Background: The significance of hilar soft tissue invasion of rete testis in malign germ cell tumors is still controversial on current guidelines. Objectives: We aimed to investigate the importance of hilar soft tissue involvement in germ cell tumors and evaluated the possibility of a risk factor such as rete testis. Method: Totally, 59 radical orchiectomy specimens operated between 2007 and 2015 at our clinics. All records were retrospectively researched. Patients’ age, level of tumor markers, tumor size, histological subtype, clinical stage, presence or absence of carcinoma in situ, vascular/lymphatic and/or hilar soft tissue invasion, tumoral necrosis, number, site and diameter of metastasis, type of further treatment (radiotherapy or chemotheraphy) and follow-up period were recorded and evaluated for all patients. Results: Twenty-six of totally 59 malign germ cell tumors were seminomatous and 33 were nonseminomatous (NS). Mean patients age was 38.54 years (range 17–89 years). Mean follow-up duration was 39.84 months (range 3–96). Serum tumor marker levels were found associated with rete testis invasion (p = 0.035). Hilar soft tissue invasion was significantly associated with vascular invasion (p = 0.001). As it was expected, vascular invasion was significantly associated with metastasis (p = 0.024). Conclusions: We concluded that there is a strong association between hilar soft tissue invasion and vascular invasion. Especially in NS germ cell tumors, hilar soft tissue involvement a risk factor for prognosis and to determine the need for additional treatment. According to our study, hilar soft tissue status should be reported on routine pathology report.

Keywords:
Testicular cancer, Hilar soft tissue involvement, Vascular invasion, Nonseminoma
1.
Engholm G, Ferlay J, Christensen N, Bray F, Gjerstorff ML, Klint A, et al. NORDCAN–a Nordic tool for cancer information, planning, quality control and research.
Acta Oncol
. 2010 Jun;49(5):725–36.
2.
Ghazarian AA, Rusner C, Trabert B, Braunlin M, McGlynn KA, Stang A. Testicular cancer among US men aged 50 years and older.
Cancer Epidemiol
. 2018 Aug;55:68–72.
3.
Yilmaz A, Cheng T, Zhang J, Trpkov K. Testicular hilum and vascular invasion predict advanced clinical stage in nonseminomatous germ cell tumors.
Mod Pathol
. 2013 Apr;26(4):579–86.
4.
Dry SM, Renshaw AA. Extratesticular extension of germ cell tumors preferentially occurs at the hilum.
Am J Clin Pathol
. 1999 Apr;111(4):534–8.
5.
Murray MJ, Huddart RA, Coleman N. The present and future of serum diagnostic tests for testicular germ cell tumours.
Nat Rev Urol
. 2016 Dec;13(12):715–25.
6.
Sibert L, Rives N, Rey D, MacE B, Grise P. Semen cryopreservation after orchidectomy in men with testicular cancer.
BJU Int
. 1999 Dec;84(9):1038–42.
7.
Gilbert K, Nangia AK, Dupree JM, Smith JF, Mehta A. Fertility preservation for men with testicular cancer: is sperm cryopreservation cost effective in the era of assisted reproductive technology?
Urol Oncol
. 2018 Mar;36(3):92.e1–9.
8.
Moraveji SF, Esfandiari F, Sharbatoghli M, Taleahmad S, Nikeghbalian S, Shahverdi A, et al. Optimizing methods for human testicular tissue cryopreservation and spermatogonial stem cell isolation.
J Cell Biochem
. 2019 Jan;120(1):613–21.
9.
Robinson R, Tait CD, Clarke NW, Ramani VA. Is it safe to insert a testicular prosthesis at the time of radical orchidectomy for testis cancer: an audit of 904 men undergoing radical orchidectomy.
BJU Int
. 2016 Feb;117(2):249–52.
10.
Song G, Xiong GY, Fan Y, Huang C, Kang YM, Ji GJ, et al. The role of tumor size, ultrasonographic findings, and serum tumor markers in predicting the likelihood of malignant testicular histology.
Asian J Androl
. 2019 Mar-Apr;21(2):196–200.
11.
Dieckmann KP, Richter-Simonsen H, Kulejewski M, Ikogho R, Zecha H, Anheuser P, et al. Testicular Germ-Cell Tumours: A Descriptive Analysis of Clinical Characteristics at First Presentation.
Urol Int
. 2018;100(4):409–19.
12.
Bonet AS, Muñoz-Delgado EG, Vico FJ, Ruiz JC, Chapado MS. Analysis of clinical-pathologic variables, staging and prognostic groups, and therapeutic results of 106 germ-cell testicular tumors.
Arch Esp Urol
. 2011 Dec;64(10):972–80.
13.
Inci K, Dogan HS, Akdogan B, Ergen A, Tasar C, Ozen H. Does age affect the prognosis of patients with testicular germ cell tumor?
Urol Int
. 2007;79(2):117–23.
14.
Gordetsky J, Sanfrancesco J, Epstein JI, Trevino K, Xu H, Osunkoya A, et al. Do Nonseminomatous Germ Cell Tumors of the Testis With Lymphovascular Invasion of the Spermatic Cord Merit Staging as pT3?
Am J Surg Pathol
. 2017 Oct;41(10):1397–402.
15.
Berney DM, Looijenga LH, Idrees M, Oosterhuis JW, Rajpert-De Meyts E, Ulbright TM, et al. Germ cell neoplasia in situ (GCNIS): evolution of the current nomenclature for testicular pre-invasive germ cell malignancy.
Histopathology
. 2016 Jul;69(1):7–10.
16.
Verrill C, Yilmaz A, Srigley JR, Amin MB, Compérat E, Egevad L, et al.; Members of the International Society of Urological Pathology Testicular Tumor Panel. Reporting and Staging of Testicular Germ Cell Tumors: The International Society of Urological Pathology (ISUP) Testicular Cancer Consultation Conference Recommendations.
Am J Surg Pathol
. 2017 Jun;41(6):e22–32.
17.
Boormans JL, Mayor de Castro J, Marconi L, Yuan Y, Laguna Pes MP, Bokemeyer C, et al. Testicular Tumour Size and Rete Testis Invasion as Prognostic Factors for the Risk of Relapse of Clinical Stage I Seminoma Testis Patients Under Surveillance: a Systematic Review by the Testicular Cancer Guidelines Panel.
Eur Urol
. 2017 Nov;S0302-2838(17)30826-6.
18.
Trevino KE, Esmaeili-Shandiz A, Saeed O, Xu H, Ulbright TM, Idrees MT. Pathological risk factors for higher clinical stage in testicular seminomas.
Histopathology
. 2018 Nov;73(5):741–7.
19.
Ruf CG, Sachs S, Khalili-Harbi N, Isbarn H, Wagner W, Matthies C, et al. Prediction of metastatic status in non-seminomatous testicular cancer.
World J Urol
. 2014 Oct;32(5):1205–11.
20.
Verrill C, Perry-Keene J, Srigley JR, Zhou M, Humphrey PA, Lopez-Beltran A, et al.; Members of the ISUP Testicular Tumor Panel. Intraoperative Consultation and Macroscopic Handling: The International Society of Urological Pathology (ISUP) Testicular Cancer Consultation Conference Recommendations.
Am J Surg Pathol
. 2018 Jun;42(6):e33–43.
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2019
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