CASE OF THE WEEK
2019-8 / APRIL 8
(CONTRIBUTORS: SOUNAK GUPTA, VICTOR E. REUTER)
A 35-year-old male presented with a 2-week history of discomfort and enlargement of the right testis. He was eventually treated with a right orchiectomy which revealed involvement by seminoma. Subsequently, he presented with early retroperitoneal relapse while on surveillance.
Quiz
Based on the images shown, how would you stage the two specimens?
a. pT2 and N1
b. pT2 and N2
c. pT1 and N2
d. pT1 and N1
1. c
pT1 and N2
Rete testis involvement does not affect stage for seminomas of the testis confined to the testicular parenchyma. A recent systematic review of the literature suggests that although rete testis invasion is considered an important prognostic indicator of relapse in clinical stage 1 seminomas, the prognostic significance is insufficient to advocate its routine use in clinical practice. Factors that lead to upstaging from pT1 to pT2 include lymphovascular invasion, involvement of the hilar soft tissue or epididymis and penetration of the visceral mesothelial layer covering the external surface of the tunica albuginea. This data has led to a change in the AJCC (8th edition) staging classification.
Testicular germ cell tumors typically metastasize to retroperitoneal and para-aortic lymph nodes. A single lymph node metastasis ≤2cm in size is staged as N1 disease, while a single lymph node >2cm, but ≤5cm is staged as N2 disease. The clinical relevance of extranodal extension remains controversial.
Amin MB, Edge SB, Greene FL, et al, eds. AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017.
Boormans JL, Mayor de Castro J, Marconi L et al. Testicular Tumour Size and Rete Testis Invasion as Prognostic Factors for the Risk of Relapse of Clinical Stage I Seminoma Testis Patients Under Surveillance: a Systematic Review by the Testicular Cancer Guidelines Panel. Eur Urol. 2017 Nov 20. pii: S0302-2838(17)30826-6.
Sounak Gupta, Victor E. Reuter
Memorial Sloan Kettering Cancer Center
guptas1@mskcc.org
Testis
seminoma, staging, rete testis, lymph node