Research Article
Year 2020,
Volume: 22 Issue: 2, 109 - 113, 30.08.2020
Abstract
Amaç: Testiküler germ hücreli tümörler (TGHT), genç yetişkin erkeklerde sık görülen ve bu dönemdeki kanser ilişkili ölümlerin önemli bir sebebi olan solid neoplazmlardır. Histopatolojik sınıflandırma ve evrelemedeki değişiklikler, prognoz ve tedaviyi etkilemektedir. Bu çalışmanın amacı, TGHT tanısı almış olguların analizini yapmak, prognostik parametreleri ve bu parametrelerin insitu germ hücreli neoplazi (İGHN), intratubuler ve intertubuler tümörlerin varlığı ile ilişkilerini gözden geçirmektir.
Gereç ve Yöntemler: Bu çalışmada TGHT tanısı almış 77 olgunun Hematoksilen&Eozin boyalı preparatları yeniden değerlendirildi. İGHN, intratubuler ve intertubuler germ hücreli tümör varlığı kaydedildi. Amerikan Birleşik Kanser Komitesi (American Joint Committee on Cancer, AJCC) 8. basımındaki değişiklikler temel alınarak yeniden histopatolojik sınıflama ve evreleme yapıldı.
Bulgular: Olguların büyük çoğunluğu (n=42) seminom tanısı aldı, bunu mikst germ hücreli tümör (n=33) ve spermatositik tümör (n=2) izledi. Olguların 30’unda rete testis invazyonu, 6’sında epididim invazyonu, 10’unda hiler yumuşak doku invazyonu, 1’inde tunika vaginalis invazyonu, 4’ünde spermatik kord invazyonu ve 22’sinde ise lenfovasküler invazyon görüldü. İntertubuler seminom 25, intratubuler karsinom 16, İGHN ise 73 olguda saptandı.
Sonuç: Histopatolojik tanı, patolojik tümör evresi, serum tümör belirteçleri ve metastaz olup olmaması tedaviyi belirleyen başlıca kriterlerdir. AJCC 8. basıma göre, hiler yumuşak dokuya invazyonun evrelemeye eklenmesi ile pT2 olgularımız arttı. Ayrıca, spermatik kord içerisinde devamlılık göstermeksizin damar trombüsünden yumuşak doku invazyonun pM1 olarak kabul edilmesi de metastatik testis tümörlerinin sayısını artırmıştır.
References
- Landero-Huerta DA, Vigueras-Villasenor RM, Yokoyama-Rebollar E, Arechaga-Ocampo E, Rojas-Castaneda JC, Jimenez-Trejo F, et al. Epigenetic and risk factors of testicular germ cell tumors: a brief review. Front Biosci (Landmark Ed). 2017;22 (7):1073-98.
- Greene MH, Kratz CP, Mai PL, Mueller C, Peters JA, Bratslavsky G, et al. Familial testicular germ cell tumors in adults: 2010 summary of genetic risk factors and clinical phenotype. Endocr Relat Cancer. 2010;17(2):R109-21.
- Ulbright TM. Recently described and clinically important entities in testis tumors: a selective review of changes incorporated into the 2016 classification of the World Health Organization. Arch Pathol Lab Med. 2019;143 (6):711-21.
- Moch H, Humphrey PA, Ulbright TM, Reuter VE. WHO classification of tumours of the urinary system and male genital organs, 4th ed. Geneva, Switzerland: WHO; 2016.
- Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, et al. AJCC cancer staging manual, 8th ed. Switzerland: Springer; 2017.
- Johnson K, Brunet B. Brain metastases as presenting feature in ‘burned out’ testicular germ cell tumor. Cureus. 2016;8(4):e551.
- Winter C, Albers P. Testicular germ cell tumors: pathogenesis, diagnosis and treatment. Nat Rev Endocrinol. 2011;7(1):43-53.
- Sheikine Y, Genega E, Melamed J, Lee P, Reuter VE, Ye H. Molecular genetics of testicular germ cell tumours. Am J Cancer Res. 2012;2(2):153-67.
- Hoei-Hansen CE, Rajpert-De Meyts E, Daugaard G, Skakkebaek NE. Carcinoma in situ testis, the progenitor of testicular germ cell tumours: a clinical review. Ann Oncol. 2005;16(6):863-8.
