title: Conservative management of small testicular tumors relative to carcinoma in situ prevalence.
abstract: OBJECTIVE
  We evaluated the prevalence of carcinoma in situ (CIS) in orchiectomy specimens performed for germ cell tumors smaller than 40 mm in diameter to propose an appropriate conservative approach to bilateral tumors or tumor of a solitary testis.
  
  
  METHODS
  Of 127 patients treated with orchiectomy between 1990 and 2002, 41 who presented with a tumor of less than 40 mm in diameter were selected for histological analysis of testicular parenchyma. The morphological items assessed were CIS, spermatogenesis and Leydig cell hyperplasia.
  
  
  RESULTS
  CIS was observed in 39 of the 41 patients (95%). CIS was evenly distributed throughout the testicular parenchyma (ie around and beyond the tumor) in all 39 cases. Spermatogenesis was observed in 12 of 41 specimens (29%), spermatogenesis without spermatozoa was noted in 14 (34%) and absent germ cells were found in 15 (37%). Leydig cell hyperplasia was observed in 24 cases (58%).
  
  
  CONCLUSIONS
  Histological analysis of whole orchiectomy specimens showed that CIS is almost always present in testicular parenchyma adjacent to germ cell tumor. In bilateral testis cancer or cancer occurring in a solitary testis tumorectomy plus radiotherapy appears to be the appropriate treatment in patients with a small tumor and no other risk factors. In patients who wish to father a child and have preserved spermatogenesis the natural history of CIS allows the postponement of testicular radiotherapy after orchiectomy, giving the double advantage of preserving testicular endocrine function and maintaining the possibility of natural fatherhood.
authors.affiliation: Human Fertility Research Group, Paule de Viguier Hospital, Urological Surgery and Andrology Department, Rangueil Hospital, Toulouse, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Huyghe
authors.forename: Michel
authors.initials: M
authors.lastname: Soulie
authors.forename: Ghislaine
authors.initials: G
authors.lastname: Escourrou
authors.forename: Roger
authors.initials: R
authors.lastname: Mieusset
authors.forename: Pierre
authors.initials: P
authors.lastname: Plante
authors.forename: Patrick
authors.initials: P
authors.lastname: Thonneau
mesh_terms: D000293:Adolescent; D000328:Adult; D002278:Carcinoma in Situ / Q000453:epidemiology* / Q000473:pathology*; D005500:Follow-Up Studies; D018237:Germinoma / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000453:epidemiology* / Q000473:pathology*; D009919:Orchiectomy; D015995:Prevalence; D013736:Testicular Neoplasms / Q000453:epidemiology* / Q000473:pathology* / Q000601:surgery