title: Disparities in Interpretation of Primary Testicular Germ Cell Tumor Pathology.
abstract: OBJECTIVE
  Accurate pathologic interpretation of testicular germ cell tumors (GCTs) can be problematic due to low incidence and variation in histologic patterns. By analyzing changes in the diagnosis of testicular specimens after secondary review, we hoped to determine how these can affect prognosis and treatment.
  
  
  METHODS
  From 1999 to 2013, a total of 235 patients underwent radical orchiectomy at a referring facility and had pathology specimens reanalyzed by our center's pathologists with expertise in genitourinary malignancies. We identified discrepancies in pathologic reporting.
  
  
  RESULTS
  Fifty (21.3%) patients had variations in interpretation of their orchiectomy specimens. A clinically significant alteration was identified in 16 (6.8%) patients, most commonly due to recognition (or misrecognition) of lymphovascular invasion (LVI) associated with nonseminomatous germ cell tumors (NSGCTs). Changes in LVI status resulted in upstaging or downstaging from clinical stage 1A to stage 1B or vice versa in six patients with NSGCTs, with a subsequent change in therapeutic strategy. In addition, one patient with stage 1 pure seminoma had been misclassified with nonseminoma.
  
  
  CONCLUSIONS
  Inaccurate interpretation of orchiectomy specimens is not uncommon and may lead to incorrect tumor staging, imprecise assignment of progression risk, and inappropriate management recommendations. Secondary opinions of primary GCT orchiectomy specimens potentially facilitate appropriate counseling and therapeutic strategies.
authors.affiliation: From the Departments of Genitourinary Oncology and.
authors.forename: Pranav
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Pathology, H. Lee Moffitt Cancer Center, Tampa, FL.
authors.forename: Jasreman
authors.initials: J
authors.lastname: Dhillon
authors.affiliation: From the Departments of Genitourinary Oncology and.
authors.forename: Gautum
authors.initials: G
authors.lastname: Agarwal
authors.affiliation: From the Departments of Genitourinary Oncology and.
authors.forename: Kamran
authors.initials: K
authors.lastname: Zargar-Shoshtari
authors.affiliation: From the Departments of Genitourinary Oncology and wade.sexton@moffitt.org.
authors.forename: Wade J
authors.initials: WJ
authors.lastname: Sexton
mesh_terms: D006801:Humans; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology*; D010338:Pathology, Clinical / Q000592:standards*; D015203:Reproducibility of Results; D013736:Testicular Neoplasms / Q000473:pathology*
keywords: Germ cell tumor; Lymphovascular invasion; Pathology; Testicular cancer