dLygie elcl yaelhprps,ia ohsudl olas ees osibfsir nda yltiaanzhino fo het sbtlueu tub im' nto nseige ..it. /)_(¯¯ツ_
Normal testis :
Focal atrophy :
Marked atrophy :
Testicular biopsies of adult males with Klinefelter syndrome are characterized by extensive fibrosis and hyalinization of the seminiferous tubules and hyperplasia of the interstitium; however, the tubules may show residual foci of spermatogenesis. Histologic findings may include small, firm testes with seminiferous tubular hyalinization; sclerosis; and atrophy with focal hyperplasia of mostly degenerated Leydig cells
I kind of reasoned through this by thinking that if they said "22 year old man" that means there has to be a Y in there in order for the person to be presumed male. That left options: 45X/46XY, 46XY, and 47XXY. Beyond that I thought that the picture didn't look normal (couldn't make out tubules or individual cells), so it couldn't be 46XY.
I figured 45X/46XY is a mosaic Turner, and I have no idea what a person with that genotype would look like, nor whether they would have testes, but I know that 47XXY would have testes because SRY is on chromosome Y which makes testes determining factor.
45, X / 46, XY is a bit tricky. Not having too much time to think, I almost went for it thinking there is increased risk for gonadoblastoma with 45X/46XY mosaicism - so maybe that's what they are going for? But what I realized after a couple NBME's, if they don't mention something about the body habitus (like here they said male), it's less likely this patient has Turner Syndrome.
We're just medical students, not pathologists. So I think if you just say okay, male so can't be 46 XX or 47 XXX. Then also probably not mosaicism cause of what I mentioned above. You are left with normal 46 XY or 47 XXY - and which is more likely to have fertility issues?