Multifocality in testicular germ cell tumors.

Area of Science:

• Uropathology
• Oncology
• Surgical Pathology

Background:

• Radical orchiectomy is standard for testicular germ cell tumors.
• Organ-sparing approaches are considered for bilateral tumors or solitary testes.
• Prevalence of multifocality in testicular germ cell tumors requires investigation.

Purpose of the Study:

• To determine the prevalence of multifocality in testicular germ cell tumor (TGCT) cases.
• To assess the pathological definition of multifocality in TGCT.
• To evaluate the association of multifocality with tumor characteristics.

Main Methods:

• Retrospective review of 145 orchiectomy specimens from 1995-2006.
• Pathological assessment of multifocality defined by distinct tumor foci, microinvasion, vascular invasion, or rete testis invasion.
• Correlation of multifocality with tumor size and histology.

Main Results:

• Multifocality was identified in 33% of patients (48/145).
• Specific findings included distinct foci (12%), microinvasive tumor (14%), vascular invasion (12%), and rete testis invasion (1.4%).
• Multifocality was more common in smaller tumors (≤2 cm, 63%) and seminomatous histology.

Conclusions:

• Multifocality is a frequent finding in testicular germ cell tumors.
• It is associated with smaller tumor size and seminomatous histology.
• Up to 63% of patients considered for organ-sparing surgery may have additional invasive tumor outside the primary mass.