Gross specimen of a testicular seminoma. Photo: Ed Uthman, MD / Wikimedia Commons, CC BY 2.0.
Annotated microscopic view of seminoma. Image: Mikael Häggström, MD / Wikimedia Commons, CC0.
| The Testicular Cancer Resource Center |
After the orchiectomy, the removed testicle and spermatic cord are sent to the pathology laboratory, where they are examined by a pathologist. The pathologist looks at the specimen and then examines thin slices of the tumor under a microscope. The result is a pathology report describing what type of tumor was found and how far it appears to have spread within or immediately around the testicle.
The pathology report is extremely important because treatment decisions are often based on what the pathologist finds.
Pathology is not simply a machine producing an unquestionable answer. It is an expert interpretation of the tissue that was sampled and examined. Pathologists use the appearance of the cells, special stains, tumor markers and other information to reach a diagnosis, but testicular tumors can be complicated and mistakes do occur. Expert review of testicular cancer pathology frequently changes important findings such as the tumor type, stage, or whether cancer cells are present in blood or lymphatic vessels.
What Should Be in the Pathology Report?
The report should identify the type of tumor that is present.
Most testicular cancers are either seminoma or nonseminoma. Nonseminomas are often mixed tumors containing more than one type of germ cell cancer, such as embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma, or seminoma.
If several types are present, the report should identify them and usually estimate approximately how much of the tumor each type represents. Knowing exactly what types of cancer are present is important because the pathology helps determine the appropriate treatment.
The report should give the size of the tumor and describe whether it has grown into nearby structures.
These can include the rete testis, tissue around the center of the testicle, the epididymis, the coverings of the testicle, and the spermatic cord. These findings help determine the pathological stage.
The report should say whether there is lymphovascular invasion, often abbreviated LVI.
This means that the pathologist can actually see cancer cells inside small blood vessels or lymphatic vessels in or around the tumor. In other words, cancer cells have gotten onto one of the routes they can use to travel away from the testicle.
Lymphovascular invasion does not mean that the cancer has definitely spread elsewhere. But it does mean that the risk of microscopic spread is higher, particularly in Stage I nonseminoma, so it can affect decisions about surveillance, chemotherapy, or RPLND.
The report should indicate whether cancer reaches the edge of the tissue that was removed, especially if the tumor involves the spermatic cord. A positive surgical margin means tumor cells are present where the tissue was cut.
The pathologist also examines tissue around the tumor.
One finding that may be reported is germ cell neoplasia in situ, usually shortened to GCNIS. These are abnormal germ cells that are considered the precursor of most adult testicular germ cell cancers.
The report may also describe whether sperm production appears normal or reduced, as well as other abnormalities in the surrounding testicular tissue. This can provide useful information, but it does not by itself determine whether a man is fertile.
The pathologist may also note other things that happen to be present, such as cysts, inflammation, hydroceles, or other benign abnormalities.
Should You Get a Second Pathology Opinion?
Because testicular cancer is relatively uncommon, many general pathologists see only a small number of testicular tumors. Some cases are straightforward, but others can be surprisingly difficult to classify.
If any of the following apply to your case, you should consider getting a second pathology opinion from someone with substantial experience in testicular cancer:
The original slides and tissue blocks can be sent to another pathology department for review.
Get a Copy
Review the pathology report with your doctor and get a copy for your own records.
If there is something in the report you do not understand, ask about it. If something important appears to be missing, your doctor can ask the pathologist to review the specimen again.
Hospitals retain pathology slides and tissue blocks for many years, although the exact retention period varies. They can usually be retrieved and sent for expert review later if necessary.
Specialized Pathology Testing
Most testicular tumors can be diagnosed by examining the tissue under the microscope, often with the help of special stains that identify proteins made by different types of cells.
In unusual cases, additional testing can help determine what kind of tumor is present. Most adult germ cell tumors contain extra genetic material from part of chromosome 12, called 12p. Testing for abnormalities involving 12p can sometimes help confirm that an unusual tumor is a germ cell tumor.
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