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Assessment of intravascular granulomas in testicular seminomas and their association with tumour relapse and dissemination
  1. Michelle R Downes1,2,
  2. Carol C Cheung1,
  3. Melania Pintilie3,
  4. Peter Chung4,5,
  5. Theodorus H van der Kwast1
  1. 1Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
  2. 2Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  3. 3Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
  4. 4Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
  5. 5Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Michelle R Downes, Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, E417, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5; michelle.downes{at}


Aims First, to determine the frequency of intravascular granulomas (IVGs) in seminomas and assess for the presence of entrapped seminoma cells. Second, to identify the relationship of this unusual form of vascular space invasion with tumour relapse and/or dissemination.

Methods 86 cases of seminoma were reviewed to identify IVGs. Immunostaining for OCT3/4 and CD68 was performed. Pathological stage, presence of conventional vascular and rete testis invasion, parenchymal granulomas and follow-up were recorded. Multivariable analysis incorporating tumour size, vascular invasion (conventional granulomas and IVGs) and rete testis invasion was performed.

Results IVGs were identified in 13 cases (13/86). CD68 confirmed histiocytes in all cases. OCT3/4 identified tumour cells in 9/13 seminomas. 27 patients had disease progression with either dissemination at presentation (n=11) or relapse (n=16). Of these 27 patients, 8 had IVG (29.6%). By comparison, 6 of 57 clinical stage 1 seminomas that did not relapse had IVG (10.53%). Multivariable analysis revealed that no single parameter was statistically significant at predicting tumour relapse and/or dissemination (size: HR 1.65; CI 0.71 to 3.82, p=0.24, rete testis invasion: HR 1.04; CI 0.48 to 2.26, p=0.92, lymphovascular space invasion/IVG: HR 1.62; CI 0.65 to 4.01, p=0.30).

Conclusions IVGs may represent a previously unrecognised form of vascular space invasion in seminomas. Studies on larger cohorts are needed to demonstrate its clinical value.


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