DIAGNOSTIC UROLOGY AND TESTIS CANCER

to lightly eosinophilic cytoplasm, but 10 tumors had cells with abundant eosinophilic cytoplasm. Large cytoplasmic vacuoles were prominent in 26 tumors. Nuclear atypicality was absent or mild in 54 cases, moderate in 4 cases, and marked in 2 cases. Mitotic rate ranged from less than 1 to 21 per 10 high power fields, with 50 tumors having no or only rare mitoses. Vascular space invasion was present in 11 cases and was prominent in 8. Follow-up of more than five years (average 8.4 years), or until evidence of metastasis was seen, was available for 16 patients. Nine were alive and well with no evidence of disease. Four were alive with disease and three died of disease. The pathologic features that best correlated with a clinically malignant course were as follows: a tumor diameter of 5.0 cm or greater, necrosis, moderate to severe nuclear atypia, vascular invasion and a mitotic rate of more than 5 mitoses per 10 high power fields. Only one of nine benign tumors for which follow-up data of 5 years of more were available had more than one of these features, whereas five of seven malignant tumors had at least three.

Editorial Comment: Sex cord stromal tumors of the testis are unusual. The authors identified 60 Sertoli cell tumors from more than 200 testicular sex cord stromal tumors, which they evaluated in consultation, and compiled pathological and descriptive features for these unusual neoplasms. As expected, tumor size, amount of nuclear atypia, increased mitotic rate and vascular invasion were associated with a more malignant phenotype. This excellent review of 60 cases with 73 references provides an illustrative view of the difficulty in assessing the likelihood of clinically malignant behavior of Sertoli cell tumors of the testis.

Jerome P. Richie, M.D.

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Integration of Surgery and Systemic Therapy: Results and Principles of Integration J. P. DONOHUE, I. LEVIOVITCH, R. S. FOSTER, J. BANIEL LVD P. TOGNONI, Indiana University School of Medicine,

Sem. Urol. Oncol., 1 6 65-71, 1998 Eight hundred seventy patients with metastatic non-seminomatous germ cell cancer underwent postche-

motherapy retroperitoneal lymph node dissection (PC-RPLND) for resection of residual disease. Several risk factors for relapse and survival were identified as highly significant (P = .00001), namely, presence of residual cancer in the specimen before salvage chemotherapy programs, tumor marker elevation, need for “re-do” PC-RPLND, or unresectability. Although more than half of the entire group (52.5%) had one or more of these risk factors, 67.5% are long-term survivors following PC-RPLND. The remaining 47.5% were referred after primary chemotherapy, without risk factors. Only 9.8% relapsed and 95.5% survived.

Editorial Comment: The authors trace the incredible success story of the modification of surgical and chemotherapeutic techniques in patients with nonseminomatous germ cell tumors and detail the Indiana University experience with 870 patients who underwent retroperitoneal lymph node dissection after chemotherapy during a 20-year period. The overall relapse rate was 28% and two-thirds had cancer. Relapse was generally seen in the higher risk subsets. The authors discuss the factors impacting on integration of chemotherapy and surgery, and they also consider cost and risk benefits in this excellent review.

Jerome P. Richie, M.D.

Indianapolis, Indiana

Vascular Density Does Not Predict Future Metastatic Disease in Clinical Stage 1 Non- Seminomatous Germ Cell Tumours of the Testis

T. M. MAHER AND A. H. S. LEE, University Department of Pathology, Southampton General Hospital, Southampton, United Kingdom

Histopathology, 32: 217-224, 1998

Aim: This study aimed to determine whether patients with stage 1 testicular non seminomatous germ cell tumours (NSGCT) with high vascular density have a greater risk of disease recurrence than those with a low vascular density.

Methods and results: Orchidectomy specimens from 42 patients with stage 1 NSGCT, treated by orchi- dectomy and surveillance alone, were studied. Vessel density was counted in tumour sections immunohis- tochemically stained for CD34. The mean of the three highest counts ( X250, field size 0.67 mm2) for each tumour was used. Tumour vessel density was very similar for relapsing and non relapsing patients. Vascular invasion was the only variable significantly predictive of disease recurrence a t 2 years post- orchidectomy (P = 0.025). There was wide variation of vessel counts between different blocks of a tumour, compared with interobserver variation. The tumour tissue type in the area of highest vessel density was embryonal carcinoma in 50% and teratoma (mature or immature) in 38%.

Conclusions: We confirmed the value of vascular invasion as a prognostic marker in stage 1 NSGCT.