title: Multifocality in testicular germ cell tumor (TGCT): what is the significance of this finding?
abstract: OBJECTIVE
  The aim of the study is to determine the association between multifocality and the pathological features of testicular germ cell tumors and its clinical implication.
  
  
  METHODS
  Orchiectomy specimens from 254 consecutive patients with testis cancer between 2003 and 2013 were included. Multifocality was defined as a distinct tumor focus of cluster of malignant cells > 0.5 mm and separable from the main tumor mass. Univariate logistic regression analysis was performed to evaluate the association between multifocality and other pathological features. Multivariate logistic regression analyses were carried out to identify potential predictive factors of multifocality for clinical stages II-III and the pathological stage ≥ pT2.
  
  
  RESULTS
  Median patient age was 33 years (range 19-70). Multifocality was identified in 58 (22.83 %) orchiectomy specimens. Subjects with multifocality had larger primary tumor lesions (3.7 vs. 3.0 cm; p < 0.05). No association was found between histology and multifocality (p = 0.95). On univariate logistic regression analysis, multifocality was not significantly associated with all pathological features. On multivariate logistic regression analysis, multifocality was not demonstrated to be an adverse pathological feature of clinical stages II-III (p = 0.23) or pathological stage ≥ pT2 (p = 0.30) when included in a model with tumor size ≥ 4 cm and rete testis invasion in seminoma tumor and neither of clinical stages II-III (p = 0.36) or pathological stage ≥ pT2 (p = 0.20) when included in a model with lymphovascular invasion and percentage of embrional cancer ≥ 50 % in non-seminoma ones.
  
  
  CONCLUSIONS
  Multifocality should not be considered an adverse pathological feature in patients with testis cancer, independently to histological subtypes.
authors: Department of Urology, School of Medicine Policlinico Hospital, University of Catania, Catania, Italy.
authors: Vincenzo
authors: V
authors: Favilla
authors: Giorgio Ivan
authors: GI
authors: Russo
authors: Fabio
authors: F
authors: Spitaleri
authors: Daniele
authors: D
authors: Urzì
authors: Marco
authors: M
authors: Garau
authors: Massimo
authors: M
authors: Madonia
authors: Alberto
authors: A
authors: Saita
authors: Furio
authors: F
authors: Pirozzi Farina
authors: Sandro
authors: S
authors: La Vignera
authors: Rosita
authors: R
authors: Condorelli
authors: Aldo E
authors: AE
authors: Calogero
authors: Sebastiano
authors: S
authors: Cimino
authors: Giuseppe
authors: G
authors: Morgia
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology* / Q000601:surgery; D009919:Orchiectomy; D018239:Seminoma / Q000473:pathology* / Q000601:surgery; D013736:Testicular Neoplasms / Q000473:pathology* / Q000601:surgery; D047368:Tumor Burden; D055815:Young Adult