Neoplastic Testicular Pathology

  • Konstantinos Charitopoulos
  • Danai Daliani
  • Maria Gkotzamanidou
  • Andreas C. Lazaris
  • Argyris Siatelis
  • Vasileios Spapis
  • Nikolaos Spetsieris


A pathologic report for radical orchiectomy specimens with tumors should include the following information: serum tumor markers [alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), lactic acid dehydrogenase (LDH)], specimen laterality, tumor focality, tumor size, macroscopic extent of tumor, histologic type of tumor, margin status, microscopic tumor extension, lymph-vascular invasion, pTNM including S status, and additional pathologic findings [i.e., germ cell neoplasia in situ (GCNIS), atrophy]. As far as tumor sampling is concerned, 1 cm2 sections for every centimeter of maximum tumor diameter should be taken, including normal macroscopic parenchyma (if present), albuginea, and epididymis, the latter two with selection of suspected areas. The most important stain for testicular cancer histologic diagnosis is hematoxylin-eosin (H-E); immunohistochemistry is particularly useful in histologic typing of tumors with extensive necrosis, poor fixation, or ambiguous morphology as well as in metastatic tumors. In the microscopic examination of tumor specimens, the presence or absence of peritumoral venous and/or lymphatic vascular invasion should be carefully investigated and reported. It should be stressed that the diagnosis of choriocarcinoma requires the identification of mononucleated cytotrophoblastic cells. In stage 1 seminomas, the presence or absence of invasion of the rete testis should be reported. With regard to microscopic evaluation of tumors with mixed histology, the individual components should be specified, and their amount should be estimated as a percentage.

In experienced hands, guided fine needle cytology and/or core biopsy can be valuable tools for the morphological diagnosis of retroperitoneal and mediastinal manifestations of malignant germ cell tumors.

A pathologic report for retroperitoneal lymphadenectomy specimens should include the following data: pre-lymphadenectomy treatment, serum tumor markers, specimen site(s), number of nodal groups present, size of largest metastatic deposit in lymph node, histologic viability of tumor, histologic type of metastatic tumor, pN status, nonregional lymph node metastasis (M1a).


