Morphology of testicular parenchyma adjacent to germ cell tumours. An interim report

Abstract

Oosterhuis JW, Kersemaekers AMF, Jacobsen GK, Timmer A, Steyerberg EW, Molier M, van Weeren PC, Stoop H, Looijenga LHJ. Morphology of testicular parenchyma adjacent to germ cell tumours. An interim report. APMIS 2003;111:32-42.A comparative morphological analysis of parenchyma adjacent to testicular germ cell tumours (TGCT) was performed in a series of 181 orchidectomy specimens: 86 with seminomas (Se), 72 with nonseminomatous germ cell tumours (NS) and 23 with combined tumours (CT, which have a Se and a NS component). The following morphological features were semiquantitatively scored: spermatogenesis (modified Johnsen score); amount of tubular atrophy; amount of carcinoma in situ (CIS); amount of intertubular tissue. Absence and presence was scored for the following features: lymphocytic infiltrate surrounding and invading CIS; intratubular seminoma (ISe); intratubular nonseminoma (INS); microlithiasis; diffuse and nodular hyperplasia of Leydig cells; angioinvasiveness; testicular angiopathy. Using non-parametric statistics these features were correlated with each other and with tumour type, tumour size and age of the patient. Se-patients presented at significantly higher age than NS-patients (36 vs 29 years, pΩ0.001). The age of patients with CT (32 years) was in between that of Se-and NS-patients. No correlation was found between patient age and tumour size. Parenchyma adjacent to Se, compared to parenchyma adjacent to NS had the following significant differences: a lower Johnsen score (5.6 vs 7.2, pΩ0.005); less frequent (85% vs 97% of specimens, pΩ0.016) and a lesser amount of CIS (26% vs 32% of tubules, pΩ0.015); more frequent peri-(80% vs 60% of specimens, pΩ0.001) and intratubular (68% vs 30% of specimens, pΩ0.001) lymphocytic infiltrates; more extensive tubular atrophy (36% vs 15% of tubules, pΩ0.001); and a larger area of intertubular tissue (42% vs 34% of parenchyma area, pΩ0.016). The pooled Se and CT had a significantly higher frequency of ISe than the NS (31% vs 17% of specimens, pΩ0.036). With one exception INS was only found adjacent to NS or CT, with a frequency of 16%, and 20% of the specimens, respectively. It was significantly associated with angio-invasiveness. In specimens lacking angio-invasion the frequency of INS was 6%. The correlation of INS with tumour size and patient age was studied in a series of 145 NS and CT (95 from the original series supplemented by 50 newer cases). In this series INS was significantly associated with smaller tumours and younger patients. Extensive tubular atrophy was significantly correlated with higher age, the diagnosis of Se, a low Johnsen score, and the presence of angiopathy. The more tubular atrophy, the less CIS (both in incidence and amount). Inversely, a higher Johnsen score is associated with smaller tumours, the diagnosis of NS or CT, a higher incidence and a larger amount of CIS, and little tubular atrophy. Tubules with mature spermatogenesis were found in 42% of the specimens regardless of tumour type. We conclude that ISe and INS are probably fr...

Malignant germ cell tumours in the elderly: a histopathological review of 50 cases in men aged 60 years or over

“…33,34 In one assessment of the stroma adjacent to testicular tumours, tubular atrophy was seen adjacent to 36% of seminomas and 15% of nonseminomas and the amount of atrophy was inversely Germ cell tumours in the elderly DM Berney et al correlated with the amount of IGCNU. 35 There was a strikingly low rate of IGCNU seen in association with these tumours in this series, and a correspondingly high rate of testicular atrophy, although only 17 tumours had sufficient seminiferous tubules to be reliably assessed. Two possible theories could explain this.…”

National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for Use of Tumor Markers in Testicular, Prostate, Colorectal, Breast, and Ovarian Cancers

“…Carcinoma in situ cells are found within the spermatogonial niche of the seminiferous tubule in the adult testis in close proximity to the Sertoli cells, the nursing cells of spermatogenesis (26 ). The carcinoma in situ cells can be detected in the adjacent parenchyma of most invasive tumors and are more frequently associated with NSGCTs than with seminomas (27 ). ITGCNU is considered to be the premalignant counterpart of an embryonic germ cell, most likely a primordial germ cell or gonocyte.…”

“…(3 ). 26,27 BACKGROUND About 95% of all malignant testicular tumors are of germ-cell origin; most of the rest are lymphomas, Leydig or Sertoli cell tumors, and mesotheliomas. Germ cell tumors of adolescents and adults are classified into 2 main types, seminomas and nonseminomatous germ cell cancers of the testis (NSGCT).…”

New insights into type II germ cell tumor pathogenesis based on studies of patients with various forms of disorders of sex development (DSD)

“…1972), sometimes referred to as intratubular germ cell neoplasia unclassified (Gondos et al, 1983) and testicular intraepithelial neoplasia (Loy et al, 1990). CIS cells are located at the basement membrane of the seminiferous tubules in close connection with the Sertoli cells in adult testis, and are often present in the adjacent parenchyma of invasive TGCTs (Jacobsen et al, 1981;Oosterhuis et al, 2003). In the male Caucasian population the incidence of CIS is similar to the lifetime risk of developing a TGCT and all patients with this lesion will eventually develop an invasive TGCT.…”