Testicular pathology in fatal COVID-19: A descriptive autopsy study
Testicular pathology in fatal COVID-19: A descriptive autopsy study
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DOI：
10.1111/andr.13073
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发表时间：
2021-07-16
期刊：
影响因子：
4.5
通讯作者：
Hallak, Jorge
中科院分区：
文献类型：
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作者：
Duarte-Neto, Amaro N.;Teixeira, Thiago A.;Hallak, Jorge
背景 多器官损伤是严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 感染的一个共同特征，其范围超出了最初观察到的严重肺炎。越来越多的证据表明睾丸也受到损害。目的 描述 COVID-19 死亡病例睾丸的病理学结果，包括病毒颗粒和抗原以及炎症细胞亚群的检测。材料和方法 通过经皮穿刺从 11 名死者身上获取死后睾丸样本，并通过逆转录聚合酶链反应 (RT-PCR) 进行 RNA 检测，并通过光学和电子显微镜 (EM) 进行 SARS-CoV-2 检测。还对 SARS-CoV-2 N 蛋白以及淋巴细胞和组织细胞标记物进行了免疫组织化学 (IHC)。结果 8例患者出现轻度间质性睾丸炎，主要由CD68+和TCD8+细胞组成。 5 例中检出纤维蛋白血栓。所有病例均表现为充血、间质水肿、肾小管基底膜增厚、间质细胞和支持细胞减少、生精减少，血管内血管细胞粘附分子（VCAM）强表达。 IHC 在所有病例中均在间质细胞、支持细胞、精原细胞和成纤维细胞中检测到 SARS-Cov-2 抗原。电镜在 4 例病例的成纤维细胞、内皮细胞、支持细胞和间质细胞、精子细胞以及睾丸网上皮细胞的细胞质中检测到病毒颗粒，而 RT-PCR 在 3 例病例中检测到 SARS-CoV-2 RNA。讨论和结论 COVID-19 相关的睾丸病变显示出睾丸炎、血管变化、基底膜增厚、睾丸间质和支持细胞缺乏以及与 SARS-CoV-2 局部感染相关的精子发生减少等综合症状，可能会损害男性的激素功能和生育能力。
Background Multi-organ damage is a common feature of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, going beyond the initially observed severe pneumonia. Evidence that the testis is also compromised is growing. Objective To describe the pathological findings in testes from fatal cases of COVID-19, including the detection of viral particles and antigens, and inflammatory cell subsets. Materials and methods Postmortem testicular samples were obtained by percutaneous puncture from 11 deceased men and examined by reverse-transcription polymerase chain reaction (RT-PCR) for RNA detection and by light and electron microscopy (EM) for SARS-CoV-2. Immunohistochemistry (IHC) for the SARS-CoV-2 N-protein and lymphocytic and histiocytic markers was also performed. Results Eight patients had mild interstitial orchitis, composed mainly of CD68+ and TCD8+ cells. Fibrin thrombi were detected in five cases. All cases presented congestion, interstitial edema, thickening of the tubular basal membrane, decreased Leydig and Sertoli cells with reduced spermatogenesis, and strong expression of vascular cell adhesion molecule (VCAM) in vessels. IHC detected SARS-Cov-2 antigen in Leydig cells, Sertoli cells, spermatogonia, and fibroblasts in all cases. EM detected viral particles in the cytoplasm of fibroblasts, endothelium, Sertoli and Leydig cells, spermatids, and epithelial cells of the rete testis in four cases, while RT-PCR detected SARS-CoV-2 RNA in three cases. Discussion and conclusion The COVID-19-associated testicular lesion revealed a combination of orchitis, vascular changes, basal membrane thickening, Leydig and Sertoli cell scarcity, and reduced spermatogenesis associated with SARS-CoV-2 local infection that may impair hormonal function and fertility in men.