Total embedding of spermatic cord and hilar soft tissue in orchiectomy for seminoma: does the extensive sampling improve pathologic risk factors?
Guidelines
Risk factors
Sampling
Testis
Journal
Virchows Archiv : an international journal of pathology
ISSN: 1432-2307
Titre abrégé: Virchows Arch
Pays: Germany
ID NLM: 9423843
Informations de publication
Date de publication:
Nov 2022
Nov 2022
Historique:
received:
28
05
2022
accepted:
22
06
2022
revised:
20
06
2022
pubmed:
2
7
2022
medline:
9
11
2022
entrez:
1
7
2022
Statut:
ppublish
Résumé
Pure seminomas represent the majority of testicular germ cell tumors and accurate diagnosis and staging require an accurate sampling of radical orchiectomy specimens. The aim of our study is to find the most informative gross sampling method for orchiectomy specimens. We performed the extensive sampling of 88 radical orchiectomy specimens embedding in their entirety testicular hilum, rete testis, hilar soft tissue, and spermatic cord. We examined the impact of this procedure on tumor stage, prognostic parameters (lymphovascular invasion and infiltration of rete testis, epididymis, tunica vaginalis, and spermatic cord), and their relationship with recurrence. Eighty-eight seminomas from 88 radical orchiectomies were sampled. Seventy-seven cases (87.5%) presented as clinical stage I and 11 cases (12.5%) as clinical stage II. The follow-up period range was 18-54 months and 82 patients (93.2%) had a minimum of 2-year follow-up. Tumor size ranged from 0.4 to 16 cm (mean 3.6) requiring a mean of 7.1 sections for entire tumoral sampling. Epididymis required 2 to 8 sections (mean 3.3), and hilum and hilar soft tissues 2 to 9 sections (mean 3.4). Epididymal infiltration and lymphovascular invasion resulted significant at multivariate analysis generating a receiver operating characteristic (ROC) curve with area under curve of 0.778. All the other parameters (except for pagetoid rete testis infiltration) were significant to predict metastasis only at univariate analysis. Extensive sampling of radical orchiectomy specimens does not improve the accuracy of staging in pure seminomas. Lymphovascular invasion and epididymal infiltration are useful to predict metastasis.
Identifiants
pubmed: 35776192
doi: 10.1007/s00428-022-03370-z
pii: 10.1007/s00428-022-03370-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
695-701Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Gurney JK, Florio AA, Znaor A et al (2019) International trends in the incidence of testicular cancer: lessons from 35 years and 41 countries. Eur Urol 76(5):615–623. https://doi.org/10.1016/j.eururo.2019.07.002
doi: 10.1016/j.eururo.2019.07.002
pubmed: 31324498
pmcid: 8653517
Mortensen MS, Lauritsen J, Gundgaard MG et al (2014) A nationwide cohort study of stage I seminoma patients followed on a surveillance program. Eur Urol 66(6):1172–1178. https://doi.org/10.1016/j.eururo.2014.07.001
doi: 10.1016/j.eururo.2014.07.001
pubmed: 25064686
Verrill C, Perry-Keene J, Srigley JR et al (2018) Members of the ISUP testicular tumor panel Intraoperative consultation and macroscopic handling: the International Society of Urological Pathology (ISUP) testicular cancer consultation conference recommendations. Am J Surg Pathol. 42(6):e33–e43. https://doi.org/10.1097/PAS.0000000000001049.
doi: 10.1097/PAS.0000000000001049.
pubmed: 29579010
Royal College of Pathologists of Australasia. RCPA testicular tumours structured reporting protocol 1st ed. 2011. Available at: https://www.rcpa.edu.au/Library/Practising-Pathology/Structured-Pathology-Reporting-of-Cancer/Cancer-Protocols/Genitourinary/Protocoltesticular-tumours . Accessed November 15, 2021
Berney D, Theaker JT, Verrill C. Royal College of Pathologists’ Standards and Datasets for reporting cancers: dataset for the histological reporting of testicular neoplasms. 3rd edition. 2014. Available at: www.rcpath.org/resourceLibrary/dataset-for-the-histological-reporting-oftesticular-neoplasms.html . Accessed November 15, 2021.
