The Utility of Sampling the Testicular Cord Margin in Germ Cell Tumors.
Daniel Berney, Anna King, Sarah Williams, Isabelle Bisson. Barts and The London School of Medicine, Queen Mary, University of London, United Kingdom
Background: Sampling of the cord margin of orchidectomy specimens is performed routinely and considered an essential block. It has been recommended previously that it is sampled before incising the main tumour. However the incidence and type of tumor involvement of the testicular cord margin has not been assessed in a large series.
Design: The files of Barts and The London Hospital and The British Testicular Tumour Panel were examined for orchidectomy cases for germ cell tumors. Any case either suspicious or diagnostic of cord margin involvement was reviewed. The macroscopy was also reviewed to see if the cord appeared normal. Cases were examined for the type of tumour present and type of invasion (vascular or stromal) was identified. The presence or absence of vascular invasion from other blocks was also recorded.
Results: 1479 orchidectomy reports for germ cell tumor were examined. Forty-eight where cord margin involvement was either suspected or reported as present were reviewed. Cord margin involvement was confirmed in 29 cases (2.0%), including 7 seminomas and 22 non-seminomas. Twenty cases (1.3%) showed purely vascular invasion with no stromal invasion (4 seminomas and 16 non-seminomas). In all of these cases, vascular invasion was also identified adjacent to the tumour and in other sections of the cord. Eight cases (0.5%) showed both vascular and stromal invasion (2 seminomas and 6 non-seminomas) with a clear association between the 'plugged' tumour within the vessels and adjacent invasion of the vessel walls and fibro-adipose tissue. In all of these cases, the cord was reported as being macroscopically abnormal. One case showed purely stromal invasion in an undescended testis with clear macroscopic involvement of the margin.
Conclusions: The presence of tumor at the testicular cord margin is rare. The clinical relevance of cord margin involvement by intra-vascular tumour may be marginal as vascular invasion reported in the main specimen will lead to adjuvant therapy. Stromal invasion was not seen in any case with a macroscopically normal cord margin. In view of the highly favourable prognosis of germ cell tumors, even after lymph node metastasis, it is extremely unlikely that tumor at the cord margin is an independent prognostic factor. We suggest that assessment of the cord margin is of little importance for the staging and treatment of germ cell tumors. Sampling the cord margin prior to incision of the tumor is unnecessary and that if the cord is normal there may be no need to examine this routinely sampled margin at all.
Category: Genitourinary (including renal tumors)
Tuesday, March 1, 2011 1:00 PM
Poster Session IV # 86, Tuesday Afternoon