96. Jahrestagung der Deutschen Gesellschaft für Pathologie e. V ...

SA-P-098
Male infertility: assessment of juvenile testes dysfunction and
risk for malignancy in cryptorchic boys based on resin semithinsection
evaluation
J . Schröder 1 , W . Rösch 2 , F . Hofstädter 1
1 University Regensburg, Pathology Dept ., Regensburg,
2 University Regensburg, Clinic St . Hedwig, Regensburg
Aims. Infertility may become more a man’s than a woman’s problem:
new data shows both were level pegging – 40% of cases are linked to women,
40 to men, and 20 to joined problems. Failure in congenital testes
descends (cryptorchidism) is the most frequent genital malformation
affecting approx. 1% of 1-year-old mature birth boys. Untreated maldescensus
testis impairs the germ cell development and reduce significantly
the fertility capacity in adults. Additionally there is an increased risk
for testicular cancer. We report how the pathologic biopsy examination
of juvenile cryptorchic testes can assess infertility and malignancy risk.
Methods. Biopsies of ectopic or cryptorchic testes were immersed in
Karnovsky-fixative, postfixed in osmium-tetroxide, dehydrated in graded
ethanols and routinely embedded in epon resin (EmBed812, LYNXautomated
EM-tissue processor). Semithin sections (1 µM) were prepared
by ultramicrotomy using a diamond knife, mounted on a glass slide
and double stained with toluidine blue/basic fuchsine as well as triple
stained according to Laczko [1975] for intracellular glycogen detection.
Results. A semithin resin section provides an excellent structure preservation
of the testicular tissue and is a proofed basis for light microscopic
spermatogenesis assessment in the tubuli contorti. The evaluation
includes the recognition and counting of different development stages
of the germinal cells and detection of specific germinal glycogen-rich
TIN-cells (testicular intraepithelial neoplasia) which represents a preneoplastic
lesion. The light microscopic biopsy examination allows the
cornerstone parameter estimation for the adult fertility, which are the:
(1) tubular index of total germinal cell number; (2) tubular index of
adult dark (A-dark Spermatogonia) spermatogonia – the stem cell pool
of all future spermatozoa [Hadziselimovic, 1983, 1990]; (3) tubular index
of primary spermatocytes.
Conclusions. The demonstrated assessment of spermatogenesis dysfunction
and malignancy risk in juvenile cryptorchic testes in semithin resin
section is a crucial step for the right therapy. Today there is consent,
that an intrauterine hormonal dysfunction of the hypothalamo-pituitary-gonadal
axis is involved in most testicular maldescended cases. In
general, late diagnosis of undescended testis will have a poor prognosis
for future fertility and increased risk for cancer. In our opinion, an electron
microscopy lab is predisposed for processing testicular biopsies for
fertility assessment.
SA-P-099
Rete testis invasion by malignant germ cell tumors of the testis
A .K . Höhn1 , J .-U . Stolzenburg2 , L .-C . Horn1 1University of Leipzig, Institute of Pathology, Leipzig,
2University of Leipzig, Clinic of Urology, Leipzig
Aims. Rete testis is a communicating network of seminal channels in the
hilum of the testis. Its invasion is described as a risk factor in German
guidelines for the management of malignant germ cell tumors. Tumor
size and rete testis invasion (RTI) were considered as prognostic factors
for recurrent disease within stage I seminomas (Warde et al. 2002) and
was suggested to represent an independent prognostic factor (Vogt et
al. 2010). The present study evaluates the documentation of RTI within
routine workup and the pattern of involvement.
Methods. 100 cases with testicular germ cell tumors were re-evaluated
regarding the presence of rete testis within the examined tissue, the
documentation of rete testis status and, if present, the pattern of RTI
(direct infiltration versus pagetoid) as well as which tumor component
was seen in RTI.
Results. The mean age was 38 years (15–75 years). Mean tumor size was
3.45 cm (0.8–14.0 cm). In the originally reports presence of RTI was recognised
in 27 and its absence in 25 cases. In 48 cases rete testis status
was not reported. After the re-evaluation 51 cases showed RTI. Among
these 31 (61%) represented direct invasion and 3 cases (6%) a pagetoid
pattern. In 17 cases (33%) a mixed pattern of invasion was found. 34 of
51 cases (67%) showed an invasion by a pure seminoma, 16 cases (31%)
showed an invasion by the seminomatous component of a combined
germ cell tumor and 1 case (%) showed a pagetoid pattern of invasion
in a non-seminomatous germ cell tumor. 42 cases showed no evidence
of RTI. In 7 cases the rete testis was not available within the examined,
paraffine-embedded tissue of the specimen.
Conclusions. In 48% the RTI-status was not documented during routine
examination. In case of RTI, the majority of cases represented direct
or mixed type pattern on involvement. The status of RTI should be
mentioned within the pathology report. In case of missing rete testis
recutting with embedding of additional tissue is recommended. Further
analyses of the correlation between the tumor size and RTI and the
prognostic impact of RTI are required.
SA-P-100
N-cadherin expression in malignant germ cell tumors of the
testis
F . Bremmer1 , S . Schweyer1 , B . Hemmerlein1 , A . Strauß2 , H .J . Radzun1 ,
C .L . Behnes1 1University of Göttingen, Department of Pathology, Göttingen,
2University of Göttingen, Department of Urology, Göttingen
Aims. Testicular germ cell tumors (TGCTs) are the most common malignancy
in young men aged 18–35 years. They are clinically and histologically
subdivided into seminomas and non-seminomas. Cadherins
are calcium-dependent transmembrane proteins of the group of adhesion
proteins. They form cell junctions in various tissues including
desmosomes and adherens junction. Furthermore, cadherins play a
role in the stabilization of cell-cell contacts, the embryonic morphogenesis,
in the maintenance of cell polarity and signal transduction. Ncadherin
(CDH1), the neuronal cadherin, stimulates cell-cell contacts
during migration and invasion of cells and is able to suppress tumor cell
growth. The aim of this study was to determine whether N-cadherin is
expressed in TGCT and potentially differentiates between the tumorentities
of TGCT.
Methods. We investigated 74 TGCT (seminoma n=40, embryonic carcinoma
n=14, teratoma n=14, chorioncarcinoma n=3, yolk sac tumor n=5)
by immunohistochemistry for the expression of N-cadherin. Furthermore,
the tumor cell lines NCCIT and NTERA were analyzed by PCR,
Western blot analysis and immunocytochemistry.
Results. The studied TGCT showed a distinct membrane-bound N-cadherin
expression for seminoma, teratoma, yolk sac tumor and chorioncarcinoma.
All examined embryonic carcinoma did not show expression
of N-cadherin. In the investigated mixed tumors each of the
embryonic carcinoma-components was negative for N-cadherin, whereas
the other tumor components were positive for N-cadherin. Both
investigated cell lines expressed N-cadherin mRNA, but only NCCIT
showed N-cadherin protein expression.
Conclusions. In contrast to embryonic carcinomas seminomas, teratomas,
yolk sac tumors and shorioncarcinomas express N-cadherin. Ncadherin
is able to differentiate embryonic carcinomas from other tumor
entities of TGCT also in mixed tumors. Thus, N-cadherin may play
a role in tumor progression and in the pathogenesis of TGCT.
Der Pathologe · Supplement 1 · 2012 |
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