Engeler D S, Hösli P O, John H, Bannwart F, Sulser T, Amin M B, Heitz P U, Hailemariam S
Institute of Clinical Pathology, Department of Pathology, University of Zurich, Switzerland.
Urology. 2000 Jul;56(1):144-8. doi: 10.1016/s0090-4295(00)00560-4.
To investigate the prepubertal prevalence of intratubular germ cell neoplasia of the unclassified type (ITGCNU) and its significance as a predictor of testicular cancer and to evaluate the effect of early orchiopexy (at younger than 2 years of age) on subsequent fertility of patients with bilateral cryptorchidism.
Testicular biopsies (n = 660) from 440 prepubertal patients with cryptorchidism who underwent orchiopexy between January 1, 1970 and December 31, 1979 were evaluated for ITGCNU using placental-like alkaline phosphatase (PLAP) antibody. The clinical outcome in 15 patients with PLAP-positive germ cells was evaluated in 1997. In addition, the effect of age at surgery on the fertility of patients with bilateral cryptorchidism was assessed by clinical follow-up until 1997 and was correlated with the histologic data at orchiopexy.
PLAP-positive germ cells morphologically identical with adult ITGCNU were found in the biopsies of 22 patients (5%). After more than two decades, none of the 15 patients with successful follow-up developed testicular cancer. The fertility outcome in the patients with bilateral cryptorchidism correlated with the number of spermatogonia at orchiopexy (P = 0.018), but correlated inversely with age at orchiopexy (P = 0.021).
PLAP-positive germ cells in prepubertal testicular biopsy specimens are not necessarily precursors of testicular cancer after orchiopexy. In addition, our data support the idea that early orchiopexy may be beneficial in preventing infertility.
研究青春期前未分类型管内生殖细胞瘤（ITGCNU）的患病率及其作为睾丸癌预测指标的意义，并评估早期睾丸固定术（2岁前）对双侧隐睾患者后续生育能力的影响。
对1970年1月1日至1979年12月31日期间接受睾丸固定术的440例青春期前隐睾患者的660份睾丸活检标本，使用胎盘样碱性磷酸酶（PLAP）抗体评估ITGCNU。1997年评估了15例PLAP阳性生殖细胞患者的临床结局。此外，通过临床随访至1997年评估手术年龄对双侧隐睾患者生育能力的影响，并将其与睾丸固定术时的组织学数据相关联。
在22例患者（5%）的活检标本中发现了形态上与成人ITGCNU相同的PLAP阳性生殖细胞。二十多年后，15例随访成功的患者均未发生睾丸癌。双侧隐睾患者的生育结局与睾丸固定术时精原细胞数量相关（P = 0.018），但与睾丸固定术时的年龄呈负相关（P = 0.021）。
青春期前睾丸活检标本中的PLAP阳性生殖细胞不一定是睾丸固定术后睾丸癌的前体。此外，我们的数据支持早期睾丸固定术可能有助于预防不育的观点。
