Biopsy Specimens

1. Inguinal exposure with testicular isolation and biopsy; Testicular biopsy is standard management in patients at high risk of ITGCN as it is thought to progress to invasive tumour in 50-100% of cases and therapy should be considered. It is also useful in the management of the contralateral testis in patients with germ cell tumours, approximately 5% of whom have ITGCN of the opposite testicle. A high incidence of ITGCN (35%) is found in young (< 30 years) patients where the contralateral testis is small (< 16 ml) and of poor quality (soft). These patients constitute a high risk group in whom it is appropriate to recommend biopsy at initial presentation. Biopsy should be 0.3-1.0 cm in maximum dimension and removed atraumatically without squeezing the tissue or handling it with forceps. Open biopsy is considered the normal procedure but needle biopsy may be adequate.

2. Transscrotal open or needle biopsy; rarely performed due to the presumed risk of wound seeding and lymphovascular spread to inguinal lymph nodes.

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