title: Reporting and Staging of Testicular Germ Cell Tumors: The International Society of Urological Pathology (ISUP) Testicular Cancer Consultation Conference Recommendations.
abstract: The International Society of Urological Pathology held a conference devoted to issues in testicular and penile pathology in Boston in March 2015, which included a presentation and discussion led by the testis microscopic features working group. This conference focused on controversies related to staging and reporting of testicular tumors and was preceded by an online survey of the International Society of Urological Pathology members. The survey results were used to initiate discussions, but decisions were made by expert consensus rather than voting. A number of recommendations emerged from the conference, including that lymphovascular invasion (LVI) should always be reported and no distinction need be made between lymphatic or blood invasion. If LVI is equivocal, then it should be regarded as negative to avoid triggering unnecessary therapy. LVI in the spermatic cord is considered as category pT2, not pT3, unless future studies provide contrary evidence. At the time of gross dissection, a block should be taken just superior to the epididymis to define the base of the spermatic cord, and direct invasion of tumor in this block indicates a category of pT3. Pagetoid involvement of the rete testis epithelium must be distinguished from rete testis stromal invasion, with only the latter being prognostically useful. Percentages of different tumor elements in mixed germ cell tumors should be reported. Although consensus was reached on many issues, there are still areas of practice that need further evidence on which to base firm recommendations.
authors.affiliation: *Nuffield Department of Surgical Sciences, University of Oxford, Oxford ††Department of Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom †Department of Pathology and Laboratory Medicine, Calgary Laboratory Services and University of Calgary, Calgary, AB ‡Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada §Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Centre, Los Angeles, CA #Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN **Department of Pathology, Memorial Sloan Kettering Cancer Centre, New York, NY ‡‡Department of Pathology, John Hopkins Hospital, Baltimore, MD ∥Department of Pathology, Hopital Tenon, Assistance Publique - Hopitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France ¶Department of Pathology and Cytology, Karolinska Hospital, Stockholm, Sweden §§Members of the ISUP Testicular Tumor Panel: Brett Delahunt, Cristina Magi-Galluzzi, Ferran Algaba, Esther Oliva, Rodolfo Montironi, Robert H Young, Muhammad T Idrees, Sean R Williamson, Ming Zhou, Peter A Humphrey, Antonio Lopez-Beltran, and Joanna Perry-Keene.
authors.forename: Clare
authors.initials: C
authors.lastname: Verrill
authors.forename: Asli
authors.initials: A
authors.lastname: Yilmaz
authors.forename: John R
authors.initials: JR
authors.lastname: Srigley
authors.forename: Mahul B
authors.initials: MB
authors.lastname: Amin
authors.forename: Eva
authors.initials: E
authors.lastname: Compérat
authors.forename: Lars
authors.initials: L
authors.lastname: Egevad
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Ulbright
authors.forename: Satish K
authors.initials: SK
authors.lastname: Tickoo
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Berney
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Epstein
mesh_terms: D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D009919:Orchiectomy; D012187:Retroperitoneal Space; D013736:Testicular Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery