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Topic:Histopathology

Histopathology in horses involves the microscopic examination of tissue samples to study the manifestations of disease. This field provides insights into the structural and cellular changes that occur in equine tissues as a result of various pathological conditions. Common applications of histopathology in equine medicine include the diagnosis of neoplastic, inflammatory, and degenerative diseases. Techniques such as tissue staining and immunohistochemistry are employed to identify specific cellular components and pathological markers. This page aggregates peer-reviewed research studies and scholarly articles that explore the methodologies, findings, and implications of histopathological investigations in equine health.
Treatment of subcutaneous lipomas in the horse.
Journal of the American Veterinary Medical Association    July 12, 2024   1-5 doi: 10.2460/javma.24.02.0146
Kearney MT, Kamm JL.To describe the treatment of subcutaneous lipomas in the horse. Methods: 3 horses. Methods: The horses were aged 1 to 2 years old, with lipoma of the abdomen, prepuce, and tarsus. Results: Recurrence of an invasive thoracic lipoma occurred in case 1 at the exit site of a passive drain. The recurrence was treated unsuccessfully with injectable cisplatin, and a second revision surgery with the use of an active drain resulted in resolution. In case 2, complete resection of an encapsulated lipoma of the lateral prepuce was successful with no recurrence. In case 3, incomplete resection of a tarsal ...
Fetal rhabdomyoma in a Thoroughbred filly.
Veterinary medicine and science    July 8, 2024   Volume 10, Issue 4 e1534 doi: 10.1002/vms3.1534
Rapezzano G, Foote A, Petrini F, Pereira R, Marcatili M.A newborn Thoroughbred filly presented with a large mass located on the ventro-rostral aspect of the mandible. The mass was surgically removed under general anaesthesia. Upon gross examination, the mass was well circumscribed with a heterogeneous lobulated appearance. The results of histopathology and immunohistochemistry were consistent with a diagnosis of congenital fetal rhabdomyoma. On follow-up at six months post-surgical excision, no abnormalities were noted on clinical examination.
Characterisation of phenotypic patterns in equine exercise-associated myopathies.
Equine veterinary journal    July 5, 2024   doi: 10.1111/evj.14128
Lindsay-McGee V, Massey C, Li YT, Clark EL, Psifidi A, Piercy RJ.Equine exercise-associated myopathies are prevalent, clinically heterogeneous, generally idiopathic disorders characterised by episodes of myofibre damage that occur in association with exercise. Episodes are intermittent and vary within and between affected horses and across breeds. The aetiopathogenesis is often unclear; there might be multiple causes. Poor phenotypic characterisation hinders genetic and other disease analyses. Objective: The aim of this study was to characterise phenotypic patterns across exercise-associated myopathies in horses. Methods: Historical cross-sectional study, w...
Equidae pythiosis in Brazil and the world: a systematic review of the last 63 years (1960-2023).
Brazilian journal of microbiology : [publication of the Brazilian Society for Microbiology]    July 5, 2024   Volume 55, Issue 3 2969-2981 doi: 10.1007/s42770-024-01435-6
Pereira DIB, Botton SA, Ianiski LB, Braga CQ, Maciel AF, Melo LG, Zambrano CG, Bruhn FRP, Santurio JM.This systematic review compiles reports of clinical pythiosis in horses, mules and donkeys from 1960 to 2023 worldwide, focusing on Brazil. We searched databases and included 71 articles detailing clinical characteristics, geographic distribution, epidemiology, diagnostic methods, therapies, and outcomes. The results showed that publications on equine pythiosis have significantly increased since 2010. Brazil reported the highest incidence, comprising 55% of cases, predominantly in the southern, northeastern, and central-western regions during summer and autumn. Cutaneous pythiosis was the most...
Equine gamma herpesvirus presence and viral load are not associated with equine glandular gastric disease.
Journal of the American Veterinary Medical Association    July 1, 2024   Volume 262, Issue 7 887 doi: 10.2460/javma.262.7.887
Löhr JM.No abstract available
Hair loss and endocrine dermatosis on horses raised in a Mimosa pudica var. unijuga-invaded area.
