title: Assessment of intravascular granulomas in testicular seminomas and their association with tumour relapse and dissemination.
abstract: OBJECTIVE
  First, to determine the frequency of intravascular granulomas (IVGs) in seminomas and assess for the presence of entrapped seminoma cells. Second, to identify the relationship of this unusual form of vascular space invasion with tumour relapse and/or dissemination.
  
  
  METHODS
  86 cases of seminoma were reviewed to identify IVGs. Immunostaining for OCT3/4 and CD68 was performed. Pathological stage, presence of conventional vascular and rete testis invasion, parenchymal granulomas and follow-up were recorded. Multivariable analysis incorporating tumour size, vascular invasion (conventional granulomas and IVGs) and rete testis invasion was performed.
  
  
  RESULTS
  IVGs were identified in 13 cases (13/86). CD68 confirmed histiocytes in all cases. OCT3/4 identified tumour cells in 9/13 seminomas. 27 patients had disease progression with either dissemination at presentation (n=11) or relapse (n=16). Of these 27 patients, 8 had IVG (29.6%). By comparison, 6 of 57 clinical stage 1 seminomas that did not relapse had IVG (10.53%). Multivariable analysis revealed that no single parameter was statistically significant at predicting tumour relapse and/or dissemination (size: HR 1.65; CI 0.71 to 3.82, p=0.24, rete testis invasion: HR 1.04; CI 0.48 to 2.26, p=0.92, lymphovascular space invasion/IVG: HR 1.62; CI 0.65 to 4.01, p=0.30).
  
  
  CONCLUSIONS
  IVGs may represent a previously unrecognised form of vascular space invasion in seminomas. Studies on larger cohorts are needed to demonstrate its clinical value.
authors.affiliation: Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Michelle R
authors.initials: MR
authors.lastname: Downes
authors.affiliation: Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.
authors.forename: Carol C
authors.initials: CC
authors.lastname: Cheung
authors.affiliation: Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Melania
authors.initials: M
authors.lastname: Pintilie
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Chung
authors.affiliation: Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.
authors.forename: Theodorus H
authors.initials: TH
authors.lastname: van der Kwast
mesh_terms: D000328:Adult; D000368:Aged; D015703:Antigens, CD / Q000032:analysis; D015214:Antigens, Differentiation, Myelomonocytic / Q000032:analysis; D014408:Biomarkers, Tumor / Q000032:analysis; D001808:Blood Vessels / Q000737:chemistry / Q000473:pathology*; D018450:Disease Progression; D006099:Granuloma / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009360:Neoplastic Cells, Circulating / Q000737:chemistry / Q000473:pathology*; D050814:Octamer Transcription Factor-3 / Q000032:analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D018239:Seminoma / Q000737:chemistry / Q000556:secondary* / Q000628:therapy; D013736:Testicular Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult; D000097382:CD68 Molecule
chemical_list: D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D014408:Biomarkers, Tumor; D050814:Octamer Transcription Factor-3; C067980:CD68 antigen, human; D000097382:CD68 Molecule; C494173:POU5F1 protein, human
keywords: CANCER; GRANULOMA; TESTIS