- Al-Hussain T, Bakshi N, Akhtar M. Intratubular germ cell neoplasia of the testis: a brief review. Adv Anat Pathol. 2015;22(3):202-12.
- Cierna Z, Mego M, Jurisica I, Machalekova K, Chovanec M, Miskovska V, et al. Fibrillin-1 (FBN-1) a new marker of germ cell neoplasia in situ. BMC Cancer. 2016;16(1):597.
- Chu YH, Huang W, Hu R. Exclusively intertubular seminoma arising in undescended testes: Report of two cases. Hum Pathol Case Reports. 2018;11:15-8.
- Henley JD, Young RH, Wade CL, Ulbright TM. Seminoma with exclusive intertubular growth: a report of 12 clinically and grossly inconspicuous tumors. Am J Surg Pathol. 2004;28 (9):1163-8.
- Yilmaz A, Cheng T, Zhang J, Trpkov K. Testicular hilum and vascular invasion predict advanced clinical stage in nonsminomatous germ cell tumors. Mod Pathol. 2013;26(4):579-86.
- Groll RJ, Warde P, Jewett MAS. A comprehensive systematic review of testicular germ cell tumor surveillance. Crit Rev Oncol Hematol. 2007;64(3):182-97.
- Lobo J, Costa AL, Vilela-Sagueiro B, Rodrigues Â, Guimarães R, Cantante M, et al. Testicular germ cell tumors: revisiting a series in light of the new WHO classification and AJCC staging systems, focusing on challenges for pathologists. Hum Pathol. 2018;82:113-24.
- Verrill C, Yilmaz A, Srigley JR, Amin MB, Compérat E, Egevad L, et al. Reporting and staging of testicular germ cell tumors: The International Society of Urological Pathology (ISUP) testicular cancer consultation conference recommendations. Am J Surg Pathol. 2017;41(6):e22-32.
- Yilmaz A, Trpkov K. Hilar invasion in testicular germ cell tumors: a potential understaging pitfall. Mod Pathol. 2015;28(Supll):269A.
- Brimo F, Srigley JR, Ryan CJ, et al. Chapter 59: Testis. In: Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, et al. eds. AJCC cancer staging manual, 8th ed. Switzerland: Springer; 2017. p.727-35.
- Divrik RT, Akdoğan B, Ozen H, Zorlu F. Outcomes of surveillance protocol of clinical stage I nonseminomatous germ cell tumors-is shift to risk adapted policy justified? J Urol. 2006;176(4 Pt 1):1424-9.
- McCleskey BC, Epstein JI, Albany C, Hashemi-Sadraei N, Idrees MT, Jorns JM, et al. The significance of lymphovascular invasion of the spermatic cord in the absence of cord soft tissue invasion. Arch Pathol Lab Med. 2017;141(6):824-9.
- Gordetsky J, Sanfrancesco J, Epstein JI, Trevino K, Xu H, Osunkoya A, et al. Do nonseminomatous germ cell tumors of the testis with lymphovascular invasion of the spermatic cord merit staging as pT3? Am J Surg Pathol. 2017;41(10):1397-402.
- Tan IB, Ang KK, Ching BC, Mohan C, Toh CK, Tan MH. Testicular microlithiasis predicts concurrent testicular germ cell tumors and intratubular germ cell neoplasia of unclassified type in adults: a meta-analysis and systematic review. Cancer. 2010;116(19):4520-32.
- Sharma P, Dhillon J, Sexton WJ. Intratubular germ cell neoplasia of the testis, bilateral testicular cancer, and aberrant histologies. Urol Clin North Am. 2015;42(3):277-85.
- Martinelli CMDS, Lengert AVH, Cárcano FM, Silva ECA, Brait M, Lopes LF, et al. MGMT and CALCA promoter methylation are associated with poor prognosis in testicular germ cell tumor patients. Oncotarget. 2017;8(31):50608-17.
- Sanmamed MF, Esteban E, Uriol E, Zarate R, Capelan M, Muriel C, et al. Epidermal growth factor receptor and epididymis invasion as prognostic biomarkers in clinical stage I testicular germ cell tumours. J Transl Med. 2017;15(1):62.
