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DEVELOPMENT OF TESTICULAR SEMINOMA AFTER PREVIOUS NEGATIVE BIOPSY FOR TESTICULAR INTRAEPITHELIAL NEOPLASIA
~022-5347/98/1596-2095$03.00/0 JOURNAL OF UROWCY h E R I C A N UnoLoG1c.a
Copyright 0 1998 by
Vol. 159.2095, June 1998 Printed in U S A .
ASSOCIATION, hc.
DEVELOPMENT OF TESTICULAR SEMINOMA AFTER PREVIOUS NEGATIVE BIOPSY FOR TESTICULAR, INTRAEPITHELIAL NEOPLASIA M. DUBS, M. K. KWIATKOWSKI, H. LAENG, F. RECKER
AND
R. TSCHOLL
From the Clinic of Urology and Institute of Pathology, Kantonsspital Aarau, Aarau, Switzerland KEY WORDS:testis, biopsy, carcinoma in situ
Testicular intraepithelial neoplasia, also termed carcinoma in situ of the testis, appears to be the uniform precursor to testicular germ tumors.' The diagnosis is made by testicular biopsy.2 To date it is accepted that 1 testicular biopsy is representative of the whole testis2 and a good predictor of ~ a n c e rIf. ~biopsy is negative for testicular intraepithelial neoplasia, the probability of tumor is low. Thus, diagnosing testicular intraepithelial neoplasia is highly sensitive and specific for cancer risk assessment.' We report the development of a n unusual secondary testicular tumor after negative testicular biopsy. CASE REPORT
A 40-year-old man presented with a history of orchiectomy on the left side and contralateral testicular biopsy in March 1992. The diagnosis was stage pTlNOMO mixed teratomaseminoma. Biopsy on the right side was considered negative (fig. 1).After 5 years a palpatory change developed in the upper pole area of the remaining right testis. Surgical exploration revealed a testicular tumor, which was removed. Histological evaluation demonstrated stage pTlNOMO seminoma confined to the testis (fig. 2). Surgery was followed by radiotherapy. A review of the 1992 biopsy revealed no testicular intraepithelial neoplasia.
FIG. 2. Histological section of same testicle 5 years later shows typical seminoma overrunning testicular interstitium in addition to tubular infiltration. Germ cell atypia was also present (not shown). H & E, reduced from x240.
epithelial neoplasia has been reported to be between 0.7 and 5.5% in different series, the incidence of false negative biopsies approximated from these series was 0.1%,' and the interval from negative testicular biopsy to development of the testicular tumor was 3 months to 18 years. These data demonstrate that a testicular intraepithelial neoplasia negative biopsy does not necessarily exclude possible subsequent tumor development. An explanation for this phenomenon may be that in rare cases testicular intraepithelial neoplasia is not equally distributed in the whole testicular area.
DISCUSSION
Our case is one of the few in the literature of a falsenegative testicular biopsy, followed by the development of testicular neoplasia. While the incidence of testicular intra-
Accepted for publication November 14, 1997.
CONCLUSIONS
These rare cases of false-negative testicular biopsy are insufficient to dismiss the testicular intraepithelial neoplasia theory.2.3 From the clinical point of view the risk of testicular tumor development after testicular intraepithelial neoplasia negative biopsy is low. Despite this positive message thepatient should still be advised to perform self-examination of the testis. REFERENCES
1. Dieckmann, K.-P., Kaiup, F. and Loy, V.: False-negative biopsy
FIG. 1. Normal seminiferous tubule of right testicle with regular histological architecture bland cytomorphology and reasonable spermatogenesis of epitheli&. Periodic acid, Schiff-diastase, reduced from ~ 4 8 0 .
for testicular intraepithelial neoplasia. J. Cancer Res. Clin. Oncol., 119: 1, 1992. 2. Berthelsen, J. G. and Skakkebaek, N. E.: Value of testicular biopsy in diagnosing carcinoma in situ testis. Scand. J. Urol. Nephrol., 1 5 165, 1981. 3. Berthelsen, J , G. and Sk&kebaek, N, E,: Distribution of carcinoma in situ in testes from infertile men. Int. J. Androl., suppl., 4: 172, 1981.
