Carcinoma in situ in boys with cryptorchidism: when can it be detected?

OBJECTIVE

To investigate the possibility of a pre-invasive phase of adult germ cell tumours being detectable in childhood.

PATIENTS AND METHODS

Seventy testicular biopsies were examined which had been taken at orchidopexies from 57 patients aged 1 to 16 years during the period 1951-1973, and for whom follow-up data on cancers and deaths up to 1989 were available.

RESULTS

Malignant germ cell tumours had developed in three testes from which biopsies were available: a right-sided teratoma and left-sided mixed germ cell tumour in one patient and a left-sided teratoma in a second patient. Carcinoma in situ was seen in only one of the 70 biopsies. This biopsy was taken from a patient aged 16 years and preceded the appearance of a teratoma by 4 years. Carcinoma in situ was not seen in a biopsy of this testis carried out 11 years before tumour diagnosis. Carcinoma in situ was also not seen in a biopsy of the contralateral testis in this patient carried out 22 years before tumour diagnosis in the testis, nor was it observed in a biopsy 17 years before the development of malignancy in the second patient.

CONCLUSION

These findings bring into question the extent to which the appearance of testicular biopsies taken during childhood orchidopexy can exclude the development of a tumour in adult life. No evidence has been found in this study for histological pre-malignant changes occurring before the onset of puberty.