title: Immunohistological detection of lymph node metastases in the testicular center as quick section diagnosis during retroperitoneal lymphadenectomy.
abstract: The object of this study was to determine whether the immunohistochemical detection of cytokeratin (CK)-positive cells is useful as quick section diagnosis, and whether the retroperitoneal lymphadenectomy (RLA) can be reduced by this method without any disadvantage for the patient. The RLA represents a combined diagnostic and therapeutic procedure for staging as well as removal of regional lymph node metastases in patients with malignant testis tumors. The disadvantage of the radical RLA is a 40 to 90% loss of potency. The risk of the reduced RLA is the relapse. The metastatic affection of the first retroperitoneal lymph node station, the so-called "sentinale" lymph nodes, allows a judgement for the remaining lymph nodes, and, therefore, for the extent of the necessary operation. The conventional frozen technique has a limited reliability, whereas the paraffin technique needs too much time. We used the immunohistochemistry as alternative method for the rapid as well as reliable evaluation of metastases. A group (7 cases) of 35 patients with non-seminomatous tumors of the testis was only treated by radical RLA after detection of CK-positive cells in the sentinale lymph nodes. The other patients were treated by modified RLA (20 cases) or reduced RLA (6 cases). The results were compared with a control group (48 cases) which was treated by radical RLA only. Using the modified RLA the relapse-free interval was not affected and the loss of ejaculation as a consequence of radical treatment could be avoided.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Institute of Pathology, Klinikum GmbH, Görlitz, FRG.
authors.forename: P
authors.initials: P
authors.lastname: Stosiek
authors.forename: A
authors.initials: A
authors.lastname: Wodke
authors.forename: M
authors.initials: M
authors.lastname: Kasper
mesh_terms: D007172:Erectile Dysfunction / Q000209:etiology; D005455:Fluorescent Antibody Technique; D006801:Humans; D007432:Intraoperative Period; D007633:Keratins / Q000032:analysis*; D008197:Lymph Node Excision / Q000009:adverse effects; D008198:Lymph Nodes / Q000737:chemistry*; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D009364:Neoplasm Recurrence, Local; D012187:Retroperitoneal Space; D013736:Testicular Neoplasms / Q000473:pathology* / Q000601:surgery
chemical_list: D007633:Keratins