Testiküler Germ Hücreli Tümörlerin Prognostik Parametrelerine Olgularımız Eşliğinde Güncel Yaklaşım

Abstract

Amaç: Testiküler germ hücreli tümörler (TGHT), genç yetişkin erkeklerde sık görülen ve bu dönemdeki kanser ilişkili ölümlerin önemli bir sebebi olan solid neoplazmlardır. Histopatolojik sınıflandırma ve evrelemedeki değişiklikler, prognoz ve tedaviyi etkilemektedir. Bu çalışmanın amacı, TGHT tanısı almış olguların analizini yapmak, prognostik parametreleri ve bu parametrelerin insitu germ hücreli neoplazi (İGHN), intratubuler ve intertubuler tümörlerin varlığı ile ilişkilerini gözden geçirmektir.

Gereç ve Yöntemler: Bu çalışmada TGHT tanısı almış 77 olgunun Hematoksilen&Eozin boyalı preparatları yeniden değerlendirildi. İGHN, intratubuler ve intertubuler germ hücreli tümör varlığı kaydedildi. Amerikan Birleşik Kanser Komitesi (American Joint Committee on Cancer, AJCC) 8. basımındaki değişiklikler temel alınarak yeniden histopatolojik sınıflama ve evreleme yapıldı.

Bulgular: Olguların büyük çoğunluğu (n=42) seminom tanısı aldı, bunu mikst germ hücreli tümör (n=33) ve spermatositik tümör (n=2) izledi. Olguların 30’unda rete testis invazyonu, 6’sında epididim invazyonu, 10’unda hiler yumuşak doku invazyonu, 1’inde tunika vaginalis invazyonu, 4’ünde spermatik kord invazyonu ve 22’sinde ise lenfovasküler invazyon görüldü. İntertubuler seminom 25, intratubuler karsinom 16, İGHN ise 73 olguda saptandı.

Sonuç: Histopatolojik tanı, patolojik tümör evresi, serum tümör belirteçleri ve metastaz olup olmaması tedaviyi belirleyen başlıca kriterlerdir. AJCC 8. basıma göre, hiler yumuşak dokuya invazyonun evrelemeye eklenmesi ile pT2 olgularımız arttı. Ayrıca, spermatik kord içerisinde devamlılık göstermeksizin damar trombüsünden yumuşak doku invazyonun pM1 olarak kabul edilmesi de metastatik testis tümörlerinin sayısını artırmıştır.

Keywords

• İntratubuler
• intertubuler
• seminoma
• mikst germ hücreli tümör

Current Approach to the Prognostic Parameters of Testicular Germ Cell Tumors Accompanied by Our Cases

Abstract

Aim: Testicular germ cell tumors (TGCT) are solid neoplasms common in young adult men and an important cause of cancer-related deaths during this period. Revisions in histopathological classification and staging affect prognosis and treatment. The aim of this study was to analyze our TGCT cases, to review prognostic parameters, and their relationship between germ cell neoplasia in situ (GCNIS), intratubular and intertubular tumors.

Material and Methods: In this study, Hematoxylin&Eosin-stained sections of 77 TGCTs were re-evaluated. The presence of GCNIS, intratubular and intertubular germ cell tumors were recorded. Histopathological classification and staging were revised based on the changes in the 8th edition of American Joint Committee on Cancer (AJCC).

Results: The majority of the patients were diagnosed as seminoma (n=42), followed by mixed germ cell tumors (n=33) and spermatocytic tumors (n=2). Rete testis invasion in 30 cases, epididymal invasion in 6 cases, hilar soft tissue invasion in 10 cases, tunica vaginalis invasion in 1 case, spermatic cord invasion in 4 cases, and lymphovascular invasion in 22 cases were detected. Intertubular seminoma in 25 cases, intratubular carcinoma in 16 cases, and GCNIS in 73 cases were detected.

Conclusion: The major criteria to determine treatment choices are histopathological diagnosis, pathological tumor stage, serum tumor markers and presence of metastasis. According to AJCC 8th edition, addition of hilar soft tissue invasion to staging has increased the number of our pT2 cases. Moreover, assuming discontinuous tumor invasion of spermatic cord by vascular invasion as pM1 has also increased the number of metastatic testis tumors.

Keywords

• Intratubular
• intertubular
• seminoma
• mixed germ cell tumor

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