Lymphovascular invasion in testicular germ cell tumors: clinicopathological correlates

INTRODUCTION We assessed clinical-pathological correlates of lymphovascular invasion in testicular germ-cell tumors. MATERIAL AND METHODS Archived pathology specimens from 145 patients treated by radical orchiectomy for testicular germ cell tumors at our institution in 1995-2006 were reanalyzed by a dedicated urologic pathologist, and the corresponding medical records were reviewed. The association of lymphovascular invasion with clinical and pathological parameters was tested using stepwise logistic regression analysis. RESULTS Lymphovascular invasion was identified in 38 (26%) patients and was associated with younger age, testicular pain at presentation, elevated serum tumor markers, nonseminoma histology, and advanced clinical stage. Orchalgia was indicated as the impetus for referral in 67 (46%) patients and characterized as a dull aching sensation, persistent or intermittent in nature. Among the 98 men diagnosed with clinical stage I, those presenting with testicular pain had a 1.8X-higher likelihood of lymphovascular invasion than those without pain (95% CI 1.13-14.9, p = 0.02), and patients with elevated serum tumor markers had an 8.5-fold increased probability of lymphovascular invasion than those presenting with normal tumor markers (CI 1.1-54.2, p = 0.05). Among men with nonseminoma histology, elevated tumor markers was the strongest predictor of lymphovascular invasion in both univariate and multivariate analyses (OR 5.05, 95% CI 1.16-21.8, p = 0.03). CONCLUSION Providing pathologists with information on pre-orchiectomy tumor marker levels and, possibly, testicular pain at presentation may increase their vigilance in searching for lymphovascular invasion, potentially improving their diagnostic accuracy. Whether it may also translate into improved oncological outcomes needs further evaluation.