The International Society of Urological Pathology held a conference devoted to issues in testicular and penile pathology in Boston in March 2015, which included a presentation and discussion led by the testis microscopic features working group. This conference focused on controversies related to staging and reporting of testicular tumors and was preceded by an online survey of the International Society of Urological Pathology members. The survey results were used to initiate discussions, but decisions were made by expert consensus rather than voting. A number of recommendations emerged from the conference, including that lymphovascular invasion (LVI) should always be reported and no distinction need be made between lymphatic or blood invasion. If LVI is equivocal, then it should be regarded as negative to avoid triggering unnecessary therapy. LVI in the spermatic cord is considered as category pT2, not pT3, unless future studies provide contrary evidence. At the time of gross dissection, a block should be taken just superior to the epididymis to define the base of the spermatic cord, and direct invasion of tumor in this block indicates a category of pT3. Pagetoid involvement of the rete testis epithelium must be distinguished from rete testis stromal invasion, with only the latter being prognostically useful. Percentages of different tumor elements in mixed germ cell tumors should be reported. Although consensus was reached on many issues, there are still areas of practice that need further evidence on which to base firm recommendations.
The American journal of surgical pathology. 2017 Mar 31 [Epub ahead of print]
Clare Verrill, Asli Yilmaz, John R Srigley, Mahul B Amin, Eva Compérat, Lars Egevad, Thomas M Ulbright, Satish K Tickoo, Daniel M Berney, Jonathan I Epstein, Members of the International Society of Urological Pathology Testicular Tumour Panel
*Nuffield Department of Surgical Sciences, University of Oxford, Oxford ††Department of Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom †Department of Pathology and Laboratory Medicine, Calgary Laboratory Services and University of Calgary, Calgary, AB ‡Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada §Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Centre, Los Angeles, CA #Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN **Department of Pathology, Memorial Sloan Kettering Cancer Centre, New York, NY ‡‡Department of Pathology, John Hopkins Hospital, Baltimore, MD ∥Department of Pathology, Hopital Tenon, Assistance Publique - Hopitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France ¶Department of Pathology and Cytology, Karolinska Hospital, Stockholm, Sweden.