title: The Significance of Lymphovascular Invasion of the Spermatic Cord in the Absence of Cord Soft Tissue Invasion.
abstract: BACKGROUND
  - Testicular germ cell tumors with lymphovascular invasion (LVI) are staged pT2, and those with spermatic cord involvement are staged pT3.
  
  
  OBJECTIVE
  - To study the clinical significance of LVI within the spermatic cord without direct involvement of the cord soft tissues.
  
  
  METHODS
  - A retrospective, multi-institutional review was performed on testicular GCTs with spermatic cord LVI in the absence of cord soft tissue invasion.
  
  
  RESULTS
  - Forty-four germ cell tumors had LVI in the spermatic cord without soft tissue invasion; 37 of 44 patients (84%) had nonseminomatous germ cell tumors (NSGCT), and 7 (16%) had pure seminomas. Patients with NSGCTs and spermatic cord LVI had worse clinical outcomes compared with patients with pure seminoma and spermatic cord LVI (P = .008). We then compared patients with NSGCTs and spermatic cord LVI (n = 37) to patients with NSGCTs and LVI limited to the testis (n = 32). A significantly greater percentage of patients with LVI in the spermatic cord presented with advanced clinical stage (76% versus 50%; P = .01). There was no statistically significant difference in disease recurrence/progression or death between patients with spermatic cord LVI and patients with LVI limited to the testis (P = .40; P = .50). There was no significant difference in the presence of embryonal dominant histology (P = .30) or rete testis invasion (P = .50) between the 2 groups. More hilar soft tissue invasion was seen in patients with LVI present in the spermatic cord (P = .004).
  
  
  CONCLUSIONS
  - In patients with NSGCTs, LVI in the spermatic cord, without soft tissue invasion, is associated with worse clinical stage at presentation compared with patients with LVI confined to the testis.
authors.forename: Brandi C
authors.initials: BC
authors.lastname: McCleskey
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Epstein
authors.forename: Constantine
authors.initials: C
authors.lastname: Albany
authors.forename: Neda
authors.initials: N
authors.lastname: Hashemi-Sadraei
authors.forename: Muhammad T
authors.initials: MT
authors.lastname: Idrees
authors.forename: Julie M
authors.initials: JM
authors.lastname: Jorns
authors.forename: David Y
authors.initials: DY
authors.lastname: Lu
authors.forename: Andres
authors.initials: A
authors.lastname: Matoso
authors.forename: Soroush
authors.initials: S
authors.lastname: Rais-Bahrami
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Schwartz
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Ulbright
authors.affiliation: From the Departments of Pathology (Drs McCleskey and Gordetsky), Urology (Drs Rais-Bahrami and Gordetsky), and Radiology (Dr Rais-Bahrami), University of Alabama, Birmingham; the Department of Pathology, University of Michigan, Ann Arbor (Dr Jorns); the Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles (Dr Lu); the Department of Pathology, Brown University, Providence, Rhode Island (Dr Matoso); the Department of Pathology, University of Pennsylvania, Philadelphia (Dr Schwartz); the Departments of Hematology/Oncology (Drs Albany and Hashemi-Sadraei) and Pathology (Drs Idrees and Ulbright), Indiana University School of Medicine, Indianapolis; and the Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland (Dr. Epstein).
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gordetsky
mesh_terms: D000293:Adolescent; D000328:Adult; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology*; D018239:Seminoma / Q000473:pathology*; D013085:Spermatic Cord / Q000473:pathology; D013736:Testicular Neoplasms / Q000473:pathology*; D013737:Testis / Q000473:pathology; D055815:Young Adult