Toxicon : official journal of the International Society on Toxinology    July 1, 2024   Volume 247 107844 doi: 10.1016/j.toxicon.2024.107844
Machado M, Queiroz-Machado CRR, Queiroz F, Gardner DR, Riet-Correa F.A Mimosa pudica var. unijuga-associated toxicity affecting horses occurred in Araguari, Triângulo Mineiro, Southeast Brazil. Affected horses had gradual hair loss of the mane and tail and endocrine dermatosis after grazing for three months during the dry season on a paddock invaded by the plant. The main histological lesions include compact ortho-keratotic hyperkeratosis and numerous flame follicles. Toxicological analysis by HPLC-UV demonstrated 0.8 mg/g of mimosine in the leaves.
Histological and Histopathological Features of the Third Metacarpal/Tarsal Parasagittal Groove and Proximal Phalanx Sagittal Groove in Thoroughbred Horses with Racing History.
Animals : an open access journal from MDPI    June 30, 2024   Volume 14, Issue 13 1942 doi: 10.3390/ani14131942
Lin ST, Foote AK, Bolas NM, Sargan DR, Murray RC.Information regarding the histopathology of the proximal phalanx (P1) sagittal groove in racehorses is limited. Twenty-nine cadaver limbs from nine Thoroughbred racehorses in racing/race-training underwent histological examination. Histological specimens of the third metacarpal/metatarsal (MC3/MT3) parasagittal grooves and P1 sagittal grooves were graded for histopathological findings in hyaline cartilage (HC), calcified cartilage (CC), and subchondral plate and trabecular bone (SCB/TB) regions. Histopathological grades were compared between (1) fissure and non-fissure locations observed in a ...
Clinically relevant doses of tiludronate do not affect bone remodelling in pasture-exercised horses.
Equine veterinary journal    June 25, 2024   Volume 57, Issue 2 513-521 doi: 10.1111/evj.14119
Tippen SP, Metzger CE, Sacks SA, Allen MR, Mitchell CF, McNulty MA.Bisphosphonates are widely used in equine athletes to reduce lameness associated with skeletal disorders. Widespread off-label use has led to concern regarding potential negative effects on bone healing, but little evidence exists to support or refute this. Objective: To investigate the influence of clinically relevant doses of tiludronate on bone remodelling and bone healing. Methods: Randomised, controlled in vivo experiments. Methods: Each horse had a single tuber coxae biopsied (Day 0), then were divided into a treatment (IV tiludronate) or control (IV saline) group. Treatments were admini...
Flowmetry and spectrophotometry for the assessment of intestinal viability in horses with naturally occurring strangulating small intestinal lesions.
Equine veterinary journal    June 18, 2024   doi: 10.1111/evj.14118
Verhaar N, Grages AM, Bienert-Zeit A, Schwieder A, Reineking W, Hewicker-Trautwein M, Kästner S, Geburek F.Ancillary diagnostic methods to enhance the accuracy of viability assessment have not been established for use in clinical practice. Objective: To assess intestinal microperfusion measured by Laser Doppler Flowmetry and Spectrophotometry (LDFS) in naturally occurring small intestinal strangulations of different origins and to compare this between viable and non-viable segments. Methods: Prospective clinical trial. Methods: Forty horses undergoing colic surgery for naturally occurring small intestinal strangulations were included. Tissue oxygen saturation (tSO), haemoglobin (tHB) and blood flow...
Optimizing the preparation of paraffin sections from stallion testes.
Histology and histopathology    June 6, 2024   18775 doi: 10.14670/HH-18-775
Asgenbaatar N, Yi M, Wang X, Ulaangerel T, Shen Y, Wen X, Du M, Dong X, Mengkh Y, Dugarjav M, Bou G.The preparation of paraffin sections is an important experimental technique in animal histological research, and key factors that determine the quality of a section include the dehydration time, waxing time, and drying temperature of the paraffin section. Paraffin sections obtained from testis tissue of adult horses exhibited higher quality with clear tissue structure and complete cell morphology after they underwent gradient dehydration for 6 hours, were immersed in wax for 60 minutes, and were dried in a 75-degree oven for 15 minutes. The detailed, optimized procedures that are developed in ...
Findings and Prognosis in 149 Horses with Histological Changes Compatible with Inflammatory Bowel Disease.
