Vas deferens

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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.

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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.

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.

Vasitis nodosa

General

  • Classically develops post-vasovasostomy (vasectomy reversal).[4]
    • Seen in association with other surgical procedures.
    • May be seen in the context of infertility (without prior vasectomy).
  • Some similarity to salpingitis isthmica nodosa.[4]

Gross

  • Mass.

Microscopic

Features:[4]

  • 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.
        • The tail is rarely seen completely in the plane of section.
  • +/-Sperm granulomas.
    • Histocytes - abundant foamy cytoplasm.
    • Sperm - small, dark staining, teardrop-shaped (~1 micrometer).

DDx:

Notes:

Image

www:

IHC

  • PSA -ve.
  • PSAP -ve.

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A. VAS DEFERENS WITH GRANULOMA, RIGHT, VASOVASOSTOMY:
- VASITIS NODOSA AND SPERM GRANULOMAS.
- COMPLETE CROSS SECTION OF VAS DEFERENS.

B. VAS DEFERENS WITH GRANULOMA, LEFT, VASOVASOSTOMY:
- VASITIS NODOSA AND SPERM GRANULOMAS.
- COMPLETE CROSS SECTION OF VAS DEFERENS.

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.
  4. 4.0 4.1 4.2 Hirschowitz, L.; Rode, J.; Guillebaud, J.; Bounds, W.; Moss, E. (Apr 1988). "Vasitis nodosa and associated clinical findings.". J Clin Pathol 41 (4): 419-23. PMC 1141468. PMID 3366928. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1141468/.
  5. Balogh, K.; Travis, WD. (Apr 1985). "Benign vascular invasion in vasitis nodosa.". Am J Clin Pathol 83 (4): 426-30. PMID 3984936.
  6. URL: http://medical-dictionary.thefreedictionary.com/elastosis. Accessed on: 26 September 2011.