Varicocele repair in severe oligozoospermia: A case report of post-operative azoospermia.

Varicocele has been implicated as a cause in 35%-50% of patients with primary infertility and up to 81% of men with secondary infertility. Although a large number of reports have shown improvement in the semen parameters after correction of varicocele, other studies have suggested no benefit. We report the first case of azoospermia after surgery in a young infertile male patient with left-sided varicocele and severe oligozoospermia undergoing laparoscopic varicocelectomy. A pregnancy was only achieved with assisted reproductive technology because semen cryopreservation was performed before surgery. In the light of the above, the deterioration of sperm count after varicocele repair in patients with severe oligozoospermia could be due to irreversible impairment of spermatogenesis of such patients, together with the possible temporary damage of the surgical repair. This possible complication could therefore turn the severe oligozoospermia into an indication to perform cryopreservation before surgery, on both clinical and medico-legal grounds. Further research is needed before drawing definitive conclusions regarding the management of varicocele-related severe oligozoospermia.

Lymph node fine needle cytology in the staging and follow-up of cutaneous lymphomas.

BACKGROUND: Lymph nodal involvement is an important clinical-pathological sign in primary cutaneous lymphoma (PCL), as it marks the transformation/evolution of the disease from localized to systemic; therefore the surveillance of lymph nodes is important in the staging and follow up of PCL. Fine needle cytology (FNC) is widely used in the diagnosis of lymphadenopathies but has rarely been reported in PCL staging and follow-up. In this study an experience on reactive and neoplastic lymphadenopathies arisen in PCL and investigated by FNC, combined to ancillary techniques, is reported. METHODS: Twenty-one lymph node FNC from as many PCL patients were retrieved; 17 patients had mycosis fungoides (MF) and 4 a primary cutaneous B-cell lymphoma (PBL). In all cases, rapid on site evaluation (ROSE) was performed and additional passes were used to perform flow cytometry (FC), immunocytochemistry (ICC) and/or polymerase chain reaction (PCR) to assess or rule out a possible clonality of the corresponding cell populations. RESULTS: FNC combined with FC, ICC, and PCR identified 12 cases of reactive, non specific, hyperplasia (BRH), 4 dermatopathic lymphadenopathy (DL), 4 lymph nodal involvement by MF and 1 lymph nodal involvement by cutaneous B-cell lymphoma. CONCLUSIONS: FNC coupled with ancillary techniques is an effective tool to evaluate lymph node status in PCL patients, provided that ROSE and a rational usage of ancillary techniques is performed according to the clinical context and the available material. The method can be reasonably used as first line procedure in PCL staging and follow up, avoiding expensive and often ill tolerated biopsies when not strictly needed.

Fine-needle cytology and flow cytometry assessment of reactive and lymphoproliferative processes of the breast.

OBJECTIVE: The breast may be affected by reactive and lymphoproliferative processes such as primary (PBL) or secondary (SBL) lymphoma, reactive intramammary lymph nodes and sclerosing lobulitis; imaging may be not specific and surgical treatment not indicated. We report an experience with fine-needle cytology (FNAC) combined with flow cytometry (FC) and immunocytochemistry (ICC) in the diagnosis of these processes. STUDY DESIGN: Thirty-seven cases comprising intramammary lymph nodes (n = 15), sclerosing lobulitis (n = 2), PBL (n = 11) and SBL (n = 9) are reported. FNAC was used to prepare traditional smears, conventional ICC or FC. Cytological diagnoses were compared to the imaging data, checked by histology or follow-up and statistically evaluated. RESULTS: Imaging was not conclusive in most PBL, SBL, sclerosing lobulitis and some intramammary lymph nodes. FNAC combined with FC and ICC provided a definitive diagnosis of intramammary lymph node, sclerosing lobulitis, PBL and SBL in 18 cases with indication of the specific subtype in 10 cases. Statistical analysis showed 90% sensitivity, 100% specificity, 100% positive predictive value and 89% negative predictive value. CONCLUSIONS: FNAC combined with FC and ICC is a helpful procedure for the diagnosis of reactive and lymphoproliferative processes of the breast. It may prevent unnecessary biopsy and speed up therapeutic procedures.