Difference between revisions of "Vas deferens"

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Vas deferens (view source)

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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.
[[Image:Normal_Vas_Deferens%2C_Human_%283952564123%29.jpg|thumb|right|Vas deferens. (WC/Ed Uthman)]]
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==
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*Surface should be inked.
*Surface should be inked.
===Microscopic===
===Microscopic===
Features:
Features:<ref name=pmid19926581/>
*Tubular structure - two muscle layers.
*Tubular structure - three muscle layers.
**Inner circular.
**Inner longitudinal (thin).
**Outer longitudinal.
**Middle circular (thick).
*Epithelium = simple, columnar, ciliated.
**Outer longitudinal (thick).
*Epithelium  
**Apical cells = columnar, ciliated.
**Basal cells = cuboidal.


Note:
Note:
*Muscle layers - like in bowel.
*Muscle layers - like in bowel.
*Lumen must be completely visualized in the plane of section.
*A complete loop of epithelium should be visualized in the plane of section.


DDx:
DDx:
*Missed vas deferens.
*Missed vas deferens.
**Intermediate size blood vessels +/- denudation.
**Ureter.
*Incomplete vasectomy - only partial lumen.
*Incomplete vasectomy - only partial lumen.


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*CD10 +ve (marker of Wolffian differentiation).
*CD10 +ve (marker of Wolffian differentiation).
*Pankeratin +ve.
*Pankeratin +ve.
*PAX-8 +ve (100%).<ref name=pmid32633248>{{cite journal |authors=Ortiz-Rey JA, Domínguez-de Dios J, Pérez-Schoch M, San Miguel-Fraile P, Gómez-de María C |title=[New immunohistochemistry markers to determine presence of vas deferens in vasectomy specimen.] |language=Spanish; Castilian |journal=Arch Esp Urol |volume=73 |issue=6 |pages=534–540 |date=July 2020 |pmid=32633248 |doi= |url=}}</ref>
*GATA-3 +ve.<ref name=pmid33012491>{{cite journal |authors=Ortiz-Rey JA, Domínguez-de Dios J, Pérez-Schoch M, San Miguel-Fraile P, Gómez-de María C |title=[E-Cadherine and GATA-3 are useful in the confirmation of the vas deferens in vasectomy specimens] |language=Spanish; Castilian |journal=Rev Esp Patol |volume=53 |issue=4 |pages=218–225 |date=2020 |pmid=33012491 |doi=10.1016/j.patol.2020.02.005 |url=}}</ref>
*ERG -ve.<ref name=pmid32633248/>
*CD34 -ve.<ref name=pmid32633248/>


===Sign out===
===Sign out===
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<pre>
<pre>
A. VAS DEFERENS, RIGHT, VASECTOMY:
A. VAS DEFERENS, RIGHT, VASECTOMY:
- VAS DEFERENS WITHIN NORMAL LIMITS, COMPLETE CROSS SECTION PRESENT.
- 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, COMPLETE CROSS SECTION PRESENT.
- VAS DEFERENS WITHIN NORMAL LIMITS, LOOP OF EPITHELIUM AND MUSCLE LAYERS PRESENT.
</pre>
</pre>


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<pre>
<pre>
A. VAS DEFERENS, LEFT, VASECTOMY:
A. VAS DEFERENS, LEFT, VASECTOMY:
- VAS DEFERENS WITHIN NORMAL LIMITS, COMPLETE CROSS SECTION PRESENT.
- VAS DEFERENS WITHIN NORMAL LIMITS, LOOP OF EPITHELIUM AND MUSCLE LAYERS PRESENT.


B. VAS DEFERENS, RIGHT, VASECTOMY:
B. VAS DEFERENS, RIGHT, VASECTOMY:
- VAS DEFERENS WITHIN NORMAL LIMITS, COMPLETE CROSS SECTION PRESENT.
- VAS DEFERENS WITHIN NORMAL LIMITS, LOOP OF EPITHELIUM AND MUSCLE LAYERS PRESENT.
</pre>
</pre>


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<pre>
<pre>
VAS DEFERENS, RIGHT AND LEFT, VASECTOMY:
VAS DEFERENS, RIGHT AND LEFT, VASECTOMY:
- VAS DEFERENS WITHIN NORMAL LIMITS.
- 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>
 
====Incomplete loop====
<pre>
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.
</pre>
</pre>


====Incomplete cross-section====
====Oblique cut====
<pre>
<pre>
A. VAS DEFERENS, RIGHT, VASECTOMY:
A. VAS DEFERENS, RIGHT, VASECTOMY:
- INCOMPLETE CROSS-SECTION OF VAS DEFERENS WITHOUT SIGNIFICANT PATHOLOGY, SEE COMMENT.
- VAS DEFERENS WITHOUT SIGNIFICANT PATHOLOGY - OBLIQUE SECTION WITH COMPRESSED
  LOOP OF EPITHELIUM, SEE COMMENT.


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


COMMENT:
COMMENT:
Clinical correlation is suggested.
Clinical correlation is suggested.
</pre>
</pre>
Notes:
*The word ''loop'' is preferred over the words ''cross section'' as:
*#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.


==Vasitis nodosa==
B. VAS DEFERENS, RIGHT, VASECTOMY:
===General===
- COMPATIBLE WITH VAS DEFERENS, WITHOUT COMPLETE LOOP OF EPITHELIUM, SEE COMMENT.
*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>
**Seen in association with other surgical procedures.
**May be seen in the context of infertility (without prior vasectomy).
*Some similarity to [[salpingitis isthmica nodosa]].<ref name=pmid3366928/>


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


===Microscopic===
Clinical correlation is suggested.
Features:<ref name=pmid3366928/>
</pre>
*Tubules in wall of vas deferens.
**Lined by columnar/cuboidal epithelium.
***May have mitotic activity.
***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:
====No vas deferens identified====
*Metastatic (prostate) carcinoma.
<pre>
A. CONNECTIVE TISSUE, RIGHT, "VASECTOMY":
- NO VAS DEFERENS IDENTIFIED.
- BENIGN FIBROMUSCULAR TISSUE WITH INTERMEDIATE BLOOD VESSELS.


Notes:
B. CONNECTIVE TISSUE, LEFT, "VASECTOMY":
*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>
- NO VAS DEFERENS IDENTIFIED.
**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>).
- 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==
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*[[Prostate gland]].
*[[Prostate gland]].
*[[Testis]].
*[[Testis]].
*[[Male infertility]].
*[[Epididymis]].


==References==
==References==
Michael
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