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Was der Onkologe vom Pathologen über Hodentumoren wissen muss

What does the oncologist need from the pathologist in testicular cancer?

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Zusammenfassung

Hintergrund

Keimzelltumoren des Hodens sind außerordentlich gut heilbar und betreffen meist junge Männer im Alter ≤35 Jahren. Selbst metastasierte Patienten können durch multimodale, Cisplatin-basierte Therapiekonzepte zu ca. 70 % geheilt werden. Patienten, bei denen die Standardtherapie versagt, haben eine sehr ungünstige Prognose, weshalb neue Biomarker und Therapieoptionen dringend benötigt werden.

Ziel der Arbeit

Diskussion histopathologischer Informationen, die für die Entscheidungsfindung der mit der Therapie von Keimzelltumoren befassten Urologen und Onkologen maßgeblich sind.

Material und Methoden

Narrative Übersichtsarbeit zu Schlüsselinformationen männlicher Keimzelltumoren für die klinische Entscheidungsfindung.

Ergebnisse

Zentrale histopathologische Informationen sind insbesondere (i) die Zuordnung eines unklaren Tumorleidens zu einem Keimzelltumorursprung über das Isochromosom 12p, (ii) die klare Benennung der verschiedenen Histologien und (iii) die Beurteilung von Risikofaktoren wie die Lymphangioinvasion oder Rete-testis-Infiltration. Der histopathologische Befund ist maßgeblich für die leitlinienkonforme, risikobasierte Therapieplanung und erfolgreiche -durchführung und hilft die therapeutische Belastung und Langzeitfolgen zu reduzieren. Für refraktäre Keimzelltumoren sind bisher keine prädiktiven oder prognostischen Biomarker oder zielgerichtete Therapien verfügbar.

Diskussion

Eine enge Interaktion und interdisziplinäre Diskussion histopathologischer und radiologischer Befunde sowie etablierter Risikofaktoren wie Serumtumormarker ist entscheidend für den Behandlungserfolg und eine Therapieintensivierung (sofern erforderlich) oder -deeskalation zur Vermeidung einer Übertherapie (sofern möglich).

Abstract

Background

Testicular type II germ cell tumours (GCTs) are an exemplar of a curable cancer and the most common malignancy in males aged ≤35 years. Even in metastatic stages, about 70% of patients can be cured by cisplatin-based chemotherapy and multimodal treatments. For patients failing platinum-based standard therapy, prognosis is poor and novel biomarkers and therapeutic options are urgently needed.

Objectives

Discussion of desired histopathological information to guide urologists’ and oncologists’ decision making in the treatment of male GCTs.

Material and methods

A narrative review of histopathological key features of male GCT tissue samples for clinical decision making.

Results

Histopathological workup is crucial to identify (i) a GCT origin in cancers of unknown primary based on isochromosome 12p (i(12p)) detection, (ii) the different type II GCT subtypes, and (iii) risk factors, i.e. lymphovascular or rete testis invasion, among others. Proper histopathological diagnosis is indispensable for guideline-endorsed, histology-driven, and risk-adapted treatment decisions, hereby helping to maintain treatment success while reducing the therapeutic burden and potential long-term sequelae of multimodal treatments. For refractory patients failing standard treatment options, prognosis remains poor and, so far, neither predictive or prognostic biomarkers nor novel therapeutic targets have been established.

Conclusions

Close interaction and interdisciplinary discussion of histopathologic and radiologic findings and established risk factors including serum tumour markers is crucial for successful treatment including intensified strategies, where necessary, or prevention of overtreatment, where possible.

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Förderung

F. Bremmer wird durch die Wilhelm-Sander-Stiftung unterstützt (Projektnummer: 2016.041.1 und 2016.041.2).

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Authors and Affiliations

  1. Klinik für Onkologie, Hämatologie und Stammzelltransplantation mit Abteilung für Pneumologie, Universitätsklinikum Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    Christoph Oing & Mia-Carlotta Peters

  2. Mildred Scheel Nachwuchszentrum, HaTriCS4, Universitäres Cancer Center Hamburg, Universitätsklinikum Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    Christoph Oing

  3. Institut für Pathologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland

    Felix Bremmer

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Correspondence to Christoph Oing.

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Interessenkonflikt

C. Oing: Reisekostenerstattung: PharmaMar, IPSEN und Medac Pharma. Vortragshonorare von IPSEN und Medac Pharma. Forschungsförderung: Roche, PharmaMar. M.-C. Peters und F. Bremmer geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Oing, C., Peters, MC. & Bremmer, F. Was der Onkologe vom Pathologen über Hodentumoren wissen muss. Pathologe 41 (Suppl 2), 111–117 (2020). https://doi.org/10.1007/s00292-020-00872-y

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