Testicular hilum and vascular invasion predict advanced clinical stage in nonseminomatous germ cell tumors

Abstract

Clinical staging is a critical step in the management of testicular germ cell tumors. Up to one-third of nonseminomatous germ cell tumors of the testis present with metastatic disease (clinical stages II and III). We investigated the predictors of metastatic disease at presentation in a cohort of 148 consecutive nonseminomatous germ cell tumors of the testis, over a 10-year period. The following clinical and pathologic features were evaluated: age, tumor size, dominant tumor histology, coagulative necrosis, vascular invasion, rete testis invasion and tumor extension into tunica vaginalis, hilar soft tissue, epididymis, or spermatic cord. Studied parameters were correlated with the clinical stage at presentation. Of the 148 patients with nonseminomatous germ cell tumors of the testis, 94 (63%) were clinical stage I, 26 (18%) were stage II, and 28 (19%) were stage III at presentation. Mean patient age was 31 years (range, 17-83). Mean tumor size was 4.1 cm (range, 0.6-19). On univariate analysis, the following parameters showed statistically significant association with the advanced clinical stage at presentation: vascular invasion (Po0.001), rete testis invasion (Po0.001), hilar soft tissue invasion (Po0.001), epididymis invasion (P ¼ 0.005), spermatic cord invasion (P ¼ 0.005), and coagulative necrosis (P ¼ 0.062). On multivariate analysis, only vascular invasion (P ¼ 0.011) and invasion into the rete testis and the hilar soft tissues (P ¼ 0.007 and P ¼ 0.017, respectively) demonstrated significant association with advanced clinical stage at presentation. We conclude that in addition to vascular invasion, tumor invasion into the hilum (rete testis or hilar soft tissue) is also strongly associated with metastatic disease at presentation and should be part of the routine pathology reporting.

Pathological risk factors for higher clinical stage in testicular seminomas

“…This was not true of the smaller cut‐off values of 2 and 3 cm, respectively. These findings differ from those described previously in non‐seminomatous germ cell tumours in the lack of support for hilar soft tissue, epididymal invasion, and rete testis invasion as prognostic risk factors, as well as the recently revised AJCC staging of germ cell tumours, which includes hilar soft tissue and epididymal invasion and a cut‐off size of 3 cm …”

What Is the Significance of Rete Testis Invasion by Malign Germ Cell Tumor and Does Hilum Predict Metastasis?

“…In the 15 patients, vascular invasion was found in 13 (86.6%) patient. Yilmaz et al [3] found that hilar soft tissues invasion is also strongly associated with metastatic disease in NS germ cell tumors [3]. In our study, 11 of 15 patients were NS germ cell tumors.…”

“…In our study, 11 of 15 patients were NS germ cell tumors. Although the majority of patients were NS germ cell tumors as in Yilmazs et al [3] There is no association between distant organ metastasis and hilar soft tissue involvement.…”

“…The importance of rete testis invasion is known for DOI: 10.1159/000500959 years in seminomatous germ cell tumors. But the significance of hilar soft tissue status as a predictor of metastatic disease is not clear in current literature [3]. Testicular hilum is composed of rete testis and extratesticular connective tissue [4].…”

Testicular Germ Cell Tumors

“…Currently, this tumor should be staged as pT1 or pT2 (depending on the absence or presence of lymphovascular invasion). However, it clearly represents extratesticular extension of the tumor and likely a higher risk of recurrence [281,282]. Other criticisms to the system include the disproportionate weight conferred to the invasion of the tunica vaginalis and the scrotum, which are relatively rare phenomena [282], and the lack of differentiation of the pattern of involvement of the spermatic cord, which may be involved by direct extension (Fig.…”