College of American Pathologists. Protocol for the examination of specimens from patients with malignant germ cell and sex cord-stromal tumors of the testis. Version: Testis 3.4.1.0. 2017. Available at: https://documents.cap.org/protocols/cp-testis-17protocol-4010.pdf Accessed November 15, 2021.
Berney DM, Comperat E, Feldman DR et al (2019) Datasets for the reporting of neoplasia of the testis: recommendations from the International Collaboration on Cancer Reporting. Histopathology 74(1):171183. https://doi.org/10.1111/his.13736
doi: 10.1111/his.13736
Dry SM, Renshaw AA (1999) Extratesticular extension of germ cell tumors preferentially occurs at the hilum. Am J Clin Pathol 111(4):534–538. https://doi.org/10.1093/ajcp/111.4.534
doi: 10.1093/ajcp/111.4.534
pubmed: 10191775
Brimo F, Srigley JR, Ryan CJ, et al (2017) Testis. In: AJCC Cancer Staging Manual (8th ed) pp 732–35
Moch H, Humphrey PA, Ulbright TM, et al. (2016) WHO classification of tumors of the urinary system and male genital organs. Lyon, France
Lee AH, Theaker JM (1994) Pagetoid spread of intratubular germ cell neoplasia into the rete testis. Hum Pathol 25(11):1256–1257. https://doi.org/10.1016/0046-8177(94)90047-7
doi: 10.1016/0046-8177(94)90047-7
pubmed: 7959675
Nazeer T, Ro JY, Kee KH, Ayala AG (1996) Spermatic cord contamination in testicular cancer. Mod Pathol 9(7):762–766
pubmed: 8832559
Albers P, Albrecht W, Algaba F et al (2015) European Association of Urology. Guidelines on Testicular Cancer: 2015 Update. Eur Urol 68(6):1054–68. https://doi.org/10.1016/j.eururo.2015.07.044
doi: 10.1016/j.eururo.2015.07.044
pubmed: 26297604
Verrill C, Yilmaz A, Srigley JR et al (2017) Reporting and staging of testicular germ cell tumors: the International Society of Urological Pathology (ISUP) Testicular Cancer Consultation Conference Recommendations. Am J Surg Pathol 41(6):e22–e32. https://doi.org/10.1097/PAS.0000000000000844
doi: 10.1097/PAS.0000000000000844
pubmed: 28368923
Sanfrancesco JM, Trevino KE, Xu H et al (2018) The significance of spermatic cord involvement by testicular germ cell tumors: should we be staging discontinuous invasion from involved lymphovascular spaces differently from direct extension? Am J Surg Pathol 42(3):306–311. https://doi.org/10.1097/PAS.0000000000001008
doi: 10.1097/PAS.0000000000001008
pubmed: 29309304
McCleskey BC, Epstein JI, Albany C et al (2017) The significance of lymphovascular invasion of the spermatic cord in the absence of cord soft tissue invasion. Arch Pathol Lab Med 141(6):824–829. https://doi.org/10.5858/arpa.2016-0226-OA
doi: 10.5858/arpa.2016-0226-OA
pubmed: 28362157
Gordetsky J, Sanfrancesco J, Epstein JI et al (2017) Do nonseminomatous germ cell tumors of the testis with lymphovascular invasion of the spermatic cord merit staging as pT3? Am J Surg Pathol 41(10):1397–1402. https://doi.org/10.1097/PAS.0000000000000917
doi: 10.1097/PAS.0000000000000917
pubmed: 28719463
Soper MS, Hastings JR, Cosmatos HA et al (2014) Observation versus adjuvant radiation or chemotherapy in the management of stage I seminoma: clinical outcomes and prognostic factors for relapse in a large US cohort. Am J Clin Oncol 37(4):356–359. https://doi.org/10.1097/COC.0b013e318277d839
