The role of the histopathologist in the management of testicular germ cell tumour in adults
M C Parkinson,
S J Harland,
P Harnden, A Sandison,
M C Parkinson
UCL Hospitals Trust and Institute of Urology, UCL London,
Search for more papers by this authorS J Harland
UCL Hospitals Trust and Institute of Urology, UCL London,
Search for more papers by this authorM C Parkinson,
S J Harland,
P Harnden, A Sandison,
M C Parkinson
UCL Hospitals Trust and Institute of Urology, UCL London,
Search for more papers by this authorS J Harland
UCL Hospitals Trust and Institute of Urology, UCL London,
Search for more papers by this authorDr M C Parkinson, Fourth Floor, Rockefeller Building, University St, London WC1E 6JJ, UK.
Abstract
In the last 20–30 years the availability of effective chemotherapy and more accurate clinical staging has greatly improved the prognosis for patients with testicular germ cell tumours. Initially, such treatment appeared to diminish the role of histopathology to the distinction between seminoma and nonseminomatous germ cell tumour (NSGCT) in the primary specimen. However, histopathology has evolved as a prognostic tool indicating the risk of relapse in various defined clinical contexts thereby facilitating therapeutic decisions. The clinical emphasis has been on quality of life and reduction of therapy both in terms of the number of patients treated and the number of chemotherapy courses given to each patient. The treatment of adult testicular germ cell tumours may differ between countries but protocols are established. Therefore it is appropriate to discuss the role of histopathology during this era of relative therapeutic stability.
References
- 1 Cullen MH, Billingham LJ & Cook J et al. Management preferences in stage I non-seminomatous germ cell tumours of the testis: an investigation among patients, controls and oncologists. Br. J. Cancer 1996; 74; 1487–1491.
- 2 Stiggelbout AM, Kiebert FM & De Haes JC et al. Surveillance versus adjuvant chemotherapy in stage I non-seminomatous testicular cancer: a decision analysis. Eur. J. Cancer 1996; 32A; 2267.
- 3
Sigg C &
Hedinger C.
Atypical germ cells in testicular biopsy in male sterility.
Int. J. Androl.
1981; 4 (Suppl.); 163–171.
10.1111/j.1365-2605.1981.tb00670.x Google Scholar
- 4 Skakkebæk NE. Possible carcinoma in-situ of the testis. Lancet 1972; 2; 516–517.
- 5 Skakkebæk NE, Berthelsen JG & Visfeldt J. Clinical aspects of testicular carcinoma in-situ. Int J. Androl. 1981; 4 (Suppl.); 152–161.
- 6 Pryor JP, Cameron KM & Chilton CP et al. Carcinoma in-situ in testicular biopsies from men presenting with infertility. Br. J. Urol. 1983; 55; 780–784.
- 7 Bettocchi C, Coker CB, Deacon J, Parkinson C & Pryor JP. A review of testicular carcinoma in-situ in infertile men. J. Androl. 1994; 15; 145–165.
- 8 Daugaard G, Rorth M, Von Der Maase H & Skakkebæk NE. Management of extragondal germ cell tumours and the significance of bilateral testicular biopsies. Ann. Oncol. 1992; 3; 283–289.
- 9 Giwercman A, Von Der Maase H & Skakkebæk NE. Epidemiological and clinical aspects of carcinoma in-situ of the testis. Eur. Urol. 1993; 23; 104–114.
- 10 Von Der Maase H, Rorth M & Walbom-Jorgensen S et al. Carcinoma in situ of contralateral testis in patients with testicular germ cell cancer; study of 27 cases in 500 patients. Br. Med. J. 1986; 293; 1398–1401.
- 11 Bottomley D, Fisher C, Hendry WF & Horwich A. Persistent carcinoma-in-situ of the testis after chemotherapy for advanced testicular germ cell tumours. Br. J. Urol. 1990; 66; 420–424.
- 12 Christensen TB, Daugaard G, Geertsen PF & Von Der Maase H. Effect of chemotherapy on carcinoma in situ of the testis. Ann. Oncol. 1998; 9; 657–660.