Animals : an open access journal from MDPI    May 30, 2024   Volume 14, Issue 11 doi: 10.3390/ani14111638
Kranenburg LC, Bouwmeester BF, van den Boom R.Inflammatory bowel disease (IBD) is a chronic disease characterized by different cell infiltrates in the intestine. The aims of this study were to report the clinical and clinicopathological findings in horses with histological changes compatible with IBD in the duodenum. Further, the clinical progression of IBD and survival were investigated. Patient records were reviewed for horses in which histological evidence of IBD was found in duodenal biopsies collected during endoscopy. The histological changes were classified as mild, moderate or severe and the predominant infiltrating cell type was ...
Dermoid cysts formation is a complication of wound pinch grafting in a horse: A case report.
Veterinary surgery : VS    May 27, 2024   Volume 53, Issue 6 1130-1137 doi: 10.1111/vsu.14114
Pressanto MC, Bombonato C, Foote AK, Coomer RPC.To describe dermoid cyst formation as an uncommon complication of the pinch grafting technique in horses. Methods: Case report. Methods: A 8 year old Arabian gelding. Methods: Clinical presentation, imaging, treatment, and histopathology records were reviewed. The horse originally presented due to delayed healing of a laceration to the distal aspect of the metatarsus. The wound was treated initially with debridement and it was allowed to fill with healthy granulation tissue prior to pinch grafting. Two months after grafting, the horse started to show self-mutilation behavior targeting the woun...
Immune-mediated Equine Vasculopathies.
The Veterinary clinics of North America. Equine practice    May 23, 2024   Volume 40, Issue 2 253-261 doi: 10.1016/j.cveq.2024.04.002
Bozorgmanesh R.Immune-mediated vasculopathies occur secondary to infection or another noninfectious stimulus. Potential triggers include heterologous antigens including viruses, injected proteins and drugs; or auto-antigens including immunoglobulins or other endogenous proteins. Although these conditions are rare in horses, immune-mediated vasculopathies can cause considerable morbidity, with variable clinical signs depending on severity and organ system affected. Examples include purpura hemorrhagica, systemic lupus erythematosus, drug-induced vasculitis, paraneoplastic vasculitis, and idiopathic immune-med...
Approach to Inflammatory Bowel Disease.
The Veterinary clinics of North America. Equine practice    May 23, 2024   Volume 40, Issue 2 287-306 doi: 10.1016/j.cveq.2024.04.004
Timko K.Inflammatory bowel disease (IBD) in the horse encompasses a group of infiltrative gastrointestinal disorders resulting in malabsorption, maldigestion, weight loss, colic, and sometimes diarrhea. The type of IBD can be classified as granulomatous, lymphocytic-plasmacytic, or eosinophilic enterocolitis. The diagnosis of IBD in equids is based on consistent clinical signs and clinicopathologic findings in conjunction with confirmatory histopathology from a gastrointestinal biopsy. Treatment usually consists of a combination of immunosuppressive medications, anthelmintics, and dietary modification...
Extensive intraocular melanoma with secondary glaucoma in a 15-month-old Thoroughbred filly.
Veterinary medicine and science    May 13, 2024   Volume 10, Issue 3 e1471 doi: 10.1002/vms3.1471
Pereira R, Gillespie S, Rapezzano G, Withers J, Duz M, Foote A.A 15-month-old, grey, Thoroughbred filly presented for investigation of a 6-week history of corneal oedema and blepharospasm on the right eye (OD). The filly was otherwise healthy. Following ophthalmic examination, glaucoma on the OD was diagnosed. A space occupying mass within the anterior chamber was documented on transpalpebral ultrasonographic examination. This mass obliterated most of the anterior intraocular structures on the peripheral nasal side (corneal endothelium and drainage angle), leading to secondary glaucoma. After systemic and topical treatment addressing secondary glaucoma, t...
Adjunctive bevacizumab therapy in an equine corneal stromal invasive squamous cell carcinoma with a 53-months follow-up.
Tierarztliche Praxis. Ausgabe G, Grosstiere/Nutztiere    May 3, 2024   Volume 52, Issue 2 108-114 doi: 10.1055/a-2253-8103
Blohm KO, Nell B.A 17-year-old Appaloosa mare was referred for evaluation of presumed refractory keratitis of the left eye. Gross examination revealed ocular discomfort and corneal neovascularization with a nasal focal opacification affecting approximately 40% of the corneal surface. On ophthalmic examination, extensive subepithelial to mid-stromal vascular branching accompanied by a homogeneous white, dense opacification, which affected up to 80% of the total corneal thickness, were apparent. Signs of concurrent uveitis were absent. Deep-stromal lamellar keratectomy with a conjunctival pedicle graft was perfo...
