The role of the histopathologist in the management of testicular germ cell tumour in adults

Abstract

In the last 20--30 years the availability of effective chemotherapy and more accurate clinical staging has greatly improved the prognosis for patients with testicular germ cell tumours. Initially, such treatment appeared to diminish the role of histopathology to the distinction between seminoma and nonseminomatous germ cell tumour (NSGCT) in the primary specimen. However, histopathology has evolved as a prognostic tool indicating the risk of relapse in various defined clinical contexts thereby facilitating therapeutic decisions. The clinical emphasis has been on quality of life and reduction of therapy both in terms of the number of patients treated and the number of chemotherapy courses given to each patient. The treatment of adult testicular germ cell tumours may differ between countries but protocols are established. Therefore it is appropriate to discuss the role of histopathology during this era of relative therapeutic stability.

Frozen section assessment in testicular and paratesticular lesions suspicious for malignancy: its role in preventing unnecessary orchiectomy

“…Potential misinterpretation on FSA may result from the presence of squamous metaplasia in a hydrocele or inflammatory epididymal lesions inducing a diagnosis of teratoma and granulomatous changes in seminoma obscuring the tumor cells [13]. In addition to interpretation error, inadequate biopsy/sampling error and communication error could cause diagnostic inaccuracy.…”

Androgen insensitivity syndrome: Risk of malignancy and timing of surgery in a paediatric and adolescent population

“…Sertoli-Leydig hamartomas are well described as well in androgen insensitivity syndrome. [7] It is possible that in PAIS, the defects underlying this syndrome may develop from a broad spectrum of mutations and genetic mechanisms, sometimes not completely understood, suggesting the possibility that risk of malignancy in this particular entity may be higher than previously thought. It is very important to be aware of the findings associated with AIS, which may be undiagnosed and drastically change the fate of patients.…”

No Long-Term Increase in Sperm Aneuploidy Rates after Anticancer Therapy

“…Important improvements have recently been achieved in the management of these diseases. After radical orchidectomy, the adjuvant treatment for testicular cancer differs according to the tumor's histology (3)(4)(5)(6). Approximately 95% of malignant tumors arising in the testis are germ-cell tumors and are classified as seminomatous or nonseminomatous (7,8).…”