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    Testis

    Background

    Orchidectomies are usually performed unilaterally to remove a testis as treatment for testicular cancer such as germ cell tumours (e.g. seminoma, teratoma, choriocarinoma) and lymphoma.1-5 Non-malignant conditions such as torsion, infection, chronic pain and trauma may also require orchidectomy.6


    Record the patient identifying information and any clinical information supplied together with the specimen description as designated on the container. See overview page for more detail on identification principles.

    • No
      • Non-routine fixation (not formalin), describe.
    • Yes
      • Special studies required, describe.
      • Ensure samples are taken prior to fixation.
    • Not performed
    • Performed, describe type and result
      • Frozen section
      • Imprints
      • Other, describe

    See general information for more detail on specimen handling procedures.

    Inspect the specimen and dictate a macroscopic description.


    External Inspection

    Orientate and identify the anatomical features of the specimen.

    Record additional orientation or designation provided by operating clinician:

    • Absent
    • Present
      • Method of designation (e.g. suture, incision)
      • Featured denoted

    Photograph the intact specimen.

    Describe the following features of the specimen:

    Procedure

    Record as stated by the clinician.

    • Needle biopsy –see Genitourinary small biopsies protocol
    • Partial orchidectomy
    • Simple orchidectomy
      • Unilateral
      • Bilateral –designate each testis numerically (correlating with ink markings) and describe separately
    • Radical orchidectomy
    • Retroperitoneal lymph node dissection
    • Other, describe

    Anatomical components included (more than one may apply) and dimensions (mm)1,4

    • Total specimen, in three dimensions

    Describe and measure the anatomical components present.

    • Spermatic cord, length
    • Testis, in three dimensions
    • Tunica vaginalis
    • Soft tissue/skin attached (if present), in three dimensions
    • Other, specify

    Specimen integrity

    • Intact
    • Disrupted or opened, describe

    Dissection

    Paint the tunica with ink, if adherent and record the colours applied.

    Take a transverse section of the proximal and mid-spermatic cord together with a shave section from the spermatic cord resection margin before opening the testis. This is essential to prevent contamination with displaced tumour from the tumour on the surgical blade. Transversely section the whole length of the cord and examine for tumour.

    Open the tunica vaginalis along the anterior border, noting any adherence to the tunica albuginea away from the cord that might indicate tumour invasion. Any abnormalities of the surface of the tunica vaginalis or tunica albuginea should be recorded. Describe the quantity and nature of any intratunical fluid.

    Orientate the testis (epididymis is located on posterior surface of testis with head of epididymis at superior pole). Bisect the testis in the longitudinal plane, through the epididymis.

    After bisecting, leave the specimen in larger quantity of formalin for further fixation.

    Ink is not generally necessary. Dissect in a similar manner to orchidectomy for tumour and process as described below.


    Internal Inspection

    Describe the cut surface appearance including the following items:1,4

    Spermatic cord abnormalities

    • No
    • Yes, describe

    Tunica vaginalis or tunica albuginea abnormalities

    • No
    • Yes, describe

    Intratunical fluid (if present)

    • Quantity (ml)
    • Nature, describe

    Specimen size (mm)

    • Testis (without tunical sac) in three dimensions

    Tumour

    • Absent
    • Present
    • Multinodularity
      • Absent
      • Present
      • Number; if more than one tumour, designate and describe each tumour separately

    Tumour size (mm)

    • In three dimensions

    Tumour description

    Colour

    • Describe

    Appearance (homogeneity/heterogeneity)

    • Uniform
    • Variegated

    Consistency

    (more than one may apply)
    • Firm
    • Solid
    • Cystic
    • Gelatinous

    Cysts

    • Absent
    • Present

    Bone

    • Absent
    • Present

    Haemorrhage

    • Absent
    • Present

    Necrosis

    • Absent
    • Present

    Macroscopic extent of tumour

    (more than one may apply)

    • Confined to testis
    • Invades hilar soft tissues
    • Invades epididymis
    • Invades tunica vaginalis
    • Invades scrotum
    • Invades spermatic cord

    Uninvolved testis appearance (background parenchyma)

    • Normal parenchyma (soft yellow/tan) and paratesticular tissue
    • Abnormal parenchyma (more than one may apply)
      • Fibrosis (areas of scarring may be present in metastatic germ cell neoplasms)
      • Haemorrhage
      • Infarction/ischaemia
      • Rupture
      • Maximum size of abnormality (mm)
      • Structures involved by abnormality, describe

    Retrieved from resection specimen

    • Describe site(s)
    • Number retrieved

    Separately submitted

    • For each specimen container, record specimen number and designation
    • Collective size of tissue in three dimensions (mm)
    • Number of grossly identified lymph nodes submitted
    • Maximum diameter of each (mm)

    Photograph the dissected specimen.