- Chieffi P. An up-date on novel molecular targets in testicular germ cell tumors subtypes. Intractable Rare Dis Res. 2019;8(2):161-4.
Current Approach to the Prognostic Parameters of Testicular Germ Cell Tumors Accompanied by Our Cases
Abstract
Aim: Testicular germ cell tumors (TGCT) are solid neoplasms common in young adult men and an important cause of cancer-related deaths during this period. Revisions in histopathological classification and staging affect prognosis and treatment. The aim of this study was to analyze our TGCT cases, to review prognostic parameters, and their relationship between germ cell neoplasia in situ (GCNIS), intratubular and intertubular tumors.
Material and Methods: In this study, Hematoxylin&Eosin-stained sections of 77 TGCTs were re-evaluated. The presence of GCNIS, intratubular and intertubular germ cell tumors were recorded. Histopathological classification and staging were revised based on the changes in the 8th edition of American Joint Committee on Cancer (AJCC).
Results: The majority of the patients were diagnosed as seminoma (n=42), followed by mixed germ cell tumors (n=33) and spermatocytic tumors (n=2). Rete testis invasion in 30 cases, epididymal invasion in 6 cases, hilar soft tissue invasion in 10 cases, tunica vaginalis invasion in 1 case, spermatic cord invasion in 4 cases, and lymphovascular invasion in 22 cases were detected. Intertubular seminoma in 25 cases, intratubular carcinoma in 16 cases, and GCNIS in 73 cases were detected.
Conclusion: The major criteria to determine treatment choices are histopathological diagnosis, pathological tumor stage, serum tumor markers and presence of metastasis. According to AJCC 8th edition, addition of hilar soft tissue invasion to staging has increased the number of our pT2 cases. Moreover, assuming discontinuous tumor invasion of spermatic cord by vascular invasion as pM1 has also increased the number of metastatic testis tumors.
References
- Landero-Huerta DA, Vigueras-Villasenor RM, Yokoyama-Rebollar E, Arechaga-Ocampo E, Rojas-Castaneda JC, Jimenez-Trejo F, et al. Epigenetic and risk factors of testicular germ cell tumors: a brief review. Front Biosci (Landmark Ed). 2017;22 (7):1073-98.
- Greene MH, Kratz CP, Mai PL, Mueller C, Peters JA, Bratslavsky G, et al. Familial testicular germ cell tumors in adults: 2010 summary of genetic risk factors and clinical phenotype. Endocr Relat Cancer. 2010;17(2):R109-21.
- Ulbright TM. Recently described and clinically important entities in testis tumors: a selective review of changes incorporated into the 2016 classification of the World Health Organization. Arch Pathol Lab Med. 2019;143 (6):711-21.
- Moch H, Humphrey PA, Ulbright TM, Reuter VE. WHO classification of tumours of the urinary system and male genital organs, 4th ed. Geneva, Switzerland: WHO; 2016.
- Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, et al. AJCC cancer staging manual, 8th ed. Switzerland: Springer; 2017.
- Johnson K, Brunet B. Brain metastases as presenting feature in ‘burned out’ testicular germ cell tumor. Cureus. 2016;8(4):e551.
- Winter C, Albers P. Testicular germ cell tumors: pathogenesis, diagnosis and treatment. Nat Rev Endocrinol. 2011;7(1):43-53.
- Sheikine Y, Genega E, Melamed J, Lee P, Reuter VE, Ye H. Molecular genetics of testicular germ cell tumours. Am J Cancer Res. 2012;2(2):153-67.
- Hoei-Hansen CE, Rajpert-De Meyts E, Daugaard G, Skakkebaek NE. Carcinoma in situ testis, the progenitor of testicular germ cell tumours: a clinical review. Ann Oncol. 2005;16(6):863-8.
- Al-Hussain T, Bakshi N, Akhtar M. Intratubular germ cell neoplasia of the testis: a brief review. Adv Anat Pathol. 2015;22(3):202-12.
- Cierna Z, Mego M, Jurisica I, Machalekova K, Chovanec M, Miskovska V, et al. Fibrillin-1 (FBN-1) a new marker of germ cell neoplasia in situ. BMC Cancer. 2016;16(1):597.
