Testicular Germ-Cell Tumors with Spermatic Cord Involvement: A Retrospective International Multi-Institutional Experience.

The 8th Edition of the American Joint Committee on Cancer (AJCC) Staging Manual designates discontinuous involvement of spermatic cord soft tissue by testicular germ cell tumors as a metastatic deposit. We conducted a retrospective international multi-institutional study to validate the current recommendations. Thirty-three (72%) nonseminomatous and 13 (28%) seminomatous testicular germ cell tumors were collected from 15 institutions in America, Europe, and Asia. Testicular tumor size ranged from 1.3 to 18.0 cm (mean: 6.1). Cases were classified as discontinuous involvement of spermatic cord soft tissue (n = 26), continuous cord involvement (n = 17), or cord lymphovascular invasion (n = 3). The mean follow-up was 39 months. Clinical stage for discontinuous involvement of spermatic cord soft-tissue patients was I (local disease) in 2/24 (8%), II (regional disease) in 6/24 (25%), and III (distant disease) in 16/24 (67%) cases; 16 (67%) patients presented with distant metastasis. Clinical stage for continuous cord involvement patients was I in 9/17 (53%), II in 4/17 (23%), and III in 4/17 (23%); 4 (23%) patients presented with distant metastasis. Disease progression was seen in 4 patients with discontinuous involvement of spermatic cord soft tissue and 5 with continuous cord-involvement (p = 0.699). When comparing discontinuous and continuous cord involvement, a significant difference was found in cord margin status (p = 0.044), spermatic cord tumor size (p = 0.016), lymph-node involvement (p = 0.037), distant metastasis (p = 0.010), individual clinical stage (p = 0.003), and nonadvanced vs. advanced disease (p = 0.003) at presentation. In multivariate analysis, after adjusting for age, histology, testicular tumor size, percent of embryonal carcinoma, lymphovascular invasion, and cord margin status, discontinuous involvement of spermatic cord soft tissue was significantly associated (p = 0.011) with advanced clinical stage at presentation. Our findings support the designation of metastatic disease for discontinuous involvement of spermatic cord soft tissue, as introduced by the 8th edition of the AJCC staging.

Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc. 2021 Sep 09 [Epub ahead of print]

Maria Del Carmen Rodriguez Pena, Sofia Canete-Portillo, Ali Amin, Manju Aron, Piergiuseppe Colombo, Roni Cox, Dilek Ertoy Baydar, Ivan Gallegos, Francesca Khani, Květoslava Michalova, Roberta Lucianò, Hiroshi Miyamoto, Adeboye O Osunkoya, Maria Rosaria Raspollini, Diego F Sánchez, Federico Scarfo, Jeffrey S So, Debra L Zynger, Shi Wei, George J Netto, Cristina Magi-Galluzzi

Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA., Department of Pathology, Brown University, Providence, RI, USA., Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA., Department of Pathology, IRCCS Humanitas Clinical and Research Center, Milan, Italy., Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA., Department of Pathology, Koc University School of Medicine, Istanbul, Turkey., Department of Pathology, Hospital Clinico, Universidad de Chile, Santiago, Chile., Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA., Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Pilsen, Czech Republic., Pathology Unit, IRCCS Ospedale San Raffaele, Milano, Italy., Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA., Departments of Pathology, Emory University, Atlanta, GA, USA., Histopathology and Molecular Diagnostics, University Hospital Careggi, Firenze, Italy., Department of Pathology, Instituto de Patología e Investigación, Asunción, Paraguay., Department of Pathology, St. Luke's Medical Center, Quezon City and Global City, Quezon City, Philippines., Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA. .

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