Histological diagnosis and the levels of tumor markers in relation to clinical stages of testicular germ cell tumors
Article published in Urologia Polska 2008/61/Supl. 1.

authors

Elżbieta Oszukowska, Waldemar Różański, Magdalena Jakubiak-Wielganowicz, Marek Sosnowski, Radzisław Kordek, Krzysztof Kula

Katedra Andrologii i Endokrynologii Płodności UM w Łodzi
II Klinika Urologii UM w Łodzi
Zakład Patologii UM w Łodzi

summary

Introduction.

Testicular tumors are the most frequently found malignancies among men aged 20 to 40 year. 95% of them originate from germ cells (TGCT – testicular germ cell tumor). GCT may be classified into seminoma (SEM), nonseminoma (NSGCT) and mixed tumors (MIX).

Objectives.

The aim of the study was to relate histological type of TGCT to the clinical stage, blood levels of tumor markers among patients treated because of TGCT in the II Clinic of Urology of Medical University of Łódź between 2001-2006.

Materials and methods.

The medical history of 80 men after radical orchiectomy were retrospectively reviewed. The histological type of TGCT, tumour diameter, presence of vascular invasion, pathological stage (pT) as well as AFP and β - hCG blood levels before orchiectomy were analyzed. The incidence of retroperitoneal lymph node enlargement and metastases were estimated in additional imaging tests. TNM classification according to UICC was used. Statistical analysis was made using software STATISTICA 7.0.

Results.

Operated men were 15 to 70 years old. TGCT were diagnosed in 71 gonads. NSGCT was found in 32 (45.1%), SEM in 29 (40.8%) and MIX in 10 (14.1%) cases. The youngest were patients with NSGCT (15-50 y., average 26.2 ±8.8 y.) and MIX (21-40 y., av. 28.4 ±5.5 y.) than with SEM (24-52 y., av. 36 ±8.5 y., p<0.05). Average tumor diameter did not differ among groups, but tumors larger than 5 cm were found in 42%, 40% and 17.8 % of men with NSGCT, MIX and SEM, respectively. TGCT filled whole testis most frequently in NSGCT (56%). In NSGCT the incidence of vascular invasion (43.8 %, p<0.05) and involvement of neighboring structures (43.8 %, p<0.05) were significantly higher vs. SEM (37.9% and 13.7%, respectively). Incidence of pT2 stage was significantly higher in NSGCT (50%, p<0.05) and MIX (50%, p<0.05) than in SEM (17.2%). Ca. embryonale

was present in 84.4% of NSGCT and 70% of MIX. The positive significant correlation among AFP levels and the tumor diameter containing ca. embryonale was found in patients without an enlargement of retroperitoneal lymph node and metastases (R= 0.56, p<0.001). The incidence of enlarged retroperitonel lymph nodes was significantly higher in NSGCT (50%, p<0,05) and MIX (70%, p<0.05) than in SEM (20.7%) patients. Distant metastases in the time of diagnosis were affirmed in 7 persons (21.9 %) with NSGCT and 1 (10%)

with MIX and at were absent in SEM. At least one tumor marker elevation was observed in all subjects with MIX and 83% with NSGCT. Blood levels of β- hCG and AFP were within normal ranges in patients with SEM (except one case with slightly elevated β-hCG). 3 patients (4.3% out of all) had both testicles removed because of TGCT. In one case (33 year old) synchronic, bilateral, multifocal NSGCT was found. In remaining 2 cases (43 and 28 years old) SEM developed after 4 and 3 years after first orchiectomy due to NSGCT.

Conclusions

1. The presence of NSGCT or MIX in testicular tumor is associated with higher risk of vascular invasion, pathological stage pT2 and risk of enlargement of retroperitoneal lymph nodes compared with SEM. 2. In patients with NSGCT without metastases the level of AFP correlates with diameter of testicular tumor containing ca embryonale. 3. Normal levels of AFP and β-hCG can be observed in SEM, but also in 17% of subjects with NSGCT. 4. After testis removal because of TCGT there is higher risk of TGCT development in the second testis requiring regular follow-up. 5. High incidence of subjects with tumor diameter above 5 cm or whole testis destruction suggest long development of disease before diagnosis. Educational action may prevent the delay in the diagnosis and treatment. Supported by grant of UM in Łódź no. 502-11-427 i 503-1089-2.