- 13 Dieckmann K-P & Loy V. The value of the biopsy of the contralateral testis in patients with testicular germ cell cancer: the recent German experience. APMIS 1998; 106; 13–20.
- 14 Harland SJ, Cook PA & Fossa SD et al. Intratubular germ cell neoplasia of the contralateral testis in testicular cancer: defining a high risk group. J. Urol. 1998; 160; 1353–1357.
- 15 Read G. Carcinoma-in-situ of the contralateral testis. Br. Med. J. 1987; 294; 121.
- 16 Shalet SM. Effect of irradiation treatment in gonadal function in men treated for germ cell cancer. Eur Urol. 1993; 23; 148–152.
- 17 Berthelsen JG & Skakkebaek NE. Gonadal function in men with testis cancer. Fertil Steril 1983; 39; 68–75.
- 18 Albers P, Goll A, Bierhoff E, Schoeneich G & Muller SC. Clinical course and histopathologic risk factor assessment in patients with bilateral testicular germ cell tumours. Urology 1999; 54; 714–718.DOI: 10.1016/s0090-4295(99)00285-x
- 19 Herr HW & Sheinfeld J. Is biopsy of the contralateral testis necessary in patients with germ cell tumours? J. Urol. 1997; 158; 1331–1334.
- 20 Soosay GN, Bobrow L, Happerfield L & Parkinson MC. Morphology and immunocytochemistry of carcinoma in situ adjacent to testicular germ cell tumours in adults and children: implications for histogenesis. Histopathology 1991; 19; 537–544.
- 21 Hawkins E, Heifetz SA, Giller R & Cushing B. The prepubertal testis (prenatal and postnatal): its relationship to intratubular germ cell neoplasia. Human Pathol 1997; 28; 404–410.
- 22 Parkinson MC, Swerdlow AJ & Pike MC. Carcinoma in situ in boys with cryptorchidism: when can it be detected? Br. J. Urol. 1994; 73; 431–435.
- 23 Swerdlow AJ, Higgins CD & Pike MC. Risk of testicular cancer in a cohort of boys with cryptorchidism. Br. Med. J. 1997; 314; 1507–1511.
- 24 Moller H, Cortes D, Engholm G & Thorup J. Risk of testicular cancer with cryptorchidism and with testicular biopsy: cohort study. Br. Med. J. 1998; 317; 729.
- 25 Cortes D, Visfeldt J, Moller H & Thorup J. Testicular neoplasia in cryptorchid boys at primary surgery: case series. Br. Med. J. 1999; 319; 888–889.
- 26 Nistal M, Codesal J & Paniagua R. Carcinoma-in-situ of the testis in infertile men. A histological, immunocytochemical and cytophotometric study of DNA content. J. Pathol. 1989; 159; 205–210.
- 27 Dieckmann K-P, Souchon R, Hahn E & Loy V. False negatives biopsies for testicular intraepithelial neoplasia. J. Urol. 1999; 162; 364–368.
- 28 Loy V, Wigand I & Dieckmann K-P. Incidence and distribution of carcinoma in-situ in testes removed for germ cell tumour: possible inadequacy of random testicular biopsies in detecting the condition. Histopathology 1990; 16; 198–200.
- 29 Jorgensen N, Rajpert -d, E-Meyts E & Graem N et al. Expression of immunohistochemical markers for testicular carcinoma in-situ by normal human fetal germ cells. Lab. Invest. 1995; 72; 223–231.
- 30 Rajpert-de-Meyts E, Kvist M & Skakkebæk NE. Heterogeneity of expression of immunohistochemical tumour markers in testicular carcinoma in-situ, pathogenetic relevance. Virchows Arch. 1996; 428; 133–139.
- 31 Rajpert-de-Meyts E & Skakkebæk NE. Expression of c-KIT protein product in carcinoma in-situ and invasive testicular tumours. Int J. Androl. 1994; 17; 85–92.
- 32
Kuczyk MA,
Serth J &
Bokemeyer C et al.
