Pathology of Germ Cell Tumors of the Testis

Isabell A. Sesterhenn, MD; Charles J. Davis, Jr, MD

Disclosures

Cancer Control. 2004;11(6):374-387. 

In This Article

Abstract and Introduction

Background: An increasing incidence of testis tumors has been noted over the second half of the 20th century. Congenital malformation of the male genitalia, prenatal risk factors, nonspecific and specific exposures in adulthood, and male infertility have all been associated with the etiology of germ cell tumors.
Methods: The histologic classification, pathology, and current concepts of testicular germ cell tumors are reviewed.
Results: Germ cell tumors occur at all ages. The tumors are identified as pure form (those of one histologic type) and mixed form (more than one histologic type). Over half of germ cell tumors consist of more than one cell type, requiring appropriate sampling for the correct diagnosis and correlation with the serum tumor markers. Burned-out germ cell tumors may occur in patients with metastatic disease with no gross evidence of a testicular tumor.
Conclusions: Appropriate management of testis tumors relies on accurate pathology and classification of these tumors.

The majority of testis tumors originate from the germ cell, which is the principal cell type of the testis. An increasing incidence of testis tumors, particularly in men of European origin, has been noted over the second half of the 20th century.[1] Germ cell tumors occur at all ages. Congenital malformation of the male genitalia, prenatal risk factors, nonspecific and specific exposures in adulthood, and male infertility have all been associated with the etiology of germ cell tumors. Over half of germ cell tumors consist of more than one cell type, requiring appropriate sampling for the correct diagnosis and correlation with the serum tumor markers (human chorionic gonadotropin [hCG] and α-fetoprotein [AFP]). The most recent WHO histologic classification of testis tumors[2] is similar to the 1998 clas-sification,[3] differing most significantly with respect to the classification of teratomas and polyembryomas ( Table 1 ). Since mature and immature teratomas have the same genetic changes and biologic potential specific for the prepubertal and postpubertal patient, teratomas are no longer subclassified as mature and immature. Polyembryoma was once classified with tumors of one histologic type; however, in recognition of the different cell types present in polyembryoma, it is now classified with tumors of more than one histologic type. The tumors are staged according to the TNM classification ( Table 2 ).[4,5]

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