Lymphovascular invasion in testicular germ cell tumors: clinicopathological correlates

Abstract

IntroductionWe assessed clinical–pathological correlates of lymphovascular invasion in testicular germ–cell tumors.Material and methodsArchived pathology specimens from 145 patients treated by radical orchiectomy for testicular germ cell tumors at our institution in 1995–2006 were reanalyzed by a dedicated urologic pathologist, and the corresponding medical records were reviewed. The association of lymphovascular invasion with clinical and pathological parameters was tested using stepwise logistic regression analysis.ResultsLymphovascular invasion was identified in 38 (26%) patients and was associated with younger age, testicular pain at presentation, elevated serum tumor markers, nonseminoma histology, and advanced clinical stage. Orchalgia was indicated as the impetus for referral in 67 (46%) patients and characterized as a dull aching sensation, persistent or intermittent in nature. Among the 98 men diagnosed with clinical stage I, those presenting with testicular pain had a 1.8X–higher likelihood of lymphovascular invasion than those without pain (95% CI 1.13–14.9, p = 0.02), and patients with elevated serum tumor markers had an 8.5–fold increased probability of lymphovascular invasion than those presenting with normal tumor markers (CI 1.1–54.2, p = 0.05). Among men with nonseminoma histology, elevated tumor markers was the strongest predictor of lymphovascular invasion in both univariate and multivariate analyses (OR 5.05, 95% CI 1.16–21.8, p = 0.03).ConclusionProviding pathologists with information on pre–orchiectomy tumor marker levels and, possibly, testicular pain at presentation may increase their vigilance in searching for lymphovascular invasion, potentially improving their diagnostic accuracy. Whether it may also translate into improved oncological outcomes needs further evaluation.

Prediction of relapse in stage I testicular germ cell tumor patients on surveillance: investigation of biomarkers

“…Remarkably, elevation of HCG significantly associated with vascular invasion and it also significantly impacted relapse-free survival, even when adjusting for vascular invasion effect. It has been suggested that HCG elevations in testicular germ cell tumors (both seminomas and non-seminomas) positively regulate the vascular endothelial growth factor (VEGF), leading to vessel neoformation, which explains both the association with vascular invasion status and the poor prognostic value of this finding [47,48].…”

Precise pathological assessment plays a key role in proper patient management in non–seminoma germ cells tumor

“…Yossepowitch et al analyzed 145 patients with testicular germ cell tumors who had undergone radical orchiectomy [ 6 ]. Lymphovascular invasion was detected in 38 (26%) men and was significantly correlated with younger age, testicular pain at presentation, elevated pre–orchiectomy serum tumor markers, nonseminoma histology, and advanced clinical stage.…”