2095
Copyright 0 1998 by
Vol. 159.2095, June 1998 Printed in U S A .
ASSOCIATION, hc.
DEVELOPMENT OF TESTICULAR SEMINOMA AFTER PREVIOUS NEGATIVE BIOPSY FOR TESTICULAR, INTRAEPITHELIAL NEOPLASIA M. DUBS, M. K. KWIATKOWSKI, H. LAENG, F. RECKER
AND
R. TSCHOLL
From the Clinic of Urology and Institute of Pathology, Kantonsspital Aarau, Aarau, Switzerland KEY WORDS:testis, biopsy, carcinoma in situ
Testicular intraepithelial neoplasia, also termed carcinoma in situ of the testis, appears to be the uniform precursor to testicular germ tumors.' The diagnosis is made by testicular biopsy.2 To date it is accepted that 1 testicular biopsy is representative of the whole testis2 and a good predictor of ~ a n c e rIf. ~biopsy is negative for testicular intraepithelial neoplasia, the probability of tumor is low. Thus, diagnosing testicular intraepithelial neoplasia is highly sensitive and specific for cancer risk assessment.' We report the development of a n unusual secondary testicular tumor after negative testicular biopsy. CASE REPORT
A 40-year-old man presented with a history of orchiectomy on the left side and contralateral testicular biopsy in March 1992. The diagnosis was stage pTlNOMO mixed teratomaseminoma. Biopsy on the right side was considered negative (fig. 1).After 5 years a palpatory change developed in the upper pole area of the remaining right testis. Surgical exploration revealed a testicular tumor, which was removed. Histological evaluation demonstrated stage pTlNOMO seminoma confined to the testis (fig. 2). Surgery was followed by radiotherapy. A review of the 1992 biopsy revealed no testicular intraepithelial neoplasia.
FIG. 2. Histological section of same testicle 5 years later shows typical seminoma overrunning testicular interstitium in addition to tubular infiltration. Germ cell atypia was also present (not shown). H & E, reduced from x240.
epithelial neoplasia has been reported to be between 0.7 and 5.5% in different series, the incidence of false negative biopsies approximated from these series was 0.1%,' and the interval from negative testicular biopsy to development of the testicular tumor was 3 months to 18 years. These data demonstrate that a testicular intraepithelial neoplasia negative biopsy does not necessarily exclude possible subsequent tumor development. An explanation for this phenomenon may be that in rare cases testicular intraepithelial neoplasia is not equally distributed in the whole testicular area.
DISCUSSION
Our case is one of the few in the literature of a falsenegative testicular biopsy, followed by the development of testicular neoplasia. While the incidence of testicular intra-
Accepted for publication November 14, 1997.
CONCLUSIONS
These rare cases of false-negative testicular biopsy are insufficient to dismiss the testicular intraepithelial neoplasia theory.2.3 From the clinical point of view the risk of testicular tumor development after testicular intraepithelial neoplasia negative biopsy is low. Despite this positive message thepatient should still be advised to perform self-examination of the testis. REFERENCES
1. Dieckmann, K.-P., Kaiup, F. and Loy, V.: False-negative biopsy
FIG. 1. Normal seminiferous tubule of right testicle with regular histological architecture bland cytomorphology and reasonable spermatogenesis of epitheli&. Periodic acid, Schiff-diastase, reduced from ~ 4 8 0 .
for testicular intraepithelial neoplasia. J. Cancer Res. Clin. Oncol., 119: 1, 1992. 2. Berthelsen, J. G. and Skakkebaek, N. E.: Value of testicular biopsy in diagnosing carcinoma in situ testis. Scand. J. Urol. Nephrol., 1 5 165, 1981. 3. Berthelsen, J , G. and Sk&kebaek, N, E,: Distribution of carcinoma in situ in testes from infertile men. Int. J. Androl., suppl., 4: 172, 1981.
2095