Yield of Testis Pathology in Older Children and Adolescents with Cryptorchidism
Joseph W. McQuaid, MD MPH1, Vera A. Paulson, MD PhD2, Michael P. Kurtz, MD MPH1, Tanya Logvinenko, PhD1, Richard N. Yu, MD PhD1, Richard S. Lee, MD1, Caleb P. Nelson, MD MPH1.
1Department of Urology, Boston Children's Hospital, Boston, MA, USA, 2Department of Pathology, Boston Children's Hospital, Boston, MA, USA.
BACKGROUND: Studies of males with cryptorchidism have demonstrated a relationship between age at orchidopexy and lifetime risk of testicular cancer, and testis biopsy is sometimes performed at the time of orchidopexy in older boys and adolescents to identify malignant changes. However, data regarding the prevalence of testicular neoplasia (TN) or carcinoma in situ (CIS) at time of surgery in this age group are lacking. We sought to determine how often testicular specimens obtained at the time of treatment for undescended testes in older boys demonstrate TN or CIS.
METHODS: We identified patients who were 10 years of age or older at time of surgery with in-house, pathologic specimens obtained between 1994 and 2016. Reports selected for initial review included the terms "testis", "testicle", "testes", or "testicular" (n=1078). We then excluded those specimens lacking operative or clinical records (n=31), lacking testicular parenchyma (n=688), obtained from a descended testicle (n=251), or obtained from a patient with a disorder of sexual differentiation (DSD) (n=33) (Figure 1). Records were reviewed for clinical variables including history of cryptorchidism, laterality, location of the undescended testicle, and type of procedure performed, and pathology variables including the presence of TN/CIS. Prevalence of malignancy in intraabdominal vs. inguinal testes was compared using Fischer's Exact Test.
RESULTS: 71 boys were included in the study with a median age of 15.3 years (range:10.1-27.7, IQR:12.9-16.5). None had a prior history of testicular malignancy. 67 patients underwent unilateral procedures including orchiectomy (45/71, 63.4%), single-stage orchidopexy (20/71, 28.2%), and two-stage orchidopexy (2/71, 2.8%). 4 patients underwent bilateral procedures including bilateral, single-stage orchidopexy (3/71, 4.2%) and two-stage orchidopexy combined with contralateral orchiectomy (1/71, 1.4%). 17/75 (22.7%) testicles were abdominal; among the non-abdominal testes, locations were the inguinal canal (42/75, 56.0%), external inguinal ring (9/75, 12.0%), superficial inguinal pouch (3/75, 4.0%), and high scrotum (4/75, 5.3%). Only 2/71 patients (2.8%) demonstrated malignancy upon pathology review (Table 1). When grouped by location, 2/16 patients (12.5%, 95%CI:3.5-36.0%) with an intraabdominal testis and 0/55 patients (0%, 95%CI:0-6.5%) with non-abdominal testis demonstrated evidence of malignancy (p=0.048). CONCLUSIONS: Among older boys without a history of DSD, no patient with a non-abdominal, undescended testicle (0/55) demonstrated evidence of malignancy on biopsy or whole-testis specimen at time of orchidopexy or orchiectomy. These findings suggest that biopsy may not be necessary in boys older than age 10 with palpable, inguinal undescended testes. Conversely, biopsy yield may be significant in the same population with abdominal testes.
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