Brandi C McCleskey, Jonathan I Epstein, Constantine Albany, Neda Hashemi-Sadraei, Muhammad T Idrees, Julie M Jorns, David Y Lu, Andres Matoso, Soroush Rais-Bahrami, Lauren E Schwartz, Thomas M Ulbright, Jennifer Gordetsky1. 1. From the Departments of Pathology (Drs McCleskey and Gordetsky), Urology (Drs Rais-Bahrami and Gordetsky), and Radiology (Dr Rais-Bahrami), University of Alabama, Birmingham; the Department of Pathology, University of Michigan, Ann Arbor (Dr Jorns); the Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles (Dr Lu); the Department of Pathology, Brown University, Providence, Rhode Island (Dr Matoso); the Department of Pathology, University of Pennsylvania, Philadelphia (Dr Schwartz); the Departments of Hematology/Oncology (Drs Albany and Hashemi-Sadraei) and Pathology (Drs Idrees and Ulbright), Indiana University School of Medicine, Indianapolis; and the Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland (Dr. Epstein).
Abstract
CONTEXT: - Testicular germ cell tumors with lymphovascular invasion (LVI) are staged pT2, and those with spermatic cord involvement are staged pT3. OBJECTIVE: - To study the clinical significance of LVI within the spermatic cord without direct involvement of the cord soft tissues. DESIGN: - A retrospective, multi-institutional review was performed on testicular GCTs with spermatic cord LVI in the absence of cord soft tissue invasion. RESULTS: - Forty-four germ cell tumors had LVI in the spermatic cord without soft tissue invasion; 37 of 44 patients (84%) had nonseminomatous germ cell tumors (NSGCT), and 7 (16%) had pure seminomas. Patients with NSGCTs and spermatic cord LVI had worse clinical outcomes compared with patients with pure seminoma and spermatic cord LVI (P = .008). We then compared patients with NSGCTs and spermatic cord LVI (n = 37) to patients with NSGCTs and LVI limited to the testis (n = 32). A significantly greater percentage of patients with LVI in the spermatic cord presented with advanced clinical stage (76% versus 50%; P = .01). There was no statistically significant difference in disease recurrence/progression or death between patients with spermatic cord LVI and patients with LVI limited to the testis (P = .40; P = .50). There was no significant difference in the presence of embryonal dominant histology (P = .30) or rete testis invasion (P = .50) between the 2 groups. More hilar soft tissue invasion was seen in patients with LVI present in the spermatic cord (P = .004). CONCLUSIONS: - In patients with NSGCTs, LVI in the spermatic cord, without soft tissue invasion, is associated with worse clinical stage at presentation compared with patients with LVI confined to the testis.
CONTEXT: - Testicular germ cell tumors with lymphovascular invasion (LVI) are staged pT2, and those with spermatic cord involvement are staged pT3. OBJECTIVE: - To study the clinical significance of LVI within the spermatic cord without direct involvement of the cord soft tissues. DESIGN: - A retrospective, multi-institutional review was performed on testicular GCTs with spermatic cord LVI in the absence of cord soft tissue invasion. RESULTS: - Forty-four germ cell tumors had LVI in the spermatic cord without soft tissue invasion; 37 of 44 patients (84%) had nonseminomatous germ cell tumors (NSGCT), and 7 (16%) had pure seminomas. Patients with NSGCTs and spermatic cord LVI had worse clinical outcomes compared with patients with pure seminoma and spermatic cord LVI (P = .008). We then compared patients with NSGCTs and spermatic cord LVI (n = 37) to patients with NSGCTs and LVI limited to the testis (n = 32). A significantly greater percentage of patients with LVI in the spermatic cord presented with advanced clinical stage (76% versus 50%; P = .01). There was no statistically significant difference in disease recurrence/progression or death between patients with spermatic cord LVI and patients with LVI limited to the testis (P = .40; P = .50). There was no significant difference in the presence of embryonal dominant histology (P = .30) or rete testis invasion (P = .50) between the 2 groups. More hilar soft tissue invasion was seen in patients with LVI present in the spermatic cord (P = .004). CONCLUSIONS: - In patients with NSGCTs, LVI in the spermatic cord, without soft tissue invasion, is associated with worse clinical stage at presentation compared with patients with LVI confined to the testis.