ABSTRACTS OF THE 21st ANNUAL MEETING OF THE ITALIAN ...

dose of radiotherapy did not significantly affect b-RFS,
possibly because of the small number of patients receiving a
dose ≥70 Gy (5/137 in group A, 21/98 in group P and 39/103
in group S). Conclusion: Our data confirm that clinical
outcome after salvage RT is poorer if compared to outcome
after adjuvant treatment. In the adjuvant setting, the
detectability of PSA impacts negatively on clinical outcome.
Further data will be presented on the impact of GS and of RT
dose on outcome.
162
FROZEN SECTION EXAMINATION IN
INTRAOPERATIVE DIAGNOSIS OF
TESTICULAR CANCER: OUR EXPERIENCE
Sara Melegari1 , Deliu-victor Matei1 , Giuseppe Renne2 ,
Gennaro Musi3 , Federica Mazzoleni4 , Fabrizio Verweij5 and Ottavio De Cobelli6 1Divisione Di Urologia, 2Divisione di Anatomia Patologica e
MDL, 3Divisione di Urologia, 4Divisione di Urologia,
5Divisione di Urologia, and 6Divisione di Urologia, Istituto
Europeo di Oncologia, Milano, Italia
Background: Testicular cancer represents between 1% and 1.5%
of all male neoplasms and 5% of urological tumors, with there
being an increase in the incidence in the last 30 years in the
majority of industrialized countries in North America, Europe
and Oceania. Testicular cancer normally appears as a casually
found, painless, unilateral mass in the scrotum; ultrasound
confirms the presence of a testicular mass and exploration of
the contralateral testis can lead to diagnosis in cases where the
testicular mass is not palpable and in cases of retroperitoneal or
visceral lesions or elevated serum markers. All patients with a
suspected testicular mass must undergo inguinal exploration;
immediate orchiectomy with division of the spermatic cord at
the internal inguinal ring must be performed if a tumor is found.
If the diagnosis is not clear, a testicular biopsy is taken for
frozen section histological examination. Frozen section
histological examination is also required in cases of solitary
testis or bilateral testicular lesions. We retrospectively reviewed
our experience concerning the reliability of frozen section
examination in primary testicular tumors by comparing each
frozen section examination result to the final diagnosis. Patients
and Methods: From 2001 to 2009, at IEO, 323 patients
underwent orchiectomy. In 80 of these patients (24.7%), the
surgeon clamped the spermatic cord and performed a biopsy for
frozen section histological examination; this was required for
patients with a small tumor without elevated serum markers and
for patients with bilateral lesions or single testis, both of which
were considered to be cases of doubt. Specimens were well
oriented and resection margins properly inked and the
pathologist performed a perpendicular section of the tumor with
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ANTICANCER RESEARCH 31: 1807-1956 (2011)
margin including the entire tumor and uninvolved testicular
parenchyma. All procedures had to be completed within 20
minutes since the spermatic cord was clamped. In cases of
malignancy, radical orchiectomy was performed and in cases of
benign findings, the lesion was simply enucleated. Slides of
frozen section and the permanent sections were reviewed and
compared with regard to the histological diagnosis and
presence/absence of malignancy. Results: Of the 80 specimens
analyzed, 18 (22.5%) were negative for malignancy and 15
(18.7%) were benign lesions such as tumors of non-specific
stroma, Leydig cell tumor, cystadenomas, or simple cysts. A
total of 50.1% of cases of malignant lesion were diagnosed, in
particular, 10 were seminoma, 16 were non seminoma germ cell
tumor, 4 were intratubular germ cell neoplasia, 10 were
lymphoma, leiomyosarcoma and others. In 8.7% of cases, the
diagnosis was delayed. The definitive pathology confirmed the
diagnosis in 90% of cases of seminoma, in 95.5% of cases of
non seminoma germ cell tumors and in 94.5% of cases of
benign lesions. Discussion: A total of 80-90% of all testicular
masses are malignant germ cell tumors and patients should
undergo orchiectomy. On the other hand, benign testicular
lesions are recognized in approximately 10-20% of cases,
enabling testis-sparing surgery based on the findings of frozen
section examination results. Frozen section is accurate for
distinguishing benign from malignant lesions and testicular
function is preserved, whenever possible, requiring close
collaboration between the surgeon and the pathologist. In a
study of 317 patients, comparing frozen section examinations
results with definitive pathology, Elert et al. obtained a correct
frozen section diagnosis for all benign lesions, 90% of
seminoma and 92% of non seminoma. Conclusion:
Intraoperative frozen section examination correctly identified
more than 90% of malignant and benign testicular masses.
Surgical management of testicular tumors based on frozen
section examination results is safe and helpful in clinical
practice.
1 Elert A, Olbert P, Hegele A, Barth P, Hofmann R and
Heidenreich A: Accuracy of frozen section examination of
testicular tumors of uncertain origin. EAU guidelines 2010.
Eur Urol 41(3): 290-293, 2002.
163
LOSS OF LKB1 EXPRESSION IS AN
EARLY MOLECULAR EVENT IN
PROSTATE CARCINOGENESIS
Giuseppe Lucarelli 1 , Monica Rutigliano 1 , Antonia Loverre 1 ,
Pasquale Ditonno 1 , Michele Battaglia 1 ,
Francesco Paolo Selvaggi 1 , Geert J. Van Leenders 2 ,
Patrick Franken 3 , Riccardo Fodde 2 , Antonio Matrone 3 ,
Cristiano Simone 3 , Alessandro Stella 3 and Nicoletta Resta 3