Alterations of the p53 tumour suppressor gene in carcinoma in-situ of the testis.
Cancer
1996; 78; 1958–66.DOI: 10.1002/(sici)1097-0142(19961101)78:9<1958::aid-cncr17>3.3.co;2-q
10.1002/(SICI)1097-0142(19961101)78:9<1958::AID-CNCR17>3.0.CO;2-X CAS PubMed Web of Science® Google Scholar
- 33 Lutzker SG. P53 tumour suppressor gene and germ cell neoplasms. APMIS 1998; 106; 85–89.
- 34 Heidenreich A, Schenknan NS & Sesterhenn I et al. Immunohistochemical and mutational analysis of the p53 tumour suppressor gene and the bcl2–2 oncogene in primary testicular germ cell tumours. APMIS 1998; 106; 90–100.
- 35 Ball RY, Sandison A & Arcas AM et al. DNA ploidy and proliferation fraction in classical seminoma and intratubular germ cell neoplasia. J. Urologic Pathology 1997; 7; 141–155.
- 36 Muller M, Lauke H & Hartmann M. The value of the AgNOR staining method in identifying carcinoma in situ testis. Pathol. Res. Pract. 1994; 190; 429–435.
- 37 Chaganti RSK & Houldsworth J. The cytogenetic theory of the pathogenesis of human adult male germ cell tumours. APMIS 1998; 106; 80–84.
- 38 Timmer A, Oosterhuis JW & Schraffordt-Koops H et al. Tumour microenvironment: possible role of integrins and the extracellular matrix in tumour biological behaviour in intratubular germ cell neoplasia and testicular seminoma. Am. J. Pathol. 1994; 144; 1035–1044.
- 39 De Graaff WE, Oosterhuis JW & De-Jong B et al. Ploidy of testicular carcinoma in-situ. Lab. Invest. 1992; 66; 166–168.
- 40 Oosterhuis JW, Gillis AJM & Van Putten WJL et al. Interphase cytogenetics of carcinoma in-situ of the testis. Eur. Urol. 1993; 23; 16–22.
- 41 Rusktalis DB. Molecular mechanisms of testicular carcinogenesis. World J. Urol. 1996; 14; 347–352.
- 42 Burke AP & Mostofi FK. Placental alkaline phosphatase immunohistochemistry of intratubular malignant germ cells and associated testicular germ cell tumours. Human Pathol 1988; 19; 663–670.
- 43 Giwercman A, Cantell L & Marks A. Placental-like alkaline phosphatase as a marker of carcinoma in-situ of the testis. Comparison with monoclonal antibodies M2A and 43–9F. APMIS 1991; 99; 586–594.
- 44 Giwercman A, Marks A & Skakkebæk NE. Carcinoma in-situ germ cells exfoliated from seminiferous epithelium into seminal fluid. Lancet 1988; 1; 530.
- 45 Giwercman A, Clausen OPF & Skakkebæk NE. Carcinoma in-situ of the testis: aneuploid cells in semen. Br. Med. J. 1988; 296; 1762–1764.
- 46 Giwercman A, Hopman AH, Ramaekers FC & Skakkebæk NE. Carcinoma in-situ of the testis, detection of malignant germ cells in seminal fluid by means of in-situ hybridisation. Am. J. Path 1990; 136; 497–502.
- 47
Meng FJ,
Zhou Y,
Giwercman A,
Skakkebæk NE,
Van-Kessel AG &
Suijkerbuijk RF.
Fluorescence in-situ hybridisation analysis of chromosome 12 anomalies in semen cells from patients with carcinoma in-situ of the testis.
J. Pathol.
1998; 186; 235–239.DOI: 10.1002/(sici)1096-9896(1998110)186:3<235::aid-path177>3.3.co;2-l
10.1002/(SICI)1096-9896(1998110)186:3<235::AID-PATH177>3.0.CO;2-U CAS PubMed Web of Science® Google Scholar
- 48 Brackenbury ET, Hargreaves TB, Howard GCW & MacIntyre MA. Seminal fluid analysis and fine needle aspiration cytology in the diagnosis of carcinoma in-situ of the testis. Eur. Urol. 1993; 23; 123–128.
