==

Latest revision as of 16:33, 9 October 2014

The vas deferens are often seen as part of a prostatectomy specimen.[1] They are the component of the spermatic cord that carries the sperm.

They often arrive alone -- removed for family planning (vasectomy).

Normal vas deferens

Vasectomy redirects here.

General

  • Seen in the context of vasectomy.

Note:

  • Vasectomy is associated with testicular changes - increased seminiferous tubule wall thickness and decreased number of Sertoli cells.[2]

Gross

  • Cylindrical piece of tissue.

Note:

  • Surface should be inked.

Microscopic

Features:[3]

  • Tubular structure - three muscle layers.
    • Inner longitudinal (thin).
    • Middle circular (thick).
    • Outer longitudinal (thick).
  • Epithelium
    • Apical cells = columnar, ciliated.
    • Basal cells = cuboidal.

Note:

  • Muscle layers - like in bowel.
  • A complete loop of epithelium should be visualized in the plane of section.

DDx:

  • Missed vas deferens.
  • Incomplete vasectomy - only partial lumen.

IHC

Features:[3]

  • CD10 +ve (marker of Wolffian differentiation).
  • Pankeratin +ve.

Sign out

Right then left

A. VAS DEFERENS, RIGHT, VASECTOMY:
- VAS DEFERENS WITHIN NORMAL LIMITS, LOOP OF EPITHELIUM AND MUSCLE LAYERS PRESENT.

B. VAS DEFERENS, LEFT, VASECTOMY:
- VAS DEFERENS WITHIN NORMAL LIMITS, LOOP OF EPITHELIUM AND MUSCLE LAYERS PRESENT.

Left then right

A. VAS DEFERENS, LEFT, VASECTOMY:
- VAS DEFERENS WITHIN NORMAL LIMITS, LOOP OF EPITHELIUM AND MUSCLE LAYERS PRESENT.

B. VAS DEFERENS, RIGHT, VASECTOMY:
- VAS DEFERENS WITHIN NORMAL LIMITS, LOOP OF EPITHELIUM AND MUSCLE LAYERS PRESENT.

Single container

VAS DEFERENS, RIGHT AND LEFT, VASECTOMY:
- VAS DEFERENS WITHIN NORMAL LIMITS, LOOPS OF EPITHELIUM AND MUSCLE LAYERS PRESENT.
Alternate
VAS DEFERENS, RIGHT AND LEFT, VASECTOMY:
- VAS DEFERENS WITHIN NORMAL LIMITS, LOOPS OF EPITHELIUM AND MUSCLE LAYERS PRESENT
  ON BOTH SLIDE A1-1 AND SLIDE A2-1.
One container is empty
A. VAS DEFERENS ("LEFT"), VASECTOMY:
- VAS DEFERENS WITHIN NORMAL LIMITS, LOOPS OF EPITHELIUM AND MUSCLE LAYERS PRESENT
  ON BOTH SLIDE A1-1 AND SLIDE A2-1.
- SEE COMMENT.

B. VAS DEFERENS ("RIGHT"), VASECTOMY:
- NO TISSUE IDENTIFIED, SEE COMMENT.

COMMENT:
Both specimens (left vas deferens and right vas deferens) may have been placed in
container A. See 'gross' section of report. Clinical correlation is essential.

Incomplete loop

A. VAS DEFERENS, RIGHT, VASECTOMY:
- VAS DEFERENS WITHOUT SIGNIFICANT PATHOLOGY - INCOMPLETE LOOP OF EPITHELIUM, SEE COMMENT.

B. VAS DEFERENS, LEFT, VASECTOMY:
- VAS DEFERENS WITHIN NORMAL LIMITS, LOOP OF EPITHELIUM AND MUSCLE LAYERS PRESENT.

COMMENT:
Clinical correlation is suggested.

Oblique cut

A. VAS DEFERENS, RIGHT, VASECTOMY:
- VAS DEFERENS WITHOUT SIGNIFICANT PATHOLOGY - OBLIQUE SECTION WITH COMPRESSED 
  LOOP OF EPITHELIUM, SEE COMMENT.

B. VAS DEFERENS, LEFT, VASECTOMY:
- VAS DEFERENS WITHIN NORMAL LIMITS, LOOP OF EPITHELIUM AND MUSCLE LAYERS PRESENT.

COMMENT:
Clinical correlation is suggested.

Notes:

  • The word loop is preferred over the words cross section as:
    1. The words cross section imply the cut is perpendicular to the axis.
    2. It is possible that a section with a loop of epithelium is the result of a non-transecting cut that generates an ovoid defect in the wall of the vas deferens.

No definite epithelium

A. VAS DEFERENS, LEFT, VASECTOMY:
- VAS DEFERENS WITHIN NORMAL LIMITS, LOOP OF EPITHELIUM AND MUSCLE LAYERS PRESENT.

B. VAS DEFERENS, RIGHT, VASECTOMY:
- COMPATIBLE WITH VAS DEFERENS, WITHOUT COMPLETE LOOP OF EPITHELIUM, SEE COMMENT.

COMMENT - PART B:
Definite vas deferens epithelium is not identified; however, the muscle layering seen is
compatible with a vas deferens. Levels were cut (x4).

Clinical correlation is suggested.

No vas deferens identified

A. CONNECTIVE TISSUE, RIGHT, "VASECTOMY":
- NO VAS DEFERENS IDENTIFIED.
- BENIGN FIBROMUSCULAR TISSUE WITH INTERMEDIATE BLOOD VESSELS.

B. CONNECTIVE TISSUE, LEFT, "VASECTOMY":
- NO VAS DEFERENS IDENTIFIED.
- BENIGN FIBROMUSCULAR TISSUE WITH INTERMEDIATE BLOOD VESSELS.

COMMENT:
Levels were cut (x3). Clinical correlation is suggested.

Vasitis nodosa

Main article: Vasitis nodosa

Bilateral absence of the vas deferens

See also

References

  1. ↑ URL: http://www.upmccancercenters.com/cancer/prostate/radprostretropubic.html. Accessed on: 26 September 2011.
  2. ↑ Jarow, JP.; Budin, RE.; Dym, M.; Zirkin, BR.; Noren, S.; Marshall, FF. (Nov 1985). "Quantitative pathologic changes in the human testis after vasectomy. A controlled study.". N Engl J Med 313 (20): 1252-6. doi:10.1056/NEJM198511143132003. PMID 4058505.
  3. ↑ 3.0 3.1 Sasaki, K.; Bastacky, SI.; Zynger, DL.; Parwani, AV. (Dec 2009). "Use of immunohistochemical markers to confirm the presence of vas deferens in vasectomy specimens.". Am J Clin Pathol 132 (6): 893-8. doi:10.1309/AJCPQZX4WS8UPKGG. PMID 19926581.
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