Clinical course and histopathologic risk factor assessment in patients with bilateral testicular germ cell tumors.
OBJECTIVE
To determine whether the clinical course or the histopathologic risk factor assessment of the secondary tumor justifies early detection of the premalignant testis, since only 5% of contralateral testicular biopsies in the case of a testicular tumor reveal a testicular intraepithelial neoplasia (TIN).


METHODS
From 1975 to 1997, 30 patients with bilateral germ cell tumors were treated; histologic and clinical data were available in all patients. In 12 patients, histopathologic re-evaluation and immunohistochemical staining of both tumors was performed for risk factor analysis.


RESULTS
At the time the primary tumor was diagnosed, the mean patient age was 28 years. The metachronous secondary tumors were detected after a mean of 5.6 years. Seminoma was the predominant histologic finding in primary (53%) and secondary (56%) tumors. Eighty-three percent of patients had clinical Stage I (Lugano classification) disease at the diagnosis of the secondary tumor and 17% Stage II. Only 3 of 12 secondary tumors showed vascular invasion. The proliferation analysis (MIB-I score) showed a mean proliferation rate of only 34% within the primary and 26% within the secondary tumors.


CONCLUSIONS
The results of our study show that the low clinical stage and good outcome associated with a histologic low-risk score of the secondary tumor does not mandate contralateral biopsy to detect TIN at the time of diagnosis of the first tumor.
Albers
P
P
Department of Urology and Institute of Pathology, Bonn University, Germany.
Göll
A
A
Bierhoff
E
E
Schoeneich
G
G
Müller
S C
SC
D000328:Adult; D001706:Biopsy; D018237:Germinoma / Q000473:pathology* / Q000556:secondary*; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D012307:Risk Factors; D013736:Testicular Neoplasms / Q000473:pathology* / Q000556:secondary*