IL-1ra gene therapy in equine osteoarthritis improves physiological, anatomical, and biological outcomes of joint degeneration.
Journal of the American Veterinary Medical Association    April 22, 2024   1-12 doi: 10.2460/javma.24.02.0078
Goodrich LR, McIlwraith CW, Grieger J, Kraus VB, Stabler T, Werpy N, Phillips J, Samulski RJ, Frisbie D.To evaluate the effects of a gene transfer approach to IL-1β inhibition in an equine osteochondral chip fragment model of joint injury using a self-complementary adeno-associated virus with interleukin receptor antagonist transgene cassette (scAAVIL-1ra), as posttraumatic osteoarthritis in horses, similar to people, is a significant clinical problem. Methods: 16 horses were utilized for the study. Methods: All horses had an osteochondral chip fragment induced arthroscopically in one middle carpal joint while the contralateral joint was sham operated. Eight horses received either scAAVIL-1ra o...
Intrahepatic mucinous cholangiocarcinoma with recurrent colic in a horse: case report and literature review of cholangiocarcinoma in horses. Barrantes Murillo DF, Cattley RC, Cullen JM, Withers C, Towns J, Pfeifle R, Wooldridge A, Neto RLALT.A 17-y-old Arabian mare was presented to the Auburn Large Animal Veterinary Teaching Hospital with a long-term history of intermittent mild recurrent colic that responded to medical treatment. CBC revealed mild lymphopenia; serum biochemistry findings were of increased gamma-glutamyl transferase and creatine kinase activities, hyperferremia, hyperglycemia, hypomagnesemia, and hypokalemia. Abdominocentesis was compatible with low-protein transudate. Due to the progression and duration of clinical signs, the owner elected euthanasia. Postmortem examination and histopathology confirmed a cholangi...
First confirmed case of equine pythiosis in Northern Veracruz, Mexico.
Acta tropica    March 27, 2024   Volume 254 107195 doi: 10.1016/j.actatropica.2024.107195
Chagoya-Fuentes JL, Gaona-López J, Hernández-Carbajal GR, Torres-Guerrero H, Lammoglia-Villagómez MA, Huerta-Peña J, Pérez-Brígido CD....A clinical case of an adult horse with invasive, ulcerative, proliferative, pyogranulomatous disease of the skin (tumor) in the shoulder region is presented. The mass had a granulomatous and crater-shaped appearance, with serosanguinous discharge and the presence of fistulas with caseous material. The tumor was removed by surgery and sent to the laboratory for diagnosis. Histopathology was performed using Grocott-Gomori methenamine silver stain. The presence of necrotic material, fibrosis, infiltrated cells, and brown-colored hyphae, characteristic of members of the genus Pythium, were observe...
Equine gamma herpesvirus presence and viral load are not associated with equine glandular gastric disease.
American journal of veterinary research    March 18, 2024   Volume 85, Issue 6 ajvr.23.12.0282 doi: 10.2460/ajvr.23.12.0282
Thompson RN, Pearson E, McDonough SP, Iannitti H, Van de Walle GR, Banse H, Perkins GA, Tomlinson JE.To investigate the role of equine herpesvirus-2 (EHV-2) and equine herpesvirus-5 (EHV-5) in equine glandular gastric disease (EGGD) by visualizing and quantifying these gamma herpesviruses in EGGD-affected and normal glandular gastric mucosa of horses. A secondary objective was to describe the histopathological abnormalities in the equine gastric glandular mucosa in horses with EGGD. Methods: 29 horses (n = 21 postmortem and 8 gastroscopy) categorized as normal (11), EGGD (12), or both EGGD and equine squamous gastric disease (6). Methods: Glandular gastric mucosal samples were collected from ...
First report of Besnoitia bennetti in Irish donkeys: an emerging parasitic disease in Europe.
