scholarly journals Discrepancy in pathology reports upon second review of radical orchiectomy specimens for testicular germ cell tumors

2020 ◽  
Vol 14 (12) ◽  
Author(s):  
Gregory J. Nason ◽  
Joan Sweet ◽  
Lauren Landoni ◽  
Ricardo Leao ◽  
Lynn Anson-Cartwright ◽  
...  
Keyword(s):  
Germ Cell ◽  
Spermatic Cord ◽  
Tumor Staging ◽  
Germ Cell Tumors ◽  
Surgical Margin ◽  
Pathology Report ◽  
Histological Subtype ◽  
Testicular Germ Cell ◽  
Radical Orchiectomy ◽  
Pathology Review

Introduction: We sought to evaluate the discrepancies between primary pathology report and second pathology review of radical orchiectomy (RO) specimens. Methods: A retrospective review was performed of RO specimens from the Ontario Cancer Registry. All cases required both a primary pathology report and a second pathology review from another institution. Histopathological variables assessed included histological subtype and components of mixed germ cell tumor (GCT), pathological tumor (pT) stage, lymphovascular invasion (LVI), spermatic cord invasion, and surgical margin. Results: Between 1994 and 2015, 5048 ROs were performed with 2719 (53.9%) seminoma and 2029 (40.2%) non-seminoma. Of these, 519 (10.3%) received a second pathology review. There was concordance between primary pathology report and second pathology review in 326 (62.8%) cases. The most common discrepancies involved a change in pT stage (n=148, 28.5%), with upstaging in 83 (16%) and downstaging in 65 (12.5%) cases relative to the original pT stage. The second most common discrepancy regarded the reporting of LVI (n=121, 23.3%), with 62 (11.9%) reporting presence of LVI when the primary pathology report did not. Other discrepancies included a change in the histological subtype in 28 (5.4%) cases and spermatic cord margin status in 5 (9.6%) cases. Conclusions: Only 10% of orchiectomy specimens underwent a second pathology review, with nearly 40% of reviews leading to a meaningful change in parameters. Such variation could lead to incorrect tumor staging, estimate of relapse risk, and inappropriate treatment decisions. Expert pathology review of RO specimens should be considered, as it has significant implications for decision making.

Testicular Germ-Cell Tumors with Spermatic Cord Involvement: A Retrospective International Multi-Institutional Experience

2021 ◽  
Author(s):  
Maria Del Carmen Rodriguez Pena ◽  
Sofia Canete-Portillo ◽  
Ali Amin ◽  
Manju Aron ◽  
Piergiuseppe Colombo ◽  
...  
Keyword(s):  
Germ Cell ◽  
Spermatic Cord ◽  
Germ Cell Tumors ◽  
Testicular Germ Cell Tumors ◽  
Testicular Germ Cell ◽  
Institutional Experience

Discontinuous Involvement of Spermatic Cord Soft Tissue in Testicular Germ Cell Tumors: A Multi-Institution Experience

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S155-S156
Author(s):  
A Ali ◽  
J So ◽  
F Khani ◽  
M Kvetoslava ◽  
H Miyamoto ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Germ Cell ◽  
Tumor Size ◽  
Spermatic Cord ◽  
Statistical Significance ◽  
Germ Cell Tumors ◽  
Testicular Tumor ◽  
Distant Metastases ◽  
Testicular Germ Cell Tumors ◽  
Testicular Germ Cell

Abstract Introduction/Objective In the 8th Edition AJCC Cancer Staging Manual, discontinuous involvement of spermatic cord soft tissue (DISC) by testicular germ cell tumors (GCT) is regarded as metastatic deposit (pM1), placing the patient in clinical prognostic stage group (CPSG) III. We conducted a multi-institution study to corroborate or refute the current recommendations. Methods: Thirty-eight cases of GCT with spermatic cord involvement were collected from 13 institutions in Europe, Phillipines and America. Clinical and pathologic data was obtained. Results Tumors included 28 (73%) non-seminomatous and 10 (26%) seminomatous GCTs. Mean testicular tumor size was 6.6 cm (range 1.3-18). After review by an uropathologist, cases were classified as cord LVI [T2] (n=3), continuous cord involvement (CCI) [T3] (n=13), and DISC (n=22). Mean cord tumor size for DISC was 0.9 cm (range 0.1-4.5). CPSG was available for 33 and follow-up (FU) for22 patients with a mean length of FU of 38 months (range 2-144). Seven (39%) DISC patients were CPSG II (regional LN metastases), and 11 (61%) CPSG III (distant metastases). On FU, 5 (45%) DISC patients had no evidence of disease (NED); 6 (55%) were alive with disease (AWD). Three (25%) CCI patients were CPSG I (local disease), 6 (50%) CPSG II, and 3 (25%) CPSG III. On FU, 6 (60%) CCI patients were NED, 4 (40%) AWD. Cord LVI patients were one in each CPSG. One cord LVI patient was NED, the others were lost at FU. All DISC (100%) patients with available CPSG had advanced disease (CPSG II or III), compared to 75% of CCI, and 67% of cord LVI patients. Conclusion Although it did not reach statistical significance (p=0.054; Fisher’s exact test), DISC patients were more likely to have CPSG II and III compared to CCI patients. Our findings suggest a worse behavior in patients with DISC, supporting a higher pathologic stage than CCI.

scholarly journals The Significance of Lymphovascular Invasion of the Spermatic Cord in the Absence of Cord Soft Tissue Invasion

