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A pathologist's view on the testis biopsy.
J W Oosterhuis1, H Stoop, G Dohle
1Department of Pathology, Josephine Nefkens Institute, Erasmus University Medical Centre, Rotterdam, The Netherlands.
International Journal of Andrology
|July 28, 2011
Summary
Testicular biopsy aids surgeons in testis-sparing surgery and diagnoses carcinoma in situ (CIS) in select patients. Pathologists require expertise and specific markers for accurate CIS diagnosis, especially in cryptorchid testes.
Area of Science:
- Pathology
- Urology
- Oncology
Background:
- Testicular biopsies are crucial for diagnosing testicular germ cell tumors and related conditions.
- Current diagnostic methods for carcinoma in situ (CIS) in contralateral testes have limitations.
- Specialized expertise is needed for accurate interpretation of testicular biopsies.
Purpose of the Study:
- To evaluate the utility of direct enzyme-histochemical staining for alkaline phosphatase (dAP) in intraoperative frozen sections for testis-sparing surgery.
- To identify patient populations at higher risk for CIS in the contralateral testis, enabling targeted biopsies.
- To establish morphological and immunohistochemical criteria for diagnosing gonadal abnormalities in cryptorchid testes.
Main Methods:
- Direct enzyme-histochemical staining (dAP) on frozen sections.
- Risk factor analysis for CIS in contralateral testicular biopsies, including intratesticular microlithiasis.
- Immunohistochemistry for CIS markers (e.g., OCT3/4) and morphological assessment of cryptorchid testes.
Main Results:
- dAP staining is a valuable tool for surgeons during intraoperative assessment.
- A specific patient group with risk factors shows a ~25% CIS rate in contralateral biopsies.
- OCT3/4 marker can yield false-negative results with specific fixatives (Bouin's, Stieve's).
- Preliminary criteria for delayed gonocyte maturation and pre-CIS in cryptorchid infant/child biopsies were defined.
Conclusions:
- Intraoperative dAP staining aids testis-sparing surgery.
- Targeted contralateral biopsies are beneficial for specific high-risk patient groups.
- Accurate CIS diagnosis requires expertise and careful consideration of immunohistochemical markers and fixatives.
- Morphological and immunohistochemical analysis provides insights into gonadal development in cryptorchidism.
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