Carcinoma in Situin Testicular Biopsies from Men Presenting with Infertility

Abstract

This study concerns 2043 male partners of infertile marriages who underwent testicular biopsy in the 28 years from 1955 to 1982. In a review of the pathological material carcinoma in situ (CIS) was diagnosed in 8 men (0.39%). Six of these men were later found to have invasive germ cell tumours; one has remained tumour-free and one is lost to follow-up. The implication of these findings in relation to the selection of patients for biopsy and the treatment of CIS when diagnosed is discussed.

Oct4

“…Certain populations of individuals are at increased risk for the development of this precursor lesion, such as patients with cryptorchid testes (even afterorchiopexy; refs. 7,8), men with sperm counts of Ͻ20 million per mL and/or testicular volume Յ12 mL (27,28), patients with a history of germ cell tumors of the contralateral testicle (10), and patients with certain types of gonadal dysgenesis (e.g., 46XX/46XY; ref. 9) or the androgen insensitivity (testicular feminization) syndrome (29).…”

Epidemiological and Clinical Aspects of Carcinoma in situ of the Testis

“…Few retrospective data indi cate a somewhat increased risk of neoplasia among infertile men, with the frequency ranging from 0.4% in a British study [15] and 0.6% in a Swiss survey [36] to about 1% in a German [37] and a Danish report [38]. However, prospec tive studies, based on well-defined groups of infertile men are still lacking.…”

“…However, some anecdotal cases of tes ticular cancer preceded by a negative biopsy [14] demon strate that a surgical biopsy may fail to disclose CIS in very few cases. Since there is abundant evidence indicating that CIS is a congenital condition, the reason for this diagnostic failure is most probably that there was a limited extension of CIS with involvement of very few tubules [15,16]. Alter natively, a few cells may have been present in the biopsy but not recognised, and this source of error may be eliminated by performing immunohistochemical staining using an anti body against placental-like alkaline phosphatase (P1AP) or with some of the monoclonal antibodies M2A ( fig.…”

Risk Factors for Carcinoma in situ of the Contralateral Testis in Patients with Testicular Cancer

“…Since CIS of the testis progresses to tumour in the majority of cases [2,3,4] and its absence on biopsy virtually precludes tumour development [2], the value of testicular biopsy is considerable. As the procedure carries some morbidity there is a reluctance to perform a biopsy in every patient with testicular cancer.…”