Houlgatte A, Fournier R, Camparo P, de la Taille A, Berlizot P, Houdelette P
Clinique d'Urologie, Hôpital d'Instruction des Armées du Val de Grâce, Paris.
Prog Urol. 1998 Dec;8(6):1039-42.
It is currently proposed to perform tumour enucleation in mono-orchid patients presenting with a small germ cell tumour, in order to preserve physiological endocrine function. However, this conservative surgery must be accompanied by treatment of any carcinoma in situ lesions present in the remaining testicular parenchyma.
The presence of carcinoma in situ was investigated in 35 patients with germ cell tumour of the testis on samples obtained from the presumably healthy pulp of the orchidectomy specimen, adjacent to and away from the tumour. Samples away from the tumour were performed according to principle of surgical testicular biopsy. Histological examination also concerned the tissue situated in contact with the tumour.
25 patients (74.22%) presented intratubular germ cell dysplasia in the testicular parenchyma presumed to be healthy. These lesions were always concomitantly observed on samples performed adjacent to and away from the tumour. It was observed more frequently in seminomas, but was also observed in other histological forms.
Because of the diffuse nature of carcinoma in situ in germ cell tumours of the testis, pulp samples adjacent to the tumour are sufficient to ensure the diagnosis during conservative surgery. Carcinoma in situ is currently treated by local radiotherapy.
目前建议对患有小的生殖细胞肿瘤的单睾患者进行肿瘤剜除术，以保留生理内分泌功能。然而，这种保守手术必须伴有对剩余睾丸实质中存在的任何原位癌病变的治疗。
对35例睾丸生殖细胞肿瘤患者进行研究，从睾丸切除标本中推测健康的髓质、肿瘤附近及远离肿瘤处获取样本，调查原位癌的存在情况。远离肿瘤的样本按照睾丸手术活检原则采集。组织学检查还涉及与肿瘤接触的组织。
25例患者（74.22%）在推测健康的睾丸实质中出现管内生殖细胞发育异常。这些病变在肿瘤附近及远离肿瘤处采集的样本中均有发现。在精原细胞瘤中更常见，但在其他组织学类型中也有发现。
由于睾丸生殖细胞肿瘤原位癌的弥漫性，肿瘤附近的髓质样本足以在保守手术期间确保诊断。目前原位癌采用局部放疗治疗。
