Clinicopathological spectrum of testicular lesions over a five-year period in a tertiary hospital
Abstract
Objectives: To study the clinical pattern and histopathological features of testicular biopsies and orchiectomy specimens in patients presenting to a tertiary hospital.
Methods: A 5 year retrospective study was conducted in histopathology section of Department of Laboratory Medicine, ACH from January 2014 to December 2018 on testicular tissue specimens (biopsies and orchiectomies). The histopathological diagnosis was made based on light microscopy followed by special stains and immunohistochemistry wherever indicated.
Results: A total of 91 specimens were received in ACH during this 5 year period. The specimens comprised of cryptorchidism (16 cases), trauma (5 cases) , vascular lesions-testicular torsion (17 cases), inflammatory lesions (11 cases), Sertoli cell only syndrome (2 cases), spermatogenic arrest (3 cases), atrophy (3 cases), obstructive causes leading to infertility (3 cases), cyst (2 cases) , tumors (28 cases) and 1 was unremarkable .Inflammatory lesions were predominantly abscess (6 cases ), granulomatous orchitis (5 cases ).Tumors were classified into germ cell tumors –seminomas (10 cases), mixed germ cell tumors (9 cases) , teratomas (3 cases), embryonal carcinoma (2 cases), spermatocytic tumors (3 cases), Leydig cell tumor (1 case).
Conclusions: The present study revealed that testicular masses were predominantly neoplastic mostly malignant primarily seen in age group 21-30 years with seminomas constituting 35.7 % of all tumors. Testicular torsion leading to ischemic necrosis were also seen in a large number of cases. Testicular biopsies might help in determining etiology of infertility which could be cryptorchidism, spermatogenic arrest, Sertoli cell only syndrome, atrophy and post testicular obstruction.
Downloads
References
2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7-34. doi: 10.3322/caac.21551. Epub 2019 Jan 8.
3. Epstein JI. The lower urinary tract and male genital system. Robbins and Cotran Pathologic Basis of Diseases, 8th ED. Saunders, 2005.
4. Howlader N, Noone AM, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2016, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2016/, based on November 2018 SEER data submission, posted to the SEER web site, April 2019.
5. Gori S, Porrozzi S, Roila F, Gatta G, De Giorgi U, Marangolo M. Germ cell tumours of the testis. Crit Rev Oncol/Hematol. 2005;53(2):141-164. doi: 10.1016/j.critrevonc.2004.05.006.
6. Nistal M, Paniagua R. Testicular biopsy. Contemporary interpretation. Urol Clin North Am. 1999;26(3):555-593. doi:https://doi.org/10.1016/S0094-0143(05)70200-7.
7. Abomelha M. Adult testicular cancer: Two decades of Saudi national data. Urol Ann. 2017;9(4):305-309. doi: 10.4103/UA.UA_11_17.
8. Hanna N, Timmerman R, Foster R, Roth B, Einhom L, Nichols C. Epidemiology of testicular cancer. In: Bast RC, Gansler TS, Holland JF,editors. Holland‑Frei Cancer Medicine. 6th ed. Hamilton, ON: BC Decker;2003.
9. Ekbom A, Akre O. Increasing incidence of testicular cancer—birth cohort effects. Apmis. 1998;106(1‐6):225-231. doi: https://doi.org/10.1111/j.1699-0463.1998.tb01340.x.
10. Cancer Incidence among Nationals of the GCC States 1998‑2009, Gulf Center for Cancer Control and Prevention (GCCCP), King Faisal Specialist Hospital and Research Centre;2013. p. 26-31.
11. Znaor A, Lortet-Tieulent J, Jemal A, Bray F. International variations and trends in testicular cancer incidence and mortality. Eur Urol. 2014;65(6):1095-1106. doi: 10.1016/j.eururo.2013.11.004. Epub 2013 Nov 14.
12. McKenney JK. Testis and testicular adnexa. In: Goldblum, JR; Lamps, LW; McKenney, JK; Myers, JL, editors. Rosai and Ackermans surgical pathology. 11th ed. Mosby St. Louis, Missouri; 2017. p.1135-1174.
13. Bissada NK, el Senoussi M, Hanash KA, Hefty T, Morcos R. Testicular seminomas in Saudi Arabia: clinical characteristics, prognostic indicators, and recommendations for management. J Surg Oncol. 1986;33(2):136-139. doi: 10.1002/jso.2930330218.
14. el-Senoussi MA, Bissada NK, el-Akkad S, Bedikian AY, Morcos R, Bull C. Epidemiology and clinical characteristics of testicular tumors in Saudi Arabia: King Faisal Specialist Hospital and Research Centre experience. J Surg Oncol. 1987;35(1):39-41. doi: 10.1002/jso.2930350109.
15. Schmoll HJ, Souchon R, Krege S, Albers P, Beyer J, Kollmannsberger C, et al. European consensus on diagnosis and treatment of germ cell cancer: a report of the European Germ Cell Cancer Consensus Group (EGCCCG). Ann Oncol. 2004;15(9):1377-1399. doi: 10.1093/annonc/mdh301.
16. Moch H, Cubilla AL, Humphrey PA, Reuter VE, Ulbright TM. The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part A: Renal, Penile, and Testicular Tumours. Eur Urol. 2016;70(1):93-105. doi: 10.1016/j.eururo.2016.02.029. Epub 2016 Feb 28.
17. Rabadi S, Ayyat F, Milad M. Testicular cancer at Aramco Dhahran Health Center. Urol Ann. 2016;8(Suppl 1):S76-S77.
18. Darwiche F, Gomha MA, Al-Mousa R, Al-Oraifi I, Jad A, Khan I, et al. Testicular tumors: King Fahad Specialist Hospital, Dammam experience. Urol Ann. 2016;8(Suppl 1):S76-S77.
19. Barayan G, Farsi H, Nassir A, Salawi R, Saada H. Testicular cancer at KFSH&RC‑Jeddah, Saudi Arabia: Importance of clinical features. Urol Ann 2016;8(1):S76-S77.
20. Cope NJ, McCullagh P, Sarsfield PT. Tumour responding accessory cells in testicular seminoma: an immunohistochemical study. Histopathology. 1999;34(6):510-526. doi:10.1111/j.1365- 2559.1999.00683.x
21. Saudi Cancer Registry, Cancer Incidence Report Saudi Arabia. 2014. Available at https ://nhic. gov. sa/ eServices/Documents/2014.pdf
22. Carver BS. Testicular cancer. In: Gomella LG, editor. The 5‑Minute Urology Consult. 3rd ed. Philadelphia: Wolters Kluwer; 2015. p. 486‑511.
OAI - Open Archives Initiative