- 49 Kang JL, Rajpert-De-Meyts W, Giwercmann A & Skakkebaek NE. The association of testicular carcinoma in situ with intratubular microcalcifications. J. Urologic Pathology 1994; 2; 235–242.
- 50 Renshaw AA. Testicular calcification: incidence, histology and proposed pathological criteria for testicular microlithiasis. J. Urol. 1998; 160; 1625–1628.
- 51 Hobarth K, Susani M, Szabo N & Kratzik C. Incidence of testicular microlithiasis. Urology 1992; 40; 464–467.
- 52 Ganem JP, Workman KR & Shaban SF. Testicular microlithiasis is associated with testicular pathology. Urology 1999; 53; 209–213.DOI: 10.1016/s0090-4295(98)00438-5
- 53 Fossa SD, Horwich A & Russell JM et al. Optimal planning target Volume for stage I testicular seminoma: a Medical Research Council randomised trial. J. Clin. Oncol. 1999; 17; 1146–1154.
- 54 Warde P, Von Der Maase H & Horwich A et al. Prognostic factors for relapse in stage I seminoma managed by surveillance. Proc. ASCO 1998; 17; 1188.
- 55 Oliver RT, Edmonds PM & Ong JY et al. Pilot studies of 2 and 1 course of carboplatin as adjuvant for stage I seminoma: should it be tested in a randomised trial against radiotherapy? Int. J. Radiol. Oncol. Biol. Phys. 1994; 29; 3–8.
- 56 Eble JN. Spermatocytic seminoma. Human Pathol. 1994; 25; 1035–1042.
- 57 Gospodarowicz MK, Warde P & Catton C. Optimum management of early stage seminoma. In Germ Cell Tumours IV. Eds Wg Jones, I Appleyard, P Harnden, Jk Joffey. London: John Libbey 1998; 153–162.
- 58 Duchesne GM, Stenning SP & Aass N et al. Radiotherapy after chemotherapy for metastatic seminoma—a diminishing role. Eur. J. Cancer. 1997; 33; 829–35.DOI: 10.1016/s0959-8049(97)00033-6
- 59 Ayala AG & Ro JY. Testicular tumours: clinically relevant histological findings. Sem. Urol. Oncol. 1998; 16; 72–81.
- 60 Cheville JC. Classification and pathology of testicular germ cell and sex cord stromal tumours. Urol. Clin. North Am. 1999; 26; 595–600.
- 61 Ulbright TA, Amin MA & Young RH. Atlas of tumour pathology. Third series. Fascicle 25. Tumours of the testis, adnexa, spermatic cord and scrotum. Washington DC: American Forces Institute of Pathology, 1999.
- 62 Pera MF, Bennett W & Cerretti DP. CD30 and its ligand: possible role in regulation of teratoma stem cells. APMIS 1998; 106; 169–173.
- 63 Haigh T, Chen C, Jones CJ & Aplin JD. Studies of mesenchymal cells from first trimester human placenta: expression of cytokeratin outside the trophoblast lineage. Placenta 1999; 20; 615–625.DOI: 10.1053/plac.1999.0441
- 64 Prescott RJ, Wells S, Bisset DL, Banerjee SS & Harris M. Audited tumour histopathology reviewed by a regional oncology centre. J. Clin. Pathol. 1995; 48; 245–249.
- 65 Segelov E, Cox KM, Raghavan D, McNeil E, Lancaster L & Rogers J. The impact of histological review on clinical management of testicular cancer. Br. J. Urol. 1993; 71; 736–738.
- 66 Lee AHS, Mead GM & Theaker JM. The value of central histopathological review of testicular tumours before treatment. Br. J. Urol. Int. 1999; 84; 75–78.