Irish veterinary journal    February 14, 2024   Volume 77, Issue 1 2 doi: 10.1186/s13620-024-00263-2
Tinkler SH, Villa L, Manfredi MT, Walshe N, Jahns H.This is the first report of Besnoitia bennetti in donkeys in Ireland. B. bennetti, an apicomplexan protozoan parasite specific to equids, is an emerging pathogen in Europe. This parasite forms chronic intracytoplasmic cysts in cells of the mesenchymal lineage, mainly fibroblasts, in the skin, sclera and mucosa. Clinical signs in affected equine hosts vary from mild to severe debilitating disease. Little is known of the phylogeny, epidemiology or transmission of B. bennetti infection in donkeys, mules or horses. Methods: Two cases of besnoitiosis in donkeys are presented. Both donkeys were born...
Equine uveitis: Outcome and adverse effects after one or two intravitreal low-dose gentamicin injections.
Equine veterinary journal    February 8, 2024   Volume 57, Issue 1 160-168 doi: 10.1111/evj.14056
Morén S, Kallberg M, Strom L.Uveitis is common in horses, potentially turning chronic (persistent or recurrent) resulting in impaired vision or blindness. All mainstay therapeutics aims at controlling inflammation, but long-term or lifelong treatment is often needed with possibly severe side effects. Therefore, intravitreal injections with low-dose gentamicin (IVGI) have been used in attempt to give a long-lasting result with potentially less side effects. Objective: To retrospectively assess outcome and long-term complications following one or two low-dose IVGI in Swedish horses with chronic uveitis. Methods: Retrospecti...
Equus caballus papillomavirus type 2 (EcPV2)-associated benign penile lesions and squamous cell carcinomas.
Veterinary medicine and science    January 16, 2024   Volume 10, Issue 1 e1342 doi: 10.1002/vms3.1342
Tuomisto L, Virtanen J, Kegler K, Levanov L, Sukura A, Sironen T, Kareskoski M.Squamous cell carcinoma is the most common genital, ocular and gastric tumour in horses. Equus caballus papillomavirus type 2 (EcPV2) DNA has been detected in several studies in equine penile squamous cell carcinomas (SCCs) and precursor lesions providing evidence of a causal role of EcPV2 in equine genital SCCs. Recently, EcPV2 E6/E7 nucleic acids were also detected in equine gastric SCCs, but further studies are required to determine the role of EcPV2 infection in the pathogenesis of gastric SCC. EcPV2 nucleic acids have been rarely described in ocular SCCs and precursor lesions. To investig...
Post-mortem feasibility of dual-energy computed tomography in the detection of bone edema-like lesions in the equine foot: a proof of concept.
Frontiers in veterinary science    January 4, 2024   Volume 10 1201017 doi: 10.3389/fvets.2023.1201017
Germonpré J, Vandekerckhove LMJ, Raes E, Chiers K, Jans L, Vanderperren K.In this proof-of-concept study, the post-mortem feasibility of dual-energy computed tomography (DECT) in the detection of bone edema-like lesions in the equine foot is described in agreement with the gold standard imaging technique, which is magnetic resonance imaging (MRI). Unassigned: A total of five equine cadaver feet were studied, of which two were pathological and three were within normal limits and served as references. A low-field MRI of each foot was performed, followed by a DECT acquisition. Multiplanar reformations of DECT virtual non-calcium images were compared with MRI for the de...
First Swedish case of fatal equine parasitic encephalitis by Halicephalobus gingivalis.
Acta veterinaria Scandinavica    December 15, 2023   Volume 65, Issue 1 56 doi: 10.1186/s13028-023-00719-5
Olofsson KM, van de Velde N, Peletto S, Iulini B, Pratley L, Modabberzadeh B, Małek E, Grandi G.Halicephalobus gingivalis is a nematode with zoonotic potential which can cause fatal opportunistic infections in various mammals. The parasite has never been diagnosed in Sweden, in any species, prior to the presented case. Methods: An imported 21-year-old Icelandic mare developed severe neurological signs. The horse was eventually euthanized and submitted for post-mortem examination where severe lesions in the kidneys were noted. Histopathology revealed the presence of H. gingivalis in both kidneys and the brain. Phylogenetic analysis of the parasite determined it to belong to Lineage 1. Con...
Preliminary evaluation of safety and migration of immune activated mesenchymal stromal cells administered by subconjunctival injection for equine recurrent uveitis.
