Screening, Diagnostik und Therapie der testikulären intraepithelialen Neoplasie (TIN)

Heidenreich, Axel; Beckert, R; Vietsch, H. V.; Engelmann, U.

doi:10.1055/s-2008-1057795

Cited by 13 publications

(6 citation statements)

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“…However, the immunohistochemical findings of non‐reactivity to PLAP and 43‐9F in spermatocytic seminomas compared to the strong immunoreactivity of CIS, embryonal carcinoma and classical seminomas suggests a basic histogenetic difference between spermatocytic seminomas and other testicular germ cell tumours. It has been suggested and commonly accepted that the PLAP‐positive CIS cells are the common precursor of seminomatous as well as non‐seminomatous germ cell tumours ( Skakkebaek et al ., 1987 ; Heidenreich et al ., 1995 ). Spermatocytic seminomas and paediatric yolk sac tumours are thought not to derive from CIS since they have been the only tumours which have not been associated with CIS so far ( Müller et al ., 1987 ).…”

Section: Discussionmentioning

confidence: 99%

Immunohistochemical expression of monoclonal antibody 43‐9F in testicular germ cell tumours

Heidenreich

et al. 1998

Int J of Andrology

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The aim of this study was to evaluate the clinical utility of immunohistochemical staining of human testicular germ cell tumours with the monoclonal antibody 43-9F to distinguish embryonal carcinoma (EC) from other malignant germ cell components in order to facilitate pathohistological assessment of prognostic risk factors for metastatic disease in clinical stage I NSGCT. Archival, formalin-fixed, paraffin-embedded tissue blocks of 24 classical seminomas, 7 spermatocytic seminomas, and 20 non-seminomatous germ cell tumours were stained for 43-9F, AFP, hCG and PLAP expression. Immunohistochemical expression was graded using a semi-quantitative scoring system: 1+ = 0-25%, 2+ = 26-50%, 3+ = 51-75% and 4+ = 76-100%. Positive immunohistochemical staining for 43-9F was found in all embryonal carcinomas and yolk sac tumours (YST); staining intensity was not statistically different between the two tumours (3.8 +/- 1.2 vs. 3.1 +/- 0.9). Classical seminomas and seminomatous components of NSGCT stained positive in 13/24 cases (54%); staining intensity was weak to moderate (1.1 +/- 0.7) in all but two cases (4+). Spermatocytic seminomas demonstrated weak positive immunostaining in 2/7 cases (29%). Adjacent CIS was found in 33/54 (61.1%) of tumours and 24/33 (72.7%) of CIS cells exhibited a weak to moderate staining intensity (1.4 +/- 0.7). AFP expression was found in 93% of YST and in only 10% of EC; however, based on the focal staining pattern, adequate differentiation of YST and EC was not possible. Positive PLAP staining was observed in 75% of EC, 79% of seminomas and in 88% of CIS cells. We did not find 43-9F staining clinically useful to distinguish embryonal carcinoma from other germ cell tumour components such as yolk sac tumour. The detection rate of CIS by 43-9F immunohistochemical staining was low and combination of PLAP staining with light microscopy was even superior. Additionally, our study confirms the link between pre-invasive CIS and embryonal carcinoma and suggests the possible direct development of embryonal carcinoma from CIS.

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Section: Discussionmentioning

confidence: 99%

Immunohistochemical expression of monoclonal antibody 43‐9F in testicular germ cell tumours

Heidenreich

et al. 1998

Int J of Andrology

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“…Local testicular irradiation will result in the disappearance of all germ cells, with the patient becoming irreversibly infertile, as documented by a Sertoli‐cell only syndrome on histopathological analysis of a biopsy after irradiation [7–9]. Most proponents of immediate testicular radiation argue that the chance to achieve paternity is quite low anyway, so that radiation will not add significantly to the development of infertility [29].…”

Section: The Advantages and Disadvantages Of Routine Contralateral Bimentioning

confidence: 99%

“… Routine contralateral testicular biopsy offers early detection of testicular cancer. It is stated that a contralateral testis biopsy as a screening procedure might identify all patients at risk for metachronous testis cancer development [6–9]. Despite its high accuracy, the probability of a false‐negative biopsy is 0.5–1%[10,11] so that all patients who test negative for TIN still have to undergo regular follow‐up investigations for the early detection of locally recurrent disease.…”

Section: The Advantages and Disadvantages Of Routine Contralateral Bimentioning

confidence: 99%

“…All patients with testis cancer represent a high‐risk group for contralateral TIN and routine contralateral biopsy seems to be justified. Patients with unilateral TGCTs have a 25‐fold greater risk of developing metachronous contralateral testicular cancer [5,9,17]. Screening of the contralateral testicle in 600, 1954 and 1014 men with testicular cancer resulted in a 5.7%, 4.9% and 6.1% prevalence of TIN, respectively [5,8,9].…”

Section: The Advantages and Disadvantages Of Routine Contralateral Bimentioning

confidence: 99%

“…It is well accepted that carcinoma in situ or testicular intraepithelial neoplasia (TIN) represent the common precursor of all TGCT except spermatocytic seminoma [4]; 70% of all TIN will progress to an invasive GCT within 7 years if left untreated and followed by surveillance [5]. Because of the proposed diffuse lobular intratesticular spread of TIN clusters it was thought that contralateral TIN in patients with unilateral TGCT can be diagnosed by one testicular random biopsy [6–9]. If a contralateral biopsy is taken in all patients with testis cancer the incidence of TIN is 3.5–6%[6–8].…”

Section: Introductionmentioning

confidence: 99%

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Contralateral testicular biopsy in testis cancer: current concepts and controversies

Heidenreich

2009

BJU International

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Of all patients with unilateral testis cancer, ≈5% harbour testicular intraepithelial neoplasia (TIN) in their contralateral testicle that will progress into an invasive germ cell tumour over time. The accurate diagnosis of TIN by a random two‐site surgical testis biopsy and effective therapy by local radiation has led to the concept of a contralateral screening biopsy in all patients with testis cancer. However, screening and preventive treatment are only indicated if the therapeutic outcome of the screened population is improved, and the physiological function of the affected organ is not impaired. Based on a critical review of previous reports, some drawbacks of this policy have to be considered and question the routine indication for contralateral testis biopsy: (i) all TIN‐negative patients still have to undergo meticulous follow‐up for metachronous testis cancer due to a false negative biopsy rate of 0.5–1.0%; (ii) local radiation of TIN results in irreversible infertility due to eradication of spermatogenesis; (iii) local radiation of TIN results in an impairment of endocrine Leydig cell function in 25% of the patients; (iv) therapeutic outcome and prognosis will not be improved in irradiated patients as compared to patients on surveillance; (v) local tumour resection for the management of metachronous testicular cancer represents an effective and viable option. Current reports do not support the strategy of contralateral testis biopsy in all patients with unilateral testicular germ cell tumours. According to the recommendations of the European Germ Cell Cancer Consensus Group, a testis biopsy might be offered to high‐risk patients for contralateral TIN (testicular volume <12 mL, history of cryptorchidism, age <30 years).

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Maligne Hodentumoren

Albers¹,

Beyer²,

Claßen³

et al.

Uroonkologie

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Screening, Diagnostik und Therapie der testikulären intraepithelialen Neoplasie (TIN)

Cited by 13 publications

References 14 publications

Immunohistochemical expression of monoclonal antibody 43‐9F in testicular germ cell tumours

Immunohistochemical expression of monoclonal antibody 43‐9F in testicular germ cell tumours

Contralateral testicular biopsy in testis cancer: current concepts and controversies

Maligne Hodentumoren

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