doi: 10.1097/COC.0b013e318277d839
pubmed: 23275274
Chung P, Daugaard G, Tyldesley S et al (2015) Evaluation of a prognostic model for risk of relapse in stage I seminoma surveillance. Cancer Med. 4(1):155–60. https://doi.org/10.1002/cam4.324
doi: 10.1002/cam4.324
pubmed: 25236854
Tandstad T, Ståhl O, Dahl O et al (2016) Treatment of stage I seminoma, with one course of adjuvant carboplatin or surveillance, risk-adapted recommendations implementing patient autonomy: a report from the Swedish and Norwegian Testicular Cancer Group (SWENOTECA). Ann Oncol 27(7):1299–1304. https://doi.org/10.1093/annonc/mdw164
doi: 10.1093/annonc/mdw164
pubmed: 27052649
Yilmaz A, Cheng T, Zhang J et al (2013) Testicular hilum and vascular invasion predict advanced clinical stage in nonseminomatous germ cell tumors. Mod Pathol 26(4):579–586. https://doi.org/10.1038/modpathol.2012.189
doi: 10.1038/modpathol.2012.189
pubmed: 23238629
Trevino KE, Esmaeili-Shandiz A, Saeed O et al (2018) Pathological risk factors for higher clinical stage in testicular seminomas. Histopathology 73(5):741–747. https://doi.org/10.1111/his.13667
doi: 10.1111/his.13667
pubmed: 29858564
Scandura G, Wagner T, Beltran L, et al. Pathological risk factors for metastatic disease at presentation in testicular seminomas with focus on the recent pT changes in AJCC TNM eighth edition. Hum Pathol. 2019 Dec;94:16-22. https://doi.org/10.1016/j.humpath.2019.10.004
Kollmannsberger C, Tandstad T, Bedard PL et al (2015) Patterns of relapse in patients with clinical stage I testicular cancer managed with active surveillance. J Clin Oncol 33(1):51–57. https://doi.org/10.1200/JCO.2014.56.2116
doi: 10.1200/JCO.2014.56.2116
pubmed: 25135991
Warde P, Specht L, Horwich A et al (2002) Prognostic factors for relapse in stage I seminoma managed by surveillance: a pooled analysis. J Clin Oncol 20(22):4448–4452. https://doi.org/10.1200/JCO.2002.01.038
doi: 10.1200/JCO.2002.01.038
pubmed: 12431967
Tandstad T, Smaaland R, Solberg A et al (2011) Management of seminomatous testicular cancer: a binational prospective population-based study from the Swedish Norwegian testicular cancer study group. J Clin Oncol 29(6):719–725. https://doi.org/10.1200/JCO.2010.30.1044
doi: 10.1200/JCO.2010.30.1044
pubmed: 21205748
Aparicio J, Sánchez-Muñoz A, Gumà J et al (2018) A risk-adapted approach to patients with stage I seminoma according to the status of rete testis: the fourth Spanish germ cell cancer group study. Oncology 95(1):8–12. https://doi.org/10.1159/000487438
doi: 10.1159/000487438
pubmed: 29587278
Horwich A, Alsanjari N, A’Hern R et al (1992) Surveillance following orchidectomy for stage I testicular seminoma. Br J Cancer 65(5):775–778. https://doi.org/10.1038/bjc.1992.164
doi: 10.1038/bjc.1992.164
pubmed: 1586607
pmcid: 1977398
Valdevenito JP, Gallegos I, Fernández C et al (2007) Correlation between primary tumor pathologic features and presence of clinical metastasis at diagnosis of testicular seminoma. Urology 70(4):777–780. https://doi.org/10.1016/j.urology.2007.05.020
doi: 10.1016/j.urology.2007.05.020
pubmed: 17991554