- 67 Price P, Hogan SJ, Bliss JM & Horwich A. The growth rate of metastatic non-seminomatous germ cell testicular tumours measured by marker production doubling time. Prognostic significance in patients treated by chemotherapy. Eur. J. Cancer 1990; 26; 453–457.
- 68
Daugaard G,
Von Der Maase H,
Olsen J,
Rorth M &
Skakkebæk NE.
Carcinoma in situ testis in patients with assumed extra-gonadal germ cell tumours.
Lancet
1987; 5; 528–529.
10.1016/S0140-6736(87)92922-9 Google Scholar
- 69 Greco FA, Vaughn WK & Hainsworth JD. Advanced poorly differentiated carcinoma of unknown primary site: recognition of a treatable syndrome. Ann. Intern. Med. 1986; 104; 547–553.
- 70 Ilson D, Motzer RJ, Rodrigues E, Reuter V, Bosl GJ & Chaganti RSK. Genetic analysis aids in the diagnosis of poorly differentiated midline carcinoma (Abstract). Proc. AACR 1992; 33; 205.
- 71 Horwich A, Alsanjari N, A'hern R, Nicholls J, Dearnaley DP & Fisher C. Surveillance following orchidectomy for stage I testicular seminoma. Br. J. Cancer 1992; 65; 775–778.
- 72 Jacobsen GK, Von Der Maase H & Specht L et al. Histopathological features of stage I seminoma treated with orchidectomy only. J. Urologic Pathology 1995; 3; 85–94.
- 73 Warde P, Gospodarowicz MK & Banerjee D et al. Prognostic factors for relapse in stage I testicular seminoma treated with surveillance. J. Urol. 1997; 157; 1705–1710.
- 74 Warde P, Von Der Maase H & Horwich A et al. Prognostic factors for relapse in stage I seminoma managed by surveillance. Clinic Oncol 1998; 17: 309a.
- 75 Marks LB, Rutgers JL & Shipley WU et al. Testicular seminoma: clinical and pathological features that may predict para-aortic lymph node metastases. J. Urol. 1990; 143; 524–527.
- 76 Von Der Maase H, Specht L & Jacobsen GK et al. Surveillance following orchidectomy for stage I seminoma of the testis. Eur. J. Cancer 1993; 29a; 1931–34.
- 77 Gospodarowicz MK, Warde PR & Panzarella T. The Princess Margaret Hospital experience in the management of stage I and II Seminoma — 1981–91. Adv. Biosci. 1994; 91; 177–185.
- 78 Warde P, Gospodarowicz MK & Panzarella T. Stage I testicular seminoma: results of adjuvant irradiation and surveillance. J. Clin. Oncol. 1995; 13; 2255–2262.
- 79 Mencel PJ, Motzer RJ, Mazumdar M, Vlamis V, Bajorin DF & Bosl GJ. Advanced seminoma: treatment results, survival, and prognostic factors in 142 patients. J. Clin. Oncol. 1994; 12; 120–126.
- 80 International Germ Cell Cancer Collaborative Group. International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancers. J. Clin. Oncol. 1997; 15; 594–603.
- 81 Fossa SD, Oliver RTD & Stenning SP et al. Prognostic factors for patients with advanced seminoma treated with platinum-based chemotherapy. Eur. J. Cancer 1997; 33; 1380–1387.DOI: 10.1016/s0959-8049(96)00425-x
- 82 Peckham MJ, Barrett A, Husband JE & Hendry WF. Orchidectomy alone in testicular stage I non-seminomatous germ cell tumours. Lancet 1982; 2; 678–680.
- 83 Freedman LS, Parkinson MC & Jones WG et al. Histopathology in the prediction of relapse of patients with stage I testicular teratoma treated by orchidectomy alone. Lancet 1987; 2; 294–297.
- 84 Lashley DB & Lowe BA. A rational approach to managing stage I non-seminomatous germ cell tumours. Urol. Clin. North Am. 1998; 25; 405–423.
- 85 Frohlich MW & Small EJ. Stage II non-seminomatous testis cancer: the roles of primary and adjuvant chemotherapy. Urol. Clin. North Am. 1998; 25; 451–459.
