Browne Tara-Jane, Richie Jerome P, Gilligan Timothy D, Rubin Mark A
Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115, USA.
Hum Pathol. 2005 Jun;36(6):640-5. doi: 10.1016/j.humpath.2005.03.011.
Clinical stage I seminomas are effectively treated with surgery raising concerns as to when to give adjuvant radiation therapy given the risk of secondary malignancies. A recent randomized trial found tumor size and rete testis invasion to be the strongest predictors of relapse in clinical stage I seminomas. These 2 parameters may be surrogate measures of tumor volume. Intertubular seminoma (ITS) of the testis describes the presence of neoplastic germ cells within the interstitium of the testis. These cells are detected away from the main macroscopic mass. Because ITS can infiltrate in a 3-dimensional fashion, it may also represent a measure of tumor volume not usually noted in standard pathology reporting. The goal of this study was to determine the incidence of ITS in pure seminomas and its association with other prognostic parameters. One hundred twenty consecutive pure seminomas surgically removed between 1998 and 2003 were evaluated. ITS was defined as the presence of an interstitial or intertubular growth pattern of tumor cells, which was noncontiguous with the main tumor and present at least 3 high-power fields away from the tumor mass. The average tumor size was 3.4 cm. Of the entire cohort of patients, which included pathological stages T1 through T3, 11% had invasion through the tunica albuginea, 51% had rete testis invasion, 51% had lymphovascular invasion, 93% had associated intratubular germ-cell neoplasia, and 36% had ITS. ITS was significantly associated with rete testis invasion ( P = .001). Logistic regression analysis looking at ITS, tumor size, patient age, and lymphovascular invasion revealed that only ITS was associated with rete testis invasion (RR, 4.1, P < .0001). ITS is present in a significant proportion of pure seminomas and has a significant association with rete testis invasion. The presence of ITS may therefore be an important prognostic factor, not only because it alters the calculated size of the tumor but also because it has an association with rete testis invasion.
临床I期精原细胞瘤通过手术治疗效果良好，但鉴于继发恶性肿瘤的风险，何时给予辅助放疗引发了关注。最近一项随机试验发现，肿瘤大小和睾丸网浸润是临床I期精原细胞瘤复发的最强预测因素。这两个参数可能是肿瘤体积的替代指标。睾丸小管间精原细胞瘤（ITS）指的是在睾丸间质内存在肿瘤性生殖细胞。这些细胞在远离主要肉眼可见肿块处被检测到。由于ITS可以呈三维方式浸润，它也可能代表一种在标准病理报告中通常未被注意到的肿瘤体积指标。本研究的目的是确定纯精原细胞瘤中ITS的发生率及其与其他预后参数的关联。对1998年至2003年间连续手术切除的120例纯精原细胞瘤进行了评估。ITS被定义为肿瘤细胞呈间质或小管间生长模式，与主要肿瘤不连续且距肿瘤肿块至少3个高倍视野。平均肿瘤大小为3.4厘米。在包括病理分期T1至T3的整个患者队列中，11%有白膜侵犯，51%有睾丸网浸润，51%有淋巴管浸润，93%有相关的管内生殖细胞肿瘤，36%有ITS。ITS与睾丸网浸润显著相关（P = .001）。对ITS、肿瘤大小、患者年龄和淋巴管浸润进行逻辑回归分析显示，只有ITS与睾丸网浸润相关（相对风险，4.1，P < .0001）。ITS在相当比例的纯精原细胞瘤中存在，且与睾丸网浸润显著相关。因此，ITS的存在可能是一个重要的预后因素，不仅因为它改变了计算出的肿瘤大小，还因为它与睾丸网浸润有关。