Frontiers in veterinary science    December 14, 2023   Volume 10 1293199 doi: 10.3389/fvets.2023.1293199
Cassano JM, Leonard BC, Martins BC, Vapniarsky N, Morgan JT, Dow SW, Wotman KL, Pezzanite LM.Equine recurrent uveitis (ERU), an immune mediated disease characterized by repeated episodes of intra-ocular inflammation, affects 25% of horses in the USA and is the most common cause of glaucoma, cataracts, and blindness. Mesenchymal stromal cells (MSCs) have immunomodulatory properties, which are upregulated by preconditioning with toll-like receptor agonists. The objective was to evaluate safety and migration of TLR-3 agonist polyinosinic, polycytidylic acid (pIC)-activated MSCs injected subconjunctivally in healthy horses prior to clinical application in horses with ERU. We hypothesized ...
Macrodendritic ulcerative keratitis and conjunctival lymphoid hyperplasia in horses with equine herpesvirus-2 and equine herpesvirus-5 infections.
Veterinary ophthalmology    December 5, 2023   Volume 27, Issue 3 277-285 doi: 10.1111/vop.13171
Ledbetter EC, Cutler TJ, Irby NL.The aim of this study was to describe the clinical, confocal microscopic, histologic, and virologic features of horses with macrodendritic ulcerative keratitis and conjunctival lymphoid hyperplasia associated with equine herpesvirus-2 and equine herpesvirus-5 infection. Methods: Four foals with bilateral ocular disease. Methods: Complete ophthalmic examination was performed for each horse, and corneal samples were collected for cytology and microbiologic evaluation, including virus isolation and molecular diagnostics for the equine herpesviruses. In vivo confocal microscopy examination of the...
Equine conjunctival haemangiosarcoma: Clinical presentation, management, and outcome of seven cases in the United Kingdom.
Open veterinary journal    October 31, 2023   Volume 13, Issue 10 1366-1378 doi: 10.5455/OVJ.2023.v13.i10.17
Kashani-Carver A, O'Halloran C, Scurrell E, Featherstone H, de Freitas FF, Lowe R.Only 27 cases of equine conjunctival haemangiosarcoma have been reported in the literature over the past 37 years. Out of these, 22% of cases were lost to follow-up, 52% were euthanized, and 26% survived. A scarcity of cases and information is available for this rarely seen conjunctival tumour. Unassigned: To describe the clinical features, management, and outcome of conjunctival hemangiosarcoma in seven horses in the UK. Unassigned: Optivet medical records were reviewed for equine cases seen or advised on with a histopathological diagnosis of conjunctival haemangiosarcoma between January 2013...
Three-Dimensional Imaging and Histopathological Features of Third Metacarpal/Tarsal Parasagittal Groove and Proximal Phalanx Sagittal Groove Fissures in Thoroughbred Horses.
Animals : an open access journal from MDPI    September 14, 2023   Volume 13, Issue 18 2912 doi: 10.3390/ani13182912
Lin ST, Foote AK, Bolas NM, Peter VG, Pokora R, Patrick H, Sargan DR, Murray RC.Fissure in the third metacarpal/tarsal parasagittal groove and proximal phalanx sagittal groove is a potential prodromal pathology of fracture; therefore, early identification and characterisation of fissures using non-invasive imaging could be of clinical value. Thirty-three equine cadaver limbs underwent standing cone-beam (CB) computed tomography (CT), fan-beam (FB) CT, low-field magnetic resonance imaging (MRI), and macro/histo-pathological examination. Imaging diagnoses of fissures were compared to microscopic examination. Imaging features of fissures were described. Histopathological fin...
Evaluation of chemical castration using intra-testicular injection of zinc gluconate into the testis of the male donkey versus surgical castration: antimullerian hormone as an endpoint marker.
BMC veterinary research    September 2, 2023   Volume 19, Issue 1 140 doi: 10.1186/s12917-023-03694-1
Hamed MA, Amin YA, Mohamed RH, El-Adl M, Bazeed SM, Elnegiry AA, Shawki HH, Al-Lethie AA.Chemical castration of male animals is an alternative to surgical castration for inducing azoospermia, consequent sterility. Intra-testicular injection of zinc gluconate has been used for chemical castration in several animal species. However, its application to equine species, such as donkeys, has yet to be reported. This study aimed to evaluate the use of zinc gluconate for the chemical castration of male donkeys and to compare its effectiveness relative to routine surgical castration. For this purpose, investigations of serum testosterone and anti-Müllerian hormone levels, testicular ultra...