Evaluating Malignancy Potential of Testicular Remnants: Implication of Age and Remnant Location on Germ Cell Viability
Tijani S. Osumah, MD, MS, Loren P. Herrera Hernandez, MD, Mohamed Ahmed, MB.BCh., Patricio C. Gargollo, MD, Candace F. Granberg, MD.
Mayo Clinic, Rochester, MN, USA.
Evaluating Malignancy Potential of Testicular Remnants: Implication of Age and Remnant Location on Germ Cell Viability
Background: Given the low incidence of viable cells in nubbins, routine removal to eliminate the theoretical risk of future malignancy remains controversial. Intra−abdominal remnants may be predisposed to containing viable germ cells (GC); however, this is supported by limited evidence. We sought to determine the overall malignancy potential in nubbins and identify predictors of histological features.
Methods: We retrospectively reviewed medical records of patients 15 years or younger undergoing surgical exploration for nonpalpable testes from 1994-2017. Remnants specimens were re-examined by a genitourinary pathologist for select histologic parameters and subcategorized by age and location at surgical exploration. Fisher’s Exact and Chi-squared tests were used to determine effect significance of variables on germ cell presence, p < 0.05 was considered significant.
Results: We identified 118 young males who met inclusion criteria. Median age at surgery was 1 year (4 months - 14 years). Clinical characteristics and histological features are summarized in Table 1.
77 (65.3%) patients had a scrotal nubbin, 31 (26.3%) were within the inguinal canal, and 10 (8.5%) were intraabdominal. Overall, 27 (22.9%) contained viable GCs. Frequency of GCs significantly differed by remnant location with the greatest proportion of GCs found in intraabdominal nubbins following by inguinal and scrotal nubbins respectively (8 (80%) vs 14 (45.2%) vs 5 (6.5%), p < 0.001). Remnants of patients ≥10 years were less prevalent overall in our series (12.7%) but were more likely to contain GCs than younger patients (12 (80.0%) vs. 15 (14.6%), p < 0.001).
Conclusions: Approximately a quarter of nubbins have components at theoretical risk of future malignant degeneration. Older age and remnant location significantly predicted presence of GCs, with intraabdominal remnants having the greatest prevalence. Further studies examining the clinical significance of the relationship between age, remnant location and histopathological findings are warranted.
Table 1: Clinical characteristics and histological features of testicular remnant specimens
| N = 118 | |
| Age, median (range) | 1 year (4 months – 14 years) |
| Laterality | |
| Left | 81 (68.6%) |
| Right | 35 (29.7%) |
| Bilateral | 2 (1.7%) |
| Location | |
| Intra-abdominal | 10 (8.5%) |
| Scrotal | 77 (65.3%) |
| Inguinal | 31 (26.3%) |
| Histological Features* | |
| Hemosiderin | 69 (58.5%) |
| Calcifications | 73 (61.9%) |
| Fibrosis | 111 (94.1%) |
| Germ Cells | 27 (22.9%) |
| Seminiferous tubules | 36 (30.5%) |
| Sertoli Cells | 36 (30.5%) |
| Leydig Cells | 9 (7.6%) |
| Spermatic cord vessels | 101 (16.4%) |
| Vas Deferens | 54 (45.7%) |
| Epididymis | 63 (53.4%) |
| Rete testis | 14 (11.9%) |
*Multiple nubbins contain more than one histological feature.
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