Staging and classification of testicular tumours: pitfalls from macroscopy to diagnosis

The accurate assessment of testicular tumours is vital for appropriate treatment to be instituted. The assessment begins at specimen receipt, as careful macroscopic examination is vital for staging, and this, in part, determines whether adjuvant treatment is given. More challenging specimens may include partial orchidectomies, biopsies and resection of lymph node or visceral metastases. Accurate histological typing is also a potential source of error as two classifications are in use, and this may lead to misunderstanding between clinician and pathologist. A specialist and multidisciplinary approach is advocated. Microscopic staging includes assessment of vascular invasion which may be complicated by artifactual spread at the dissecting bench, local invasion, assessment of the cord and occasionally lymph node deposits. From careful macroscopic examination, to accurate histological typing and reporting of adverse pathological parameters, the pathologist plays a major role in the successful treatment of a group of rare, but largely treatable, tumours.