精索淋巴管侵犯在无精索软组织侵犯情况下的意义
The Significance of Lymphovascular Invasion of the Spermatic Cord in the Absence of Cord Soft Tissue Invasion.
作者信息
McCleskey Brandi C, Epstein Jonathan I, Albany Constantine, Hashemi-Sadraei Neda, Idrees Muhammad T, Jorns Julie M, Lu David Y, Matoso Andres, Rais-Bahrami Soroush, Schwartz Lauren E, Ulbright Thomas M, Gordetsky Jennifer
机构信息
From the Departments of Pathology (Drs McCleskey and Gordetsky), Urology (Drs Rais-Bahrami and Gordetsky), and Radiology (Dr Rais-Bahrami), University of Alabama, Birmingham; the Department of Pathology, University of Michigan, Ann Arbor (Dr Jorns); the Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles (Dr Lu); the Department of Pathology, Brown University, Providence, Rhode Island (Dr Matoso); the Department of Pathology, University of Pennsylvania, Philadelphia (Dr Schwartz); the Departments of Hematology/Oncology (Drs Albany and Hashemi-Sadraei) and Pathology (Drs Idrees and Ulbright), Indiana University School of Medicine, Indianapolis; and the Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland (Dr. Epstein).
出版信息
Arch Pathol Lab Med. 2017 Jun;141(6):824-829. doi: 10.5858/arpa.2016-0226-OA. Epub 2017 Mar 31.
CONTEXT
- Testicular germ cell tumors with lymphovascular invasion (LVI) are staged pT2, and those with spermatic cord involvement are staged pT3.
OBJECTIVE
- To study the clinical significance of LVI within the spermatic cord without direct involvement of the cord soft tissues.
DESIGN
- A retrospective, multi-institutional review was performed on testicular GCTs with spermatic cord LVI in the absence of cord soft tissue invasion.
RESULTS
- Forty-four germ cell tumors had LVI in the spermatic cord without soft tissue invasion; 37 of 44 patients (84%) had nonseminomatous germ cell tumors (NSGCT), and 7 (16%) had pure seminomas. Patients with NSGCTs and spermatic cord LVI had worse clinical outcomes compared with patients with pure seminoma and spermatic cord LVI (P = .008). We then compared patients with NSGCTs and spermatic cord LVI (n = 37) to patients with NSGCTs and LVI limited to the testis (n = 32). A significantly greater percentage of patients with LVI in the spermatic cord presented with advanced clinical stage (76% versus 50%; P = .01). There was no statistically significant difference in disease recurrence/progression or death between patients with spermatic cord LVI and patients with LVI limited to the testis (P = .40; P = .50). There was no significant difference in the presence of embryonal dominant histology (P = .30) or rete testis invasion (P = .50) between the 2 groups. More hilar soft tissue invasion was seen in patients with LVI present in the spermatic cord (P = .004).
CONCLUSIONS
- In patients with NSGCTs, LVI in the spermatic cord, without soft tissue invasion, is associated with worse clinical stage at presentation compared with patients with LVI confined to the testis.
背景
- 伴有淋巴管侵犯（LVI）的睾丸生殖细胞肿瘤分期为pT2，伴有精索受累的分期为pT3。
目的
- 研究精索内存在LVI但精索软组织未直接受累的临床意义。
设计
- 对精索存在LVI且无精索软组织侵犯的睾丸生殖细胞肿瘤进行了一项回顾性、多机构研究。
结果
- 44例生殖细胞肿瘤在精索内存在LVI但无软组织侵犯；44例患者中37例（84%）为非精原性生殖细胞肿瘤（NSGCT），7例（16%）为纯精原细胞瘤。与纯精原细胞瘤合并精索LVI的患者相比，NSGCT合并精索LVI的患者临床结局更差（P = 0.008）。然后，我们将NSGCT合并精索LVI的患者（n = 37）与NSGCT合并LVI局限于睾丸的患者（n = 32）进行比较。精索LVI的患者中临床晚期的比例显著更高（76%对50%；P = 0.01）。精索LVI患者与LVI局限于睾丸的患者在疾病复发/进展或死亡方面无统计学显著差异（P = 0.40；P = 0.50）。两组在胚胎性为主的组织学表现（P = 0.30）或睾丸网侵犯（P = 0.50）方面无显著差异。精索存在LVI的患者中可见更多的肾门软组织侵犯（P = 0.004）。
结论
- 在NSGCT患者中，与LVI局限于睾丸的患者相比，精索内存在LVI且无软组织侵犯与就诊时更差的临床分期相关。
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