Impaired Spermatogenesis in Ipsilateral Testes with Germ Cell Tumors
Celina Villa, Bing Zhu, Robert E Brannigan, Jeremy T Choy, Stephen M Rohan, Ximing J Yang. Northwestern University, Chicago, IL
Background: Fertility preservation is a growing concern in patients with testicular germ cell tumors (GCT). A subset of patients presenting with azoospermia before chemotherapy may undergo testicular sperm extraction to preserve fertility. Little is known about the spermatogenesis status and histology of the background testicular tissue in patients with testicular GCT. We sought to investigate the histology of ipsilateral testicular tissue in patients with GCT to evaluate for features of infertility.
Design: Infertility features [spermatogenesis (SG), intratubular germ cell neoplasia (ITGCN), germ cell sloughing (GCS), leydig cell hyperplasia, chronic inflammation] were investigated near (≤0.5 cm) and distant (>0.5 cm) from GCT in orchiectomy specimens. SG was analyzed and graded based on the modified Johnsen score (SG intact: score 10, decreased: score 8-9, severely decreased: score 1-7). Additional features were graded as follows: ITGCN(present, absent); GCS(present, absent); leydig cell hyperplasia(0: < 10 leydig cells/cluster, 1: 10-25 cells/cluster, 2: 25-50 cells/cluster, 3: >50 cells/cluster); chronic inflammation(0: absent, 1: mild, 2: moderate, 3: severe). These features of infertility were compared between groups with pure seminomas and non- seminomas (pure embryonal, mixed GCT with and without seminoma), as well as areas near versus areas distant from tumor.
Results: 45 orchiectomy specimens were analyzed including 24 pure seminomas and 21 non-seminoma tumors. SG was impaired nearest the tumors compared with distant SG in all tumors (p<0.05) and pure seminomas (p<0.05). No significant difference in SG was observed when comparing seminomas and non-seminomas. ITGCN was present in 93% (24/25) of cases nearest and 47% (21/45) of cases distant to the tumor (p<0.05). GCS was more prevalent distant from the tumor than near the tumor [60% (27/45) and 47% (21/45), respectively (p=0.3)]. When comparing other features of infertility (leydig cell hyperplasia, chronic inflammation), there was no significant difference between tumor type and distance.
Conclusions: Significant impairment of ipsilateral SG is associated with GCT nearest the tumors compared with distant SG. SG appears not to be influenced by tumor type. ITGCN is significantly more frequent nearest the tumor; however, nearly half of cases distant from the tumor contain ITGCN. GCS is more prevalent away from versus near the tumor. Although SG may be intact in tissue distant from GCT, other features of infertility may be prevalent. These results may be helpful when considering testicular sperm extraction.
Category: Genitourinary (including renal tumors)
Monday, March 4, 2013 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 163, Monday Morning