Novel Detection of Testicular Carcinoma In Situ in AgarCytos of Testicular Sperm Extraction Specimens Using OCT3/4 and PLAP
Marloes Hessel, Kathleen W D'Hauwers, Alexander F Hulsbergen, Didi D Braat, Liliana Ramos, Christina A Hulsbergen-van de Kaa. Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
Background: Infertile men have an increased risk of developing testicular cancer. Men with non-obstructive azoospermia (NOA) can be offered testicular sperm extraction (TESE) for diagnosis and fertility treatment. Carcinoma in situ (CIS) can be detected by immunohistochemistry in testicular biopsies and semen, using placental-like alkaline phosphatase (PLAP) and OCT3/4. The objective of this study is to assess, for the first time, the presence of CIS using these markers in remnants of TESE specimens.
Design: In this observational study, performed between January 2011 and April 2012, 183 males with NOA underwent a urological work-up followed by a diagnostic TESE. After cryopreservation of sperm, if present, an AgarCyto was made of the remnants of these biopsies (n=253). Sections were stained with hematoxylin-eosin as well as PLAP and OCT3/4 to detect CIS.
Results: Eight men (4.4%) were diagnosed with a (pre)malignancy. 6 with seminoma and 2 with CIS. Seven underwent orchidectomy and one irradiation. In 5/6 seminoma cases the ultrasound (US) was suspect for tumor, and 2 patients underwent immediate orchidectomy without ipsilateral TESE. In 4/4 patients TESE was diagnostic for CIS and in 1 case also for seminoma unsuspected on US. The two CIS cases were diagnosed by TESE and confirmed by histology or repeated TESE. In one case TESE was negative despite a suspect US, but orchidectomy revealed seminoma without CIS.
|Patient||TESE (n)||US R||US L||TESE R||TESE L||Histology R||Histology L|
|1||1||MC T||Normal||-||No CIS||CIS and seminoma||-|
|2||1||MC T||MC OT||CIS||No CIS||CIS and seminoma||Leydigcelltumor|
|3||1||LC T||Normal||No CIS||No CIS||Seminoma without CIS||-|
|4||1||MC T||T||CIS||CIS and seminoma||CIS and seminoma||CIS and seminoma|
|5||1||T VAR||VAR||-||No CIS||Seminoma||-|
|6||2||MC IH||CIS and seminoma(1,2)||CIS and seminoma|
|7||2||Normal||MC||CIS (2)||CIS (1,2)||CIS||CIS|
|8||2||-||-||CIS (1,2)||No CIS (1,2)||-||-|