- 86 Sternberg CN. The management of stage 1 testis cancer. Urol. Clin. North Am. 1998; 25; 435–449.
- 87 Read G, Stenning SP & Cullen MH et al. Medical Research Council prospective study of surveillance for stage I testicular teratoma. J. Clin. Oncol. 1992; 10; 1762–1768.
- 88 Cullen MH, Stenning SP & Parkinson MC et al. Short course adjuvant chemotherapy in high risk stage I non-seminomatous germ cell tumours of the testis. A Medical Research Council Report. J. Clin. Oncol. 1996; 14; 1106–1113.
- 89 Sesterhenn IA, Weiss RB & Mostofi FR et al. Prognosis and other clinical correlates of pathologic review in stage I and II testicular carcinoma: a report from the testicular cancer intergroup study. J. Clin. Oncol. 1992; 10; 69–78.
- 90 Dean RC & Moul JW. New tumour markers of testis cancer. Urol. Clin. North Am. 1998; 25; 365–373.
- 91
Albers P,
Miller GA &
Orazi A et al.
Immunohistochemical assessment of tumour proliferation and Volume of embryonal carcinoma identified patients with clinical stage A non-seminomatous testicular germ cell tumour at low risk of occult metastases.
Cancer
1995; 75; 844–850.
10.1002/1097-0142(19950201)75:3<844::AID-CNCR2820750316>3.0.CO;2-C CAS PubMed Web of Science® Google Scholar
- 92
Albers P,
Bierhoff E,
Neu D,
Fimmers R,
Wernert N &
Muller SC.
MIB-1 immunohistochemistry in clinical stage I non-seminomatous testicular germ cell tumours predicts patients at low risk for metastasis.
Cancer
1997; 79; 1710–1716.DOI: 10.1002/(sici)1097-0142(19970501)79:9<1710::aid-cncr11>3.3.co;2-q
10.1002/(SICI)1097-0142(19970501)79:9<1710::AID-CNCR11>3.0.CO;2-0 CAS PubMed Web of Science® Google Scholar
- 93 Leibovitch I, Foster RS, Kopecky KK, Albers P, Ulbright TM & Donohue JP. Identification of clinical stage A non-seminomatous testis cancer patients at extremely low risk for metastatic disease: a combined approach using quantative immunohistochemical histopathologic and radiologic assessment. J. Clin. Oncol. 1998; 16; 261–268.
- 94
Heidenreich A,
Sesterhenn IA &
Moul JW.
Prognostic risk factors with low stage testicular germ cell tumours.
Cancer
1997; 79; 1641–1645.DOI: 10.1002/(sici)1097-0142(19970501)79:9<1641::aid-cncr1>3.3.co;2-r
10.1002/(SICI)1097-0142(19970501)79:9<1641::AID-CNCR1>3.0.CO;2-F CAS PubMed Web of Science® Google Scholar
- 95 Williams SD, Stablein DM & Einhorn LH et al. Immediate adjuvant chemotherapy versus observation with treatment at relapse in pathological stage II testicular cancer. N Eng J. Med. 1987; 317; 1433–1438.
- 96 Stoter G, Sylvester R & Sleijfer DT. Multivariate analysis of prognostic factors in patients with disseminated non-seminomatous testicular cancer: results from a European organisation for research of the treatment of cancer multi-institutional phase III study. Cancer Res. 1984; 47; 2714–2718.
- 97 Mead GM, Stenning SP & Parkinson MC et al. The second Medical Research Council study in prognostic factors in non-seminomatous germ cell tumours. J. Clin. Oncol. 1992; 10; 85–94.
- 98 Dodd PM, Motzer RJ & Bajorin DF. Poor risk germ cell tumours. Urol. Clin. North Am. 1998; 25; 485–493.
- 99
Stenning SP,
Parkinson MC &
Fisher C et al.
Post chemotherapy residual masses in germ cell tumour patients.
