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Annals of Oncology 14:1412-1418, 2003
© 2003 European Society for Medical Oncology

Original Paper

Testicular carcinoma in situ in patients with extragonadal germ-cell tumours: the clinical role of pretreatment biopsy

S. D. Fosså1,+, N. Aass2, A. Heilo3, G. Daugaard4, N. E. Skakkebæk5, A. E. Stenwig6, J. M. Nesland6, L. H. J. Looijenga7 and J. W. Oosterhuis7

Departments of 1 Clinical Research, 2 Oncology, 3 Radiology and 6 Pathology, The Norwegian Radium Hospital, Oslo, Norway; Departments of 4 Oncology and 5 Growth and Reproduction, Danish National Hospital, Copenhagen, Denmark; 7 Department of Pathology, Laboratory for Experimental Patho-Oncology, Erasmus MC, University Medical Center Rotterdam, Josephine Nefkens Institute, Rotterdam, The Netherlands

Received 12 March 2002; accepted 26 May 2003

Background:

The aim of this study was to determine the prevalence of testicular carcinoma in situ (CIS) in patients with a malignant extragonadal germ-cell tumour (EGGCT) and the incidence of metachronous invasive testicular cancer (TC) in relation to the pretreatment demonstration of CIS.

Patients and methods:

Sixty-eight patients with EGGCT (53 retroperitoneal, 15 mediastinal) had pre-chemotherapy histological assessment of one (13) or both (55) testicle(s). A total of 123 testicles were examined for the presence of CIS.

Results:

Testicular CIS was found in 21 patients (31%) (18 retroperitoneal EGGCT, three mediastinal EGGCT). Two patients had bilateral CIS. Five patients, four of them with proven pretreatment CIS, developed a metachronous TC. The 10-year invasive-free TC survival rate for all 68 patients was 88%, but only 65% for those with proven pretreatment CIS. The overall 10-year survival rate for all patients was 82%. CIS was demonstrated in seven of 48 trans-scrotal core biopsies, in 10 of 56 trans-scrotal surgical biopsies and in five of 11 orchiectomy specimens.

Conclusions:

Approximately one-third of patients with EGGCT present with testicular CIS, predominantly those with a retroperitoneal tumour. These patients have a considerable risk of metachronous TC development in spite of chemotherapy. The pretreatment demonstration of testicular CIS in patients with EGGCT gives the possibility of individualised counselling and safe follow-up, and is therefore highly recommended. The data are in agreement with a multi-site development of malignant germ-cell tumours, but do not exclude the possibility that the retroperitoneal EGGCTs in particular represent metastases from a burned-out TC.

Key words: extragonadal germ-cell malignancy, invasive testicular cancer, testicular carcinoma in situ


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