Extent Of Local Tumour Spread

Border: pushing/infiltrative. Lymphocytic reaction: prominent/sparse.

Lymphocytic reaction is a consistent (80%) feature of seminoma, and granulomas can also be present in up to 50% of cases. Sometimes the inflammatory infiltrate can be so intense that it partially obscures the germ cells and immunohistochemical markers are necessary. The intensity of inflammation and presence of granulomas are not prognostically significant.

ITGCN/carcinoma in situ: sample the adjacent testis.

Intratubular spread: seminoma/embryonal carcinoma.

It can be difficult to distinguish between ITGCN and intratubular spread, although in embryonal carcinoma ITGCN will be PLAP/CD117 positive and intratubular spread PLAP negative/CD30 positive. Intratubu-lar embryonal carcinoma has been suggested as an intermediate step between ITGCN and established embryonal carcinoma. Intratubular spread of seminoma and ITGCN into the rete can also mimic embryonal carcinoma or carcinoma of the rete.

Rete: Pagetoid or luminal spread—seminoma/embryonal carcinoma. Extratesticular extension of germ cell tumours is commoner at the rete/hilum.

Tunica albuginea/vaginalis, epididymis, spermatic cord.

The TNM classification applies to germ cell tumours of the testis.

pTis ITGCN (carcinoma in situ)

pT1 tumour involves testis and epididymis or tunica albuginea, no lymphovascular invasion or involvement of tunica vaginalis pT2 tumour involves testis and epididymis with lymphovascular invasion, or extends through tunica albuginea to involve tunica vaginalis

pT4 = into scrotum ± vascular/ lymphatic invasion pT3 = into spermatic cord ± vascular/lymphatic invasion

Figure 33.1. Testicular germ cell tumours. |QÂ|

pT3 tumour involves spermatic cord ± lymphovascular invasion pT4 tumour involves scrotum ± lymphovascular invasion.

In mixed germ cell tumours the pT classification is determined by the highest stage of its components. Synchronous bilateral tumours are staged as independent primary tumours.

Invasion beyond tunica albuginea involves scrotal structures except scrotal skin or subcutaneous tissues (both pT4).

Invasion of the spermatic cord refers to direct extension beyond the rete or epididymis.

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