- Chu YH, Huang W, Hu R. Exclusively intertubular seminoma arising in undescended testes: Report of two cases. Hum Pathol Case Reports. 2018;11:15-8.
- Henley JD, Young RH, Wade CL, Ulbright TM. Seminoma with exclusive intertubular growth: a report of 12 clinically and grossly inconspicuous tumors. Am J Surg Pathol. 2004;28 (9):1163-8.
- Yilmaz A, Cheng T, Zhang J, Trpkov K. Testicular hilum and vascular invasion predict advanced clinical stage in nonsminomatous germ cell tumors. Mod Pathol. 2013;26(4):579-86.
- Groll RJ, Warde P, Jewett MAS. A comprehensive systematic review of testicular germ cell tumor surveillance. Crit Rev Oncol Hematol. 2007;64(3):182-97.
- Lobo J, Costa AL, Vilela-Sagueiro B, Rodrigues Â, Guimarães R, Cantante M, et al. Testicular germ cell tumors: revisiting a series in light of the new WHO classification and AJCC staging systems, focusing on challenges for pathologists. Hum Pathol. 2018;82:113-24.
- Verrill C, Yilmaz A, Srigley JR, Amin MB, Compérat E, Egevad L, et al. Reporting and staging of testicular germ cell tumors: The International Society of Urological Pathology (ISUP) testicular cancer consultation conference recommendations. Am J Surg Pathol. 2017;41(6):e22-32.
- Yilmaz A, Trpkov K. Hilar invasion in testicular germ cell tumors: a potential understaging pitfall. Mod Pathol. 2015;28(Supll):269A.
- Brimo F, Srigley JR, Ryan CJ, et al. Chapter 59: Testis. In: Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, et al. eds. AJCC cancer staging manual, 8th ed. Switzerland: Springer; 2017. p.727-35.
- Divrik RT, Akdoğan B, Ozen H, Zorlu F. Outcomes of surveillance protocol of clinical stage I nonseminomatous germ cell tumors-is shift to risk adapted policy justified? J Urol. 2006;176(4 Pt 1):1424-9.
- McCleskey BC, Epstein JI, Albany C, Hashemi-Sadraei N, Idrees MT, Jorns JM, et al. The significance of lymphovascular invasion of the spermatic cord in the absence of cord soft tissue invasion. Arch Pathol Lab Med. 2017;141(6):824-9.
- Gordetsky J, Sanfrancesco J, Epstein JI, Trevino K, Xu H, Osunkoya A, et al. Do nonseminomatous germ cell tumors of the testis with lymphovascular invasion of the spermatic cord merit staging as pT3? Am J Surg Pathol. 2017;41(10):1397-402.
- Tan IB, Ang KK, Ching BC, Mohan C, Toh CK, Tan MH. Testicular microlithiasis predicts concurrent testicular germ cell tumors and intratubular germ cell neoplasia of unclassified type in adults: a meta-analysis and systematic review. Cancer. 2010;116(19):4520-32.
- Sharma P, Dhillon J, Sexton WJ. Intratubular germ cell neoplasia of the testis, bilateral testicular cancer, and aberrant histologies. Urol Clin North Am. 2015;42(3):277-85.
- Martinelli CMDS, Lengert AVH, Cárcano FM, Silva ECA, Brait M, Lopes LF, et al. MGMT and CALCA promoter methylation are associated with poor prognosis in testicular germ cell tumor patients. Oncotarget. 2017;8(31):50608-17.
- Sanmamed MF, Esteban E, Uriol E, Zarate R, Capelan M, Muriel C, et al. Epidermal growth factor receptor and epididymis invasion as prognostic biomarkers in clinical stage I testicular germ cell tumours. J Transl Med. 2017;15(1):62.
- Chieffi P. An up-date on novel molecular targets in testicular germ cell tumors subtypes. Intractable Rare Dis Res. 2019;8(2):161-4.
There are 27 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Research Article |
| Authors | |
| Publication Date | August 30, 2020 |
| Submission Date | April 28, 2020 |
| Published in Issue | Year 2020 Volume: 22 Issue: 2 |
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