CODE: 21 - Quick pathological assessment of testicular cancer. Preliminary report
Article published in Urologia Polska 2006/59/Suplement 1.

authors

Roman Sosnowski ¹, Iwona Skoneczna ¹, Bożena Sikora ¹, Agata Wlazło ¹, Marcin Ligaj ², Ewa Kraszewska ³, Tomasz Demkow ¹

¹ Klinika Nowotworów Układu Moczowego, Centrum Onkologii - Instytut w Warszawie
² Zakład Patologii, Centrum Onkologii - Instytut w Warszawie
³ Biuro Badań Klinicznych i Biostatystyki, Centrum Onkologii - Instytut w Warszawie

summary

Introduction. Due to high proliferate index and potential malignancy of testicular cancer chemotherapy should be started as quickly as possible. Final pathology examination is required for diagnosis of testicular cancer and starting chemotherapy.

Objectives. The aim of the study was to assess the correlation of intraoperative examination (frozen sections) with final pathology examination of the removed testis.

Materials and methods. 13 patients with testicular tumor (6 left-side, 7 right-side), median age 28 years (25 to 67 yrs), underwent inguinal orchiectomy. In 10 cases the level of biological tumor markers: AFP and beta-HCG were within the normal range. The abdominal CT scan was positive for retroperitoneal lymph nodes in 3/13 pts. After orchiectomy, the testis was by-sectioned longitudinally by pathologist and gross examination was performed, then samples were taken for frozen sections, routinely stained with H-E and impression cytology was taken. Final pathology result was obtained from wax fixed tissue specimens routinely stained with H-E.

Results. In 2 cases during intraoperative examination malignant cells were not seen, which was confirmed by final pathology. In 9/13 pts germinal testicular cancer cells were found, in 1 pt folliculoma and in 1 pt lymphoma cells. Final pathology result confirmed quick intraoperative assessment in all of the cases. (test Kappa = 1.0; p<0.001). Usually advanced testicular cancer is accompanied by significant rising of specific tumor markers (AFP, beta-HCG). In some cases the only elevated marker is LDH, which is highly non-specific and can be elevated also in lymphoma patients. The standard procedure in all cases of suspected testicular cancer is inguinal orchiectomy with subsequent pathological diagnosis (usual time of such a procedure is about 14 days). There is a need for a quick pathological diagnosis for those patients, enabling to start chemotherapy as soon as possible. We propose the intraoperative assessment based on impression cytology made out of frozen material, the time to make diagnosis is about 15 minutes for experienced pathologist.

Conclusions. In case of advanced germinal testicular cancer patients, immediate start of chemotherapy is essential, so quick assessment of tumor pathology is required. Frozen sections and impression cytology performed by experienced pathologist seems to be the promising and reliable diagnostic tool and requires future investigation.