Department of Pathology, IRCCS San Raffaele Hospital, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
Department of Pathology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
Virchows Arch. 2022 Nov;481(5):695-701. doi: 10.1007/s00428-022-03370-z. Epub 2022 Jul 1.
Pure seminomas represent the majority of testicular germ cell tumors and accurate diagnosis and staging require an accurate sampling of radical orchiectomy specimens. The aim of our study is to find the most informative gross sampling method for orchiectomy specimens. We performed the extensive sampling of 88 radical orchiectomy specimens embedding in their entirety testicular hilum, rete testis, hilar soft tissue, and spermatic cord. We examined the impact of this procedure on tumor stage, prognostic parameters (lymphovascular invasion and infiltration of rete testis, epididymis, tunica vaginalis, and spermatic cord), and their relationship with recurrence. Eighty-eight seminomas from 88 radical orchiectomies were sampled. Seventy-seven cases (87.5%) presented as clinical stage I and 11 cases (12.5%) as clinical stage II. The follow-up period range was 18-54 months and 82 patients (93.2%) had a minimum of 2-year follow-up. Tumor size ranged from 0.4 to 16 cm (mean 3.6) requiring a mean of 7.1 sections for entire tumoral sampling. Epididymis required 2 to 8 sections (mean 3.3), and hilum and hilar soft tissues 2 to 9 sections (mean 3.4). Epididymal infiltration and lymphovascular invasion resulted significant at multivariate analysis generating a receiver operating characteristic (ROC) curve with area under curve of 0.778. All the other parameters (except for pagetoid rete testis infiltration) were significant to predict metastasis only at univariate analysis. Extensive sampling of radical orchiectomy specimens does not improve the accuracy of staging in pure seminomas. Lymphovascular invasion and epididymal infiltration are useful to predict metastasis.
精原细胞瘤占睾丸生殖细胞肿瘤的大多数，准确的诊断和分期需要对根治性睾丸切除术标本进行准确的取样。我们的研究目的是找到对睾丸切除术标本进行最具信息量的大体取样方法。我们对 88 例根治性睾丸切除术标本进行了广泛取样，包括整个睾丸门、睾丸网、门软组织结构和精索。我们研究了这种方法对肿瘤分期、预后参数（血管淋巴管浸润和睾丸网、附睾、鞘膜和精索浸润）的影响，以及它们与复发的关系。从 88 例根治性睾丸切除术中共采集 88 例精原细胞瘤。77 例（87.5%）为临床 I 期，11 例（12.5%）为临床 II 期。随访时间范围为 18-54 个月，82 例患者（93.2%）至少随访 2 年。肿瘤大小从 0.4 到 16 厘米（平均 3.6 厘米），需要平均 7.1 个切片进行整个肿瘤取样。附睾需要 2 到 8 个切片（平均 3.3 个），睾丸门和门软组织结构需要 2 到 9 个切片（平均 3.4 个）。多变量分析显示附睾浸润和血管淋巴管浸润具有显著意义，产生的接收者操作特征（ROC）曲线的曲线下面积为 0.778。所有其他参数（除了派杰样睾丸网浸润外）仅在单变量分析中对预测转移具有显著意义。根治性睾丸切除术标本的广泛取样并不能提高纯精原细胞瘤分期的准确性。血管淋巴管浸润和附睾浸润有助于预测转移。
