Rete Testis Invasion by Malignant Germ Cell Tumor and/or Intratubular Germ Cell Neoplasia: What Is the Significance of This Finding?
AP Vogt, AO Osunkoya. Emory University School of Medicine, Atlanta, GA
Background: Pathologic stage and post-surgical treatment guidelines of malignant germ cell tumors (MGCT), currently take into account angiolymphatic invasion (ALI), degree of extra testicular invasion and serum tumor marker levels. The significance of rete testis invasion by MGCT or intratubular germ cell neoplasia (IGCNU) however remains controversial.
Design: A search through the surgical pathology and expert consultation files at our institution from 2002 to 2009 was made for MGCT and IGCNU in orchiectomy specimens. Clinicopathologic data including rete testis status was obtained.
Results: 292 orchiectomy specimens were identified. 136 were associated with MGCT. Mean patient age was 33 yrs (range: 14-67 yrs). The mean greatest tumor dimension was 4.1 cm (range: 0.8-18 cm). 56 were pure seminoma (40%), 50 were non-seminomatous MGCT (35%) and 35 were MGCT including seminoma (25%). IGCNU was identified in 99 cases (70%). Pathologic stage at presentation was as follows: stage 1, 71 patients (50%); stage 2, 62 patients (45%); stage 3, 2 patients (1%) and indeterminate, 6 patients (4%). 78 patients had documented rete testis status: rete testis invasion, 41 (53%); no rete testis invasion, 37 (47%). ALI was present in 62 (44%) cases. Follow up information was available in 43 patients with known rete testis status. Mean follow up duration was 43 months (range: 3-65 months). 20 patients had rete testis invasion and 23 patients had no rete testis invasion. IGCNU was present in patients with rete testis invasion in 18 cases (90%), compared to only 13 cases (57%) in patients without rete testis invasion p=0.016. Serum markers were elevated in 10 (50%) patients with rete testis invasion compared to only 6 patients (26%) without rete testis invasion. The combination of rete testis invasion and ALI were present in 8 cases and were found to be associated with elevated serum tumor markers in 7 of the 8 (88%), compared to the combination of no invasion of the rete testis and ALI showing elevated serum tumor markers in 3 of 8 cases (38%). 7 patients (35%) with rete testis invasion developed metastatic disease and 11 patients (48%) without rete testis invasion developed metastatic disease.
Conclusions: Rete testis status should be documented in orchiectomy specimens with MGCT. IGCNU may be the only component of a MGCT involving the rete testis. In this series, elevated tumor markers were more likely associated with ALI and positive rete testis status. Positive rete testis status does not appear to be an independent predictor of patient outcome.
Category: Genitourinary (including renal tumors)
Monday, March 22, 2010 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 141, Monday Morning