Dieckmann K P, Loy V
Department of Urology, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, Germany.
APMIS. 1998 Jan;106(1):13-20; discussion 20-3. doi: 10.1111/j.1699-0463.1998.tb01315.x.
Testicular intraepithelial neoplasia (TIN; so-called carcinoma in situ of the testis), the precursor of testicular germ cell neoplasms can be detected by testicular biopsy many years before the clinical manifestation of the tumour. This study looked at the prevalence of contralateral TIN in patients with testicular germ cell cancer. The purpose was to evaluate this new approach of early detection of testicular cancer and to evaluate the current management strategies.
PATIENTS, METHODS: 1954 consecutive patients with unilateral testicular germ cell tumour underwent contralateral biopsy. All specimens were examined immunohistologically with staining for placental alkaline phosphatase. Patients with TIN were usually submitted to low-dose radiotherapy of the testis. A rebiopsy was performed after 3 months. Endocrinological evaluations were done before, during and after treatment.
TIN was observed in 4.9% (95% confidence intervals 3.95%-5.91%). Testicular atrophy constitutes a 4.3 fold increased risk of having contralateral TIN. 64% of the cases with TIN were found in clinically normal testes. Patients with TIN were significantly younger than those without (p < 0.017). No case with TIN was found in patients older than 50 years. Three patients developed a second testicular tumour during follow-up despite a negative biopsy. After radiotherapy, all of 23 patients had complete disappearance of TIN in the rebiopsy. After chemotherapy, 3 of 10 patients had persistent TIN histologically. After radiotherapy, 12 of 41 patients required testosterone replacement.
The prevalence of contralateral TIN accords well with the known prevalence of bilateral testicular tumours. Testicular atrophy is a strong indicator for the presence of TIN but about 60% of TIN-cases occur without atrophy. Local radiotherapy to the testis with 18-20 Gy is efficaceous in eradicating TIN, but it causes significant damage to almost one quarter of these patients. Chemotherapy is an unsafe treatment for TIN. This study shows the feasibility of early detection of testicular cancer in a high-risk population by means of searching for TIN. Although the management of the condition still needs refinement, the TIN-concept offers an avenue for the early detection of testicular cancer and early conservative management.
睾丸上皮内瘤变（TIN；即所谓的睾丸原位癌）是睾丸生殖细胞肿瘤的前驱病变，可在肿瘤临床表现出现多年前通过睾丸活检检测到。本研究观察了睾丸生殖细胞癌患者对侧TIN的患病率。目的是评估这种早期检测睾丸癌的新方法，并评估当前的管理策略。
1954例连续的单侧睾丸生殖细胞肿瘤患者接受了对侧活检。所有标本均进行免疫组织化学检查，检测胎盘碱性磷酸酶染色情况。TIN患者通常接受睾丸低剂量放疗。3个月后进行再次活检。在治疗前、治疗期间和治疗后进行内分泌评估。
TIN的患病率为4.9%（95%置信区间3.95%-5.91%）。睾丸萎缩使对侧出现TIN的风险增加4.3倍。64%的TIN病例在临床上正常的睾丸中被发现。TIN患者明显比无TIN患者年轻（p<0.017）。50岁以上患者未发现TIN病例。3例患者在随访期间尽管活检阴性仍发生了第二例睾丸肿瘤。放疗后，23例患者在再次活检时TIN完全消失。化疗后，10例患者中有3例组织学上仍有持续性TIN。放疗后，41例患者中有12例需要睾酮替代治疗。
对侧TIN的患病率与已知的双侧睾丸肿瘤患病率相符。睾丸萎缩是TIN存在的有力指标，但约60%的TIN病例在无萎缩的情况下发生。用18-20Gy对睾丸进行局部放疗对根除TIN有效，但几乎四分之一的患者会受到严重损害。化疗对TIN是一种不安全的治疗方法。本研究表明，通过寻找TIN在高危人群中早期检测睾丸癌是可行的。尽管该病的管理仍需完善，但TIN概念为早期检测睾丸癌和早期保守治疗提供了一条途径。