2017 ◽  
Vol 141 (6) ◽  
pp. 824-829 ◽  
Author(s):  
Brandi C. McCleskey ◽  
Jonathan I. Epstein ◽  
Constantine Albany ◽  
Neda Hashemi-Sadraei ◽  
Muhammad T. Idrees ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Germ Cell ◽  
Spermatic Cord ◽  
Lymphovascular Invasion ◽  
Soft Tissues ◽  
Clinical Stage ◽  
Germ Cell Tumors ◽  
Testicular Germ Cell ◽  
Tissue Invasion ◽  
Significant Difference

Context.— Testicular germ cell tumors with lymphovascular invasion (LVI) are staged pT2, and those with spermatic cord involvement are staged pT3. Objective.— To study the clinical significance of LVI within the spermatic cord without direct involvement of the cord soft tissues. Design.— A retrospective, multi-institutional review was performed on testicular GCTs with spermatic cord LVI in the absence of cord soft tissue invasion. Results.— Forty-four germ cell tumors had LVI in the spermatic cord without soft tissue invasion; 37 of 44 patients (84%) had nonseminomatous germ cell tumors (NSGCT), and 7 (16%) had pure seminomas. Patients with NSGCTs and spermatic cord LVI had worse clinical outcomes compared with patients with pure seminoma and spermatic cord LVI (P = .008). We then compared patients with NSGCTs and spermatic cord LVI (n = 37) to patients with NSGCTs and LVI limited to the testis (n = 32). A significantly greater percentage of patients with LVI in the spermatic cord presented with advanced clinical stage (76% versus 50%; P = .01). There was no statistically significant difference in disease recurrence/progression or death between patients with spermatic cord LVI and patients with LVI limited to the testis (P = .40; P = .50). There was no significant difference in the presence of embryonal dominant histology (P = .30) or rete testis invasion (P = .50) between the 2 groups. More hilar soft tissue invasion was seen in patients with LVI present in the spermatic cord (P = .004). Conclusions.— In patients with NSGCTs, LVI in the spermatic cord, without soft tissue invasion, is associated with worse clinical stage at presentation compared with patients with LVI confined to the testis.

The Significance of Spermatic Cord Involvement by Testicular Germ Cell Tumors

2018 ◽  
Vol 42 (3) ◽  
pp. 306-311 ◽  
Author(s):  
Joseph M. Sanfrancesco ◽  
Karen E. Trevino ◽  
Huiping Xu ◽  
Thomas M. Ulbright ◽  
Muhammad T. Idrees
Keyword(s):  
Germ Cell ◽  
Spermatic Cord ◽  
Germ Cell Tumors ◽  
Testicular Germ Cell Tumors ◽  
Testicular Germ Cell

PD19-08 DISCREPANCY IN PATHOLOGY REPORTS UPON SECOND REVIEW OF RADICAL ORCHIECTOMY SPECIMENS FOR TESTICULAR GERM CELL TUMORS

2020 ◽  
Vol 203 ◽  
pp. e385
Author(s):  
Gregory Nason* ◽  
Lauren Landoni ◽  
Spencer Mok ◽  
Lynn Anson-Cartwright ◽  
Padraig Warde ◽  
...  
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumors ◽  
Testicular Germ Cell Tumors ◽  
Testicular Germ Cell ◽  
Radical Orchiectomy ◽  
Pathology Reports

Serum Lactate Dehydrogenase Isoenzyme 1 and Relapse in Patients with Nonseminomatous Testicular Germ Cell Tumors Clinical Stage I

2001 ◽  
Vol 40 (4) ◽  
pp. 536-540 ◽  
Author(s):  
Finn Edler von Eyben ◽  
Ebbe Lindegaard Madsen ◽  
Ole Blaabjerg ◽  
Per Hyltoft Petersen ◽  
Hans von der Maase ◽  
...  
Keyword(s):  
Lactate Dehydrogenase ◽  
Germ Cell ◽  
Clinical Stage ◽  
Germ Cell Tumors ◽  
Serum Lactate ◽  
Stage I ◽  
Serum Lactate Dehydrogenase ◽  
Testicular Germ Cell Tumors ◽  
Testicular Germ Cell ◽  
Dehydrogenase Isoenzyme

Recent Advances in New Discovered Molecular Targets in Testicular Germ Cell Tumors

2018 ◽  
Vol 25 (5) ◽  
pp. 575-583 ◽  
Author(s):  
Paolo Chieffi
Keyword(s):  
Germ Cell ◽  
Primordial Germ Cells ◽  
Germ Cell Tumors ◽  
Molecular Targets ◽  
Testicular Germ Cell Tumor ◽  
Research Literature ◽  
Testicular Germ Cell ◽  
Solid Malignancy ◽  
Bibliographic Data ◽  
New Biomarkers

Background: Testicular germ cell tumor (TGCT) is the most common solid malignancy occurring in young men between 20 and 34 years of age, and its incidence has increased significantly over the last decades. TGCTs can be subdivided into seminoma and nonseminoma germ cell tumors (NSGCTs), which includes yolk sac tumor, choriocarcinoma, embryonal cell carcinoma, and teratoma. Seminomas and NSGCTs present significant differences in therapy, prognosis, and both show characteristics of the Primordial Germ Cells (PGCs). Methods: I undertook a search of bibliographic data from peer-reviewed research literature. Results: Seventy papers were included in the mini-review showing that a large number of new biomarkers have given further advantages to discriminate the different histotypes and could represent useful novel molecular targets for anticancer strategies. Conclusion: A deeper understanding of the pathogenesis of TGCTs is likely to significantly improve not only our knowledge on stem cells and oncogenesis but also the disease management with more selective tumor treatment.

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