Cancer
1998; 83; 1409–1419.DOI: 10.1002/(sici)1097-0142(19981001)83:7<1409::aid-cncr19>3.0.co;2-8
10.1002/(sici)1097-0142(19981001)83:7<1409::aid-cncr19>3.0.co;2-8 CAS PubMed Web of Science® Google Scholar
- 100
Steyerberg EW,
Keizer HJ &
Messemer JE et al.
Residual pulmonary masses after chemotherapy for metastatic non-seminomatous germ cell tumour: prediction of histology.
Cancer
1997; 79; 345–355.DOI: 10.1002/(sici)1097-0142(19970115)79:2<345::aid-cncr18>3.0.co;2-0
10.1002/(sici)1097-0142(19970115)79:2<345::aid-cncr18>3.0.co;2-0 CAS PubMed Web of Science® Google Scholar
- 101 Einhorn LH. Do all germ cell tumour patients with residual masses in multiple sites require post-chemotherapy resections. J. Clin. Oncol. 1997; 15; 409.
- 102
Tiffany P,
Morse MJ &
Bosl G et al.
Sequential excision of residual thoracic and retroperitoneal masses after chemotherapy for stage III germ cell tumours.
Cancer
1986; 57; 978–983.
10.1002/1097-0142(19860301)57:5<978::AID-CNCR2820570517>3.0.CO;2-9 PubMed Web of Science® Google Scholar
- 103 Toner GC, Panicek DM & Heelan RJ et al. Adjuvant surgery after chemotherapy for non-seminomatous germ cell tumours: recommendations for patient selection. J. Clin. Oncol. 1990; 8; 1683–1694.
- 104 Qvist HL, Fossa SD & Ous S et al. Post-chemotherapy tumour residuals in patients with advanced non-seminoimatous testicular cancer: is it necessary to resect all residual masses? J. Urol. 1991; 145; 300–303.
- 105 Gerl A, Clemm C & Schmeller N et al. Sequential resection of residual abdominal and thoracic masses after chemotherapy for metastatic non-seminomatous germ cell tumour. Br. J. Cancer 1994; 70; 960–965.
- 106 Brenner PC, Herr HW & Morse MJ et al. Simultaneous retroperitoneal, thoracic and cervical resection of post-chemotherapy residual masses in patients with metastatic non-seminomatous germ cell tumours of the testis. J. Clin. Oncol. 1996; 14; 1765–1769.
- 107 Tognini PG, Foster RS & McGraw P et al. Combined post chemotherapy retroperitoneal lymph node dissection and resection of chest tumour under the same anaesthetic is appropriate based on morbidity and tumour pathology. J. Urol. 1998; 159; 1833–1835.
- 108
Davey DD,
Ulbright TM &
Loehrer PJ et al.
The significance of atypia within teratomatous metastases after chemotherapy for malignant germ cell tumours.
Cancer
1987; 59; 533–539.
10.1002/1097-0142(19870201)59:3<533::AID-CNCR2820590329>3.0.CO;2-X CAS PubMed Web of Science® Google Scholar
- 109 Michael H, Lucia J, Foster RS & Ulbright TM. The pathology of late recurrence of testicular germ cell tumours. Am. J. Surg. Pathol. 2000; 24; 257–273.
- 110 Ulbright TM & Roth LM. A pathologic analysis of lesions following modern chemotherapy for metastatic germ cell tumour. Pathol Annu.: 25;partI, 313–340, 1990.
- 111 Steyerberg EW, Keizer HJ & Fossa SD et al. Resection of residual retroperitoneal masses in testicular cancer: evaluation and improvement of selection criteria. Br. J. Cancer 1996; 74; 1492–1498.
- 112 Foster RS & Donohue JP. Can retroperitoneal lymphadenectomy be omitted in some patients after chemotherapy? Urol. Clin. North Am. 1998; 25; 479–484.
- 113 Steyerberg EW, Gerl A & Fossa SD et al. Validity of prediction of residual retroperitoneal mass histology in non-seminomatous testicular cancer. J. Clin. Oncol. 1998; 16; 269–274114.
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