Pathological Analysis of Testicular Germ Cell Tumor with Metastasis in Retroperitoneal Lymph Nodes
William P Tarrant, Bogdan A Czerniak, Charles C Guo. UT MD Anderson Cancer Center, Houston, TX
Background: Retroperitoneal lymph nodes are the most common metastatic site for testicular germ cell tumor (GCT). To understand the relationship between the primary GCT and metastasis, we compared the histopathologic features of GCT between orchiectomy and retroperitoneal lymph node dissection (RPLND) specimens.
Design: We retrospectively searched our surgical pathology files from 2002 to 2011 and identified 100 patients with testicular GCT who underwent RPLND for metastatic disease. The pathologic features of GCT in both orchiectomy and RPLND specimens were evaluated. Patients' demographic and clinical data were c ollected from medical records.
Results: The mean age of patients at initial diagnosis was 28 years (range, 15-58 years). The mean size of testicular tumors was 5.2 cm (range, 0.5-20.0 cm). The orchiectomy specimens showed mixed GCT (n=67), teratoma (n=21), seminoma (n=5), embryonal carcinoma (n=3), yolk sac tumor (n=1), and no viable tumor (n= 8). The components in the mixed GCTs included teratoma (n=56), embryonal carcinoma (n=50), yolk sac tumor (n=48), seminoma (n=21), and choriocarcinoma (n=11). In addition, somatic malignant components were found in 5 orchiectomy specimens. Most RPLND specimens showed extensive necrosis. The most common viable GCT component in the RPLND specimens was teratoma (n=90); in 21 of those cases, a teratomatous component was not observed in the corresponding orchiectomy specimen. Other viable GCT components included embryonal carcinoma (n=15), yolk sac tumor (n = 11), choriocarcinoma (n=1), and seminoma (n=1). Somatic malignant components were present in 5 RPLND specimens, but none of them had a somatic component in the corresponding orchiectomy specimens. Overall, 13 patients died of disease at a mean of 42 months (range, 7-263 months) after RPLND, and 87 were alive at a mean of 80 months (range, 5-269 months). While only 1 of the 5 patients with somatic components in the primary GCT died of disease, 3 of the 5 patients with somatic components in the metastasis died.
Conclusions: Teratoma was the most common viable GCT component in the RPLND specimens. Some patients had a teratomatous component only in the RPLND specimen but not in the orchiectomy specimen. Although this difference could be due to undersampling of the orchiectomy specimen, the metastatic teratomatous component may also result from transformation of other non-teratomatous GCT components. In addition, our limited study suggests that the presence of a somatic component in the RPLND metastasis may portend a worse prognosis than such a component in the testicular primary tumor.
Category: Genitourinary (including renal tumors)
Monday, March 19, 2012 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 146, Monday Morning