    Note photographs taken, diagrams recorded and markings used for identification.


    Processing

    Dissect the specimen further and submit sections for processing according to the diagram provided.

    Tumour sampling should be generous to ensure documentation of all tumour types present. This is important, as the finding of other tumour types may alter the clinical management of the patient. It is important that blocks include the adjacent testicular parenchyma to allow for the assessment of lymphovascular invasion and germ cell neoplasia in situ.

    Extratesticular extension is most likely to occur at the hilum and can be unidentifiable macroscopically. Even if tumour is distant, it is recommended to include a section of hilum to show that it is free from tumour.5 The sample needs to be thoroughly examined with all nodes submitted for microscopic examination. If performed carefully, there should be at least 50 nodes identified. All lymph node tissue should be included for histologic examination.

    Different areas of the tumour must be sampled, particularly including haemorrhagic and necrotic areas and solid/fleshy areas. All of the haemorrhagic tumour must be blocked, as choriocarcinoma is often haemorrhagic with little residual viable tumour.

    Sections of tumour should include at least one section showing the relation of the tumour to the testicular hilum. If the tumour is well away from the hilum, there should be a separate section of the hilum clearly showing this region is free of tumour. Sections of tumour should include the adjacent tunica albuginea and adjacent testicular parenchyma. Sections of uninvolved testicular parenchyma and a longitudinal section of the epididymis should be included. Specifically, in the case of partial orchidectomy specimens, it is important that the intratesticular surgical margin is carefully evaluated to ensure that no residual tumour is present in the remaining testis.

    In adjuvant chemotherapy specimens, sampling can be more difficult because necrosis is frequently (but not always) present.

    As a general rule, one block per 10mm of lesional tissue should be submitted, and all variegated areas should be sampled.

    Submit representative sections of:

    • Spermatic cord
      • Shave section of surgical margin
      • Mid and proximal spermatic cord
    • Tumour
      • Submit all if <20mm
      • Submit all if fibrosis/an area of scarring is present
      • 1 section per 10mm of tumour
      • All haemorrhagic areas
      • Sections including rete and epididymis
      • Section of tumour closest to tunica albuginea/vaginalis
      • Interface with background testicular parenchyma5

    Submit all lymph nodes, recording the number in each cassette

    No focal lesions present

    Submit one representative section from each testis.

    Abnormalities present

    Submit representative sections of:

    • Lesion, 2-3 sections
    • Paratesticular structures involved
    • Interface with uninvolved testis

    Record details of each cassette.

    An illustrated block key similar those provided below may be useful.

    Block allocation key

    Cassette id.
    Site
    No. of pieces
    A
    Shave cord margin
     
    B
    Mid cord
     
    C
    Proximal cord
     
    D-E
    Testis tumour
     
    F
    Tumour closest to tunica
     
    G
    Tumour to rete/epididymis
     
    H-I
    Haemorrhagic areas (if present)
     
    J
    Tumour with background parenchyma
     
    K+
    Lymph nodes
     
    Cassette id.
    Site
    No. of pieces
    A
    Shave cord margin
     
    B-D
    Testis –representative sections
     
    E
    Epididymis
     
     

    Acknowledgements

    A/Prof Hemamali Samaratunga and Dr David Clouston for their contributions in reviewing and editing this protocol.


    References

    1. Berney D, Theaker J, Verrill C. Dataset for histopathology reporting of testicular neoplasms, The Royal College of Pathologists, London, 2014.
    2. Bharadwa J and Nargund VH. Re: Leroy X, Rigot J-M, Aubert S, Ballereau C, Gosselin B. Value of frozen section examination for the management of nonpalpable incidental testicular tumors. Eur. Urol. 2003;44:458-60. Eur Urol 2004;45(3):390-391; author reply 391-392.
    3. Dieckmann KP. Reply to J. Bharadwa and V.H. Nargund; Re: Leroy X, Rigot JM, Aubert S, Ballereau C, Gosselin B. Value of frozen section examination for the management of nonpalpable incidental testicular tumors. Eur. Urol. 2003;44:458-60. Eur Urol 2004;45(3):391-392.
    4. Clouston D, Charles A, Delahunt B, Davis I, Delprado W, Eade T, Kench J, Lawrentschuk N and Samaratunga H. Testicular tumours structured reporting protocol, The Royal College of Pathologists of Australasia, Surry Hills, NSW, 2011.
    5. Dry SM and Renshaw AA. Extratesticular extension of germ cell tumors preferentially occurs at the hilum. Am J Clin Pathol 1999;111(4):534-538.
    6. O’Rourke D, Turner G and Allen D. Tissue Pathways for Urological Pathology, The Royal College of Pathologists, London, 2010.

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      Testis 2

      Testis dissection

      Testis 1

      Testis tumour with haemorrhage

      Testis 3

      Testis with seminoma

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      25-Mar-2019
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