Jørgensen N, Müller J, Giwercman A, Skakkebaek N E
University Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark.
Cancer Surv. 1990;9(2):287-302.
Carcinoma in situ (CIS) of the testis is a preinvasive lesion that with time progresses into invasive germ cell tumour. CIS precedes all types of germ cell tumours except spermatocytic seminoma. An increased risk of harbouring CIS has been reported in men with a history of cryptorchidism, in contralateral testes of men previously treated for unilateral germ cell tumour, in intersex patients, in men with assumed extragonadal germ cell tumour and possibly in infertile men. CIS develops into invasive germ cell cancer in 50% of untreated patients within five years of diagnosis, and it is believed that with time CIS will progress into germ cell cancer in almost all patients. A testicular biopsy is necessary to diagnose CIS. Cells with the characteristics of CIS cells have been detected in seminal fluid, and it may be possible to develop methods for diagnosing the condition by analysis of the semen. We recommend orchidectomy as the treatment of choice in cases of unilateral CIS, if the other testis has a potential for fertility. In other cases, such as patients with testicular tumour and CIS of the contralateral testis, we recommend localized irradiation of the testis with CIS. Leydig cell function seems to be slightly impaired, but sufficient for sexual function, after irradiation. CIS cells show morphological and immunohistochemical similarities with primordial germ cells (gonocytes), whereas they share only few features with spermatogonia. Therefore, we suggest that CIS cells are malignant cells derived from gonocytes during embryonic development.
睾丸原位癌（CIS）是一种浸润前病变，随着时间的推移会发展为浸润性生殖细胞肿瘤。除精母细胞性精原细胞瘤外，CIS先于所有类型的生殖细胞肿瘤出现。据报道，隐睾病史的男性、既往接受过单侧生殖细胞肿瘤治疗的男性对侧睾丸、两性畸形患者、疑似性腺外生殖细胞肿瘤的男性以及可能的不育男性患CIS的风险增加。在未经治疗的患者中，50%在诊断后五年内CIS会发展为浸润性生殖细胞癌，并且据信随着时间的推移，几乎所有患者的CIS都会发展为生殖细胞癌。诊断CIS需要进行睾丸活检。精液中已检测到具有CIS细胞特征的细胞，通过精液分析可能开发出诊断该疾病的方法。如果对侧睾丸有生育潜力，我们建议对单侧CIS病例选择睾丸切除术作为治疗方法。在其他情况下，如患有睾丸肿瘤且对侧睾丸有CIS的患者，我们建议对有CIS的睾丸进行局部放疗。放疗后，睾丸间质细胞功能似乎略有受损，但对性功能来说足够。CIS细胞在形态学和免疫组化方面与原始生殖细胞（生殖母细胞）相似，而与精原细胞仅有很少的共同特征。因此，我们认为CIS细胞是胚胎发育过程中源自生殖母细胞的恶性细胞。