  1. Ahmed H, Arya M, Mushtaq I et al (2010) Testicular and paratesticular tumours in pre-pubertal population. Lancet Oncol 11:476–483CrossRefPubMedGoogle Scholar
  2. Al-Agha OM, Axiotis CA (2007) An indepth look at Leydig cell tumor of the testis. Arch Pathol Lab Med 131:311–317PubMedGoogle Scholar
  3. Alanee S, Shukla AR, Metcalf PD et al (2009) Paediatric testicular cancer: an updated review of incidence and conditional survival from the surveillance, epidemiology and end results database. Br J Urol Int 104:1280–1283CrossRefGoogle Scholar
  4. Albers P (2016) Testicular cancer. In: European Association of Urology Guidelines. European Association of Urology. Available via Accessed 24 Nov 2016
  5. Amin W, Parwani A (2009) Adenomatoid Tumor of Testis. Clin Med Pathol 2:17–22CrossRefPubMedPubMedCentralGoogle Scholar
  6. Amin MB (ed) (2010) Diagnostic Pathology. Genitourinary. AMIRSYS, Salt Lake CityGoogle Scholar
  7. Arndt CA, Stoner JA, Hawkins DS et al (2009) Vincristine, actinomycin, and cyclophosphamide compared with vincristine, actinomycin, and cyclophosphamide alternating with vincristine, topotecan, and cyclophosphamide for intermediate-risk rhabdomyosarcoma: children's oncology group study D9803. J Clin Oncol 27(31):5182–5188CrossRefPubMedPubMedCentralGoogle Scholar
  8. Bahrami A, Ro JY, Ayala AG (2007) An Overview of Testicular Germ Cell Tumors. Arch Pathol Lab Med 131(8):1267–1280PubMedGoogle Scholar
  9. Beck SD, Foster RS, Bihrle R et al (2007) Is full bilateral retroperitoneal lymph node dissection always necessary for postchemotherapy residual tumor? Cancer 110:1235–1240CrossRefPubMedGoogle Scholar
  10. Berkowitz GS, Lapinski RE, Dolgin SE et al (1993) Prevalence and natural history of cryptorchidism. Pediatrics 92:44PubMedGoogle Scholar
  11. Boden G, Gibb R (1951) Radiotherapy and testicular neoplasms. Lancet 2(6696):1195–1197CrossRefGoogle Scholar
  12. Bostwick DG, Chen L (eds) (2014) Urologic Surgical Pathology. MOSBY Elsevier, AmsterdamGoogle Scholar
  13. Carmignani L, Salvioni R, Gadda F et al (2006) Long-term follow-up and clinical characteristics of testicular Leydig cell tumor: experience with 24 cases. J Urol 176:2040–2043CrossRefPubMedGoogle Scholar
  14. Cerilli LA, Kuang W, Rogers D (2010) A practical approach to testicular biopsy interpretation for male infertility. Arch Pathol Lab Med 134:1197–1204PubMedGoogle Scholar
  15. Cortes D, Thorup JM, Visfeldt J (2001) Cryptorchidism: aspect of fertility and neoplasms. A study including data of 1335 consecutive boys who underwent testicular biopsy simultaneously with surgery for cryptorchidism. Horm Res 55:21–25PubMedGoogle Scholar
  16. Hadziselimovic F, Herzog B (2001) The importance of both and early orchidopexy and germ cell maturation for fertility. Lancet 358:1156–1157CrossRefPubMedGoogle Scholar
  17. International Germ Cell Cancer Collaborative Group Consensus Classification (1997) A prognostic factor-based staging system for metastatic germ cell cancers. International Germ Cell Cancer Collaborative Group. J Clin Oncol 15(2):594–603CrossRefGoogle Scholar
  18. Khan O, Protheroe A (2007) Testis Cancer. Postgrad Med J 83:624–632CrossRefPubMedPubMedCentralGoogle Scholar
  19. Moch H, Humphrey PA, Ulbright TM, Reuter VE (eds) (2016) WHO Classification of Tumours of the urinary System and Male Genital Organs. IARC, LyonGoogle Scholar
  20. NCCN Guidelines Version 2.2017 (2016) In: National Comprehensive Cancer Network, 1/11/2016. Available via Accessed 18 Nov 2016
  21. Nielsen OS, Munro AJ, Duncan W et al (1990) Is placental alkaline phosphatase (PLAP) a useful marker for seminoma? Eur J Cancer 26(10):1049–1054CrossRefPubMedGoogle Scholar
  22. Oldenburg J, Alfsen GC, Lien HH et al (2003) Postchemotherapy retroperitoneal surgery remains necessary in patients with nonseminomatous testicular cancer and minimal residual tumor masses. J Clin Oncol 21:3310–3317CrossRefPubMedGoogle Scholar
  23. Oldenburg J, Fosså SD, Nuver J et al (2013) Testicular seminoma and non-seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 24(Suppl 6):vi125–vi132CrossRefPubMedGoogle Scholar
  24. Pohl H, Shukla A, Metcalf P et al (2004) Pre-pubertal testis tumour: actual prevalence rate of histological types. J Urol 172:2370–2372CrossRefPubMedGoogle Scholar
  25. Presti JC (2013) Genital Tumors. In: McAninch J, Lue T (eds) Smith and Tanagho’s General Urology, 18th edn. McGraw-Hill, New York, pp 380–392Google Scholar
  26. Rabbani F, Goldenberg SL, Gleave ME et al (1998) Retroperitoneal lymphadenectomy for post-chemotherapy residual masses: is a modified dissection and resection of residual masses sufficient? Br J Urol 81:295–300CrossRefPubMedGoogle Scholar
  27. Saleh R, Mahfouz EZ, Agarwal A, Farouk H (2010) Ηistopathologic patterns of testicular biopsies in infertile azoospermic men with varicocele. Fertile Steril 94:2482–2485CrossRefGoogle Scholar
  28. SEER Cancer Statistics FactSheets (2016) Testis Cancer. National Cancer Institute. Bethesda, MD. Available via
  29. Siegel RL, Miller KD, Jemal A (2016) Cancer statistics. CA Cancer J Clin 66:7–30CrossRefPubMedPubMedCentralGoogle Scholar
  30. Silverberg E (1982) Cancer in young adults (ages 15–34). CA Cancer J Clin 32:32–42CrossRefPubMedGoogle Scholar
  31. Stephenson A, Gilligan T (2012) Neoplasms of the testis. In: Kavoussi L, Novick A, Partin A, Peters C (eds) Campbell-Walsh Urology, 10th edn. Saunders, Philadelphia, pp 837–867CrossRefGoogle Scholar
  32. Taskinen S, Fagerholm R, Aronniemi J et al (2008) Testicular tumors in children and adolescents. J Pediatr Urol 4:134–137CrossRefPubMedGoogle Scholar
  33. Taylor JG, Cheuk AT, Tsang PS et al (2009) Identification of FGFR4-activating mutations in human rhabdomyosarcomas that promote metastasis in xenotransplanted models. J Clin Invest 119(11):3395–3407PubMedGoogle Scholar
  34. Trussel JC, Lee PA (2004) The relationship of cryptorchidism to fertility. Curr Urol Rep 5:142–145CrossRefGoogle Scholar
  35. Williams SB, Han M, Jones R, Andrawis R (2004) Adenomatoid tumor of the testes. Urology 63(4):779–781CrossRefPubMedGoogle Scholar
  36. Wood DP Jr, Herr HW, Heller G et al (1992) Distribution of retroperitoneal metastases after chemotherapy in patients with nonseminomatous germ cell tumors. J Urol 148:1812–1815. discussion 1815-1816CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Konstantinos Charitopoulos
    • 1
  • Danai Daliani
    • 1
  • Maria Gkotzamanidou
    • 1
  • Andreas C. Lazaris
    • 1
  • Argyris Siatelis
    • 1
  • Vasileios Spapis
    • 1
  • Nikolaos Spetsieris
    • 1
  1. 1.AthensGreece

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