A 40-year old man was unable to impregnate his 30-year old wife for five years. His past medical history was unremarkable. Clinical examination was unrevealing and the testicular volume on both sides was 20 ml (measured by orchidometer). Semen analyses on 4 occasions over 2 years have all showed azoospermia and were fructose positive. Total testosterone, FSH and LH serum levels have all been within reference range on 4 repeated estimations over 2 years. Mature Sertoli cells with their apical aspects displaced to one side “wind swept tree tops” are seen. This patient’s condition represents atypical germ cell aplasia and without bilateral testicular biopsies could have been misdiagnosed as obstructive azoospermia.
Germ cell aplasia does not represent a diagnosis but it is rather a
characteristic histopathologic finding first described by Del Castillo et al. in
1947 which is sometimes referred to by his name. No germ cells are present in the seminiferous tubules but Sertoli cells are present (hence the name Sertoli-cell-only syndrome).