title: Delayed orchiectomy at postchemotherapy retroperitoneal lymph node dissection due to laterality of retroperitoneal metastatic pattern consistent with testicular primary: assessment of pathologic findings.
abstract: OBJECTIVE
  It has been estimated that extragonadal germ cell tumors (EGCTs) constitute 3% to 5% of germ cell neoplasms. An interesting clinical scenario occurs when a patient with a presumed EGCT and normal testicular examination and ultrasound findings has a retroperitoneal metastatic pattern consistent with either a right or left-sided testicular primary. We reviewed the pathologic data of patients presenting with these clinical findings after delayed orchiectomy at postchemotherapy retroperitoneal lymph node dissection (PC-RPLND).
  
  
  METHODS
  We identified 14 patients with apparent EGCT who had undergone simultaneous orchiectomy at PC-RPLND at our institution from July 1979 to July 2002 because of a lateralizing pattern of retroperitoneal metastases concerning for a testicular primary. Of the 14 patients, 3 had completely normal testicular ultrasound findings after chemotherapy and 11 had minimal ultrasound findings not consistent with a testicular tumor.
  
  
  RESULTS
  Two (14%) of the PC orchiectomy specimens contained mature teratoma and eight (57%) contained necrosis and/or focal fibrosis. Thus, 10 (71%) of 14 patients undergoing PC orchiectomy at PC-RPLND because of metastatic disease laterality had evidence of a testicular primary.
  
  
  CONCLUSIONS
  Most (71%) patients with a presumed EGCT who underwent PC orchiectomy because of lateralizing retroperitoneal metastases had histologic evidence of a testicular primary (20% teratoma, 80% focal necrosis or fibrosis). If the retroperitoneal pattern of metastatic tumor spread is consistent with a primary testicular tumor, we offer PC orchiectomy to patients with apparent EGCT at PC-RPLND, even if the PC testicular examination and ultrasound findings are normal.
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA. jimbrown@mcg.edu
authors.forename: James A
authors.initials: JA
authors.lastname: Brown
authors.forename: Richard
authors.initials: R
authors.lastname: Bihrle
authors.forename: Richard S
authors.initials: RS
authors.lastname: Foster
mesh_terms: D003131:Combined Modality Therapy; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D009919:Orchiectomy; D012186:Retroperitoneal Neoplasms / Q000556:secondary*; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D013997:Time Factors