A pathologic report for radical orchiectomy specimens with tumors should include the following information: serum tumor markers [alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), lactic acid dehydrogenase (LDH)], specimen laterality, tumor focality, tumor size, macroscopic extent of tumor, histologic type of tumor, margin status, microscopic tumor extension, lymph-vascular invasion, pTNM including S status, and additional pathologic findings [i.e., germ cell neoplasia in situ (GCNIS), atrophy]. As far as tumor sampling is concerned, 1 cm2 sections for every centimeter of maximum tumor diameter should be taken, including normal macroscopic parenchyma (if present), albuginea, and epididymis, the latter two with selection of suspected areas. The most important stain for testicular cancer histologic diagnosis is hematoxylin-eosin (H-E); immunohistochemistry is particularly useful in histologic typing of tumors with extensive necrosis, poor fixation, or ambiguous morphology as well as in metastatic tumors. In the microscopic examination of tumor specimens, the presence or absence of peritumoral venous and/or lymphatic vascular invasion should be carefully investigated and reported. It should be stressed that the diagnosis of choriocarcinoma requires the identification of mononucleated cytotrophoblastic cells. In stage 1 seminomas, the presence or absence of invasion of the rete testis should be reported. With regard to microscopic evaluation of tumors with mixed histology, the individual components should be specified, and their amount should be estimated as a percentage.
In experienced hands, guided fine needle cytology and/or core biopsy can be valuable tools for the morphological diagnosis of retroperitoneal and mediastinal manifestations of malignant germ cell tumors.
A pathologic report for retroperitoneal lymphadenectomy specimens should include the following data: pre-lymphadenectomy treatment, serum tumor markers, specimen site(s), number of nodal groups present, size of largest metastatic deposit in lymph node, histologic viability of tumor, histologic type of metastatic tumor, pN status, nonregional lymph node metastasis (M1a).
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