Original contributionIntertubular growth in pure seminomas: associations with poor prognostic parameters
Introduction
Standard treatment of clinical stage I seminomas includes orchidectomy and external beam radiation. Because of their sensitivity to radiation, most seminomas have a good prognosis, irrespective of their presenting stage. Clinicians are now rethinking the standard treatment strategies for early stage disease especially because the risk of second malignancies in postradiation patients is a real concern, particularly given the early age of diagnosis in many of these patients [1].
Over the last 20 years, postorchidectomy surveillance programs have been introduced as an alternative treatment to adjuvant therapy for clinical stage I seminomas. Recently, a large randomized trial found, by multivariate analysis, that tumor size of more than 4 cm and rete testis invasion were the strongest predictors of relapse in patients with clinical stage I seminoma managed by surveillance only [2]. Seminomas are usually nodular and well circumscribed, facilitating gross measurement. Macroscopic measurement, akin to that in lobular carcinoma of the breast, may become more difficult especially when the pattern of invasion is more diffuse. An intertubular growth pattern, although often present at the periphery of a grossly discernable mass, can be identified microscopically away from the main mass. In this instance, the cells typically do not form a macroscopic mass, and therefore, it is difficult to give an accurate assessment of the true size of the tumor. This type of growth pattern, which we have called intertubular seminoma (ITS), may alter the estimated size of the mass and, when infiltrating in 3 dimensions, may represent a measure of tumor volume not usually noted in standard pathology reports. We set out to determine the incidence of ITS in pure seminomas and assess its associations with other prognostic parameters including rete testis involvement.
Section snippets
Methods
A retrospective computer search of the pathology records at the Brigham and Women's Hospital, Boston, Mass, from January 1988 to January 2003 identified 120 consecutive orchidectomy specimens that contained pure seminomas. All the hematoxylin and eosin slides from each case were reviewed to confirm the diagnosis. All the tumors were staged according to the American Joint Committee on Cancer pathological classification for testicular tumors (sixth edition) [3]. In addition, they were assessed
Results
We reviewed 120 cases of pure seminoma. The mean age of the patients was 35.1 years (age range, 20-68 years) and the average gross size of the tumors was 3.4 cm (size range, 1-9 cm). According to the American Joint Committee on Cancer pathological staging system (sixth addition) [3], 47.5% were T1, 41.5% were T2, and 11% were classified as T3 tumors. When looking at tumor size by stage, the 95% confidence interval for mean stage T1 was 2.57 (range, 2.167-2.966), stage T2 was 3.96 (range,
Discussion
Only a small percentage (10%-20%) of clinical stage I seminomas harbor occult retroperitoneal lymph node metastases [6], [7]. As a consequence, surveillance-only protocols were established a number of years ago as an alternative treatment strategy for clinical stage I seminomas. The reported relapse rates for patients managed by surveillance only range from 15% to 19% [2], [8], [9], [10], [11]. Numerous studies over the last number of years have addressed the question of stage I seminomas
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Cited by (20)
Neoplasms of the Testis
2020, Urologic Surgical PathologyExclusively intertubular seminoma arising in undescended testes: Report of two cases
2018, Human Pathology: Case ReportsCitation Excerpt :It remains controversial whether exclusively intertubular seminoma represents an early invasive phase and could later progress to the usual confluent pattern of seminoma if left untreated [11]. Previous findings in favor of this precursor assumption include the observations that interstitial tumor cell infiltration frequently occurred in the vicinity of overt seminoma nodules and in the contralateral testes of patients with macroscopically unilateral seminoma [12,13]. Of note, the presence of interstitial tumor cell infiltration alongside a main seminoma nodule has been associated with a higher likelihood of rete testis invasion [13], which is a significant predictor of inferior outcome for stage I seminoma [14].
Frequency and Markers of Precursor Lesions and Implications for the Pathogenesis of Testicular Germ Cell Tumors
2018, Clinical Genitourinary CancerCitation Excerpt :Two other testes (3%) with only TER had no precursor lesions. A systematic review and meta-analysis summarized the frequency of GCNIS, ITSE, and MGCT in all selected studies (Tables 4 and 5, and Figures 3-6).12-24 Combined, the previous studies and our study reported 1077 patients.
Update on testis tumours
2012, PathologyTesting testes: Problems and recent advances in the diagnosis of testicular tumours and implications for treatment
2012, Clinical OncologyCitation Excerpt :Involvement of the rete testis has been reported to present as either discontinuous pagetoid spread of seminoma within tubules [15] (Figure 1) or as inter-tubular spread within the parenchyma [16]. It is hypothesised that parenchymal infiltration of tumour is more significant as it represents not only true invasion of the rete, but also physically greater primary tumour volume [17]. At the moment, it should be correct practise to identify rete invasion and to subclassify it.