Pathology report question

[leaffan-Dave]

Can anyone explain a couple of things on my report.
1) "the tumour is a spermatocytic seminoma showing the usual three cell types."

Is Seminoma not one type of cell?

2) "intratubular germ cell neoplasia is noted adjacent to the tumour"

What exactly is this?

I was told that it was pure seminoma and finally got around to getting this report from my doctor. Just wondering....

[clyde_on]

here ya go

Clinics and Pathology


Disease Spermatocytic seminoma has a relatively mild clinical course. Most patients present with a painless swelling of one testis, but in some cases tenderness was reported. Metastases are very rare and have been basically reported only in cases with sarcomatous transformation.
Phenotype / cell stem origin The origin of spermatocytic seminoma from the germ cell lineage has been clearly demonstrated by a number of studies, however the cell of origin have been a matter of debate. The initial hypothesis suggested that the spermatocyte was the progenitor cell and the tumour might contain post-meiotic haploid cells. Subsequent studies failed to find haploid DNA values, thus arguing against a true meiotic-phase tumour. Other hypotheses stipulated that spermatocytic seminoma might be a better differentiated variant of classical seminoma (composed of cells differentiating in the direction of spermatocytes but which have not yet reached this stage) or may originate from type B (dark) spermatogonia, which are committed to enter meiosis. Finally, some researchers suggested that spermatocytic seminoma might be derived from primordial germ cells or gonocytes. The current consensus, based on comparative studies of the phenotypes of spermatocytic seminoma, normal germ cells and other germ cell derived tumours, is that spermatocytic seminoma is derived from spermatogonia that are committed to enter meiosis but have not yet done so.
Importantly, spermatocytic seminoma is not derived from carcinoma in situ (CIS), the gonocytes-like intratubular precursor lesion for germ cell tumours of adolescents and young adults (classical seminoma and non-seminoma).
Etiology Aetiology of spermatocytic seminoma is unknown.
Epidemiology Spermatocytic seminoma is rare and represents around 2-5% of seminomas. It occurs in patients at 45-80 years of age, and is extremely rare in young men under than 35. This is in contrast to the classical seminoma, which demonstrates the peak of age-specific incidence around 35 years of age.
Cytology A characteristic feature of spermatocytic seminoma is the presence of three types of cells with different nuclear size: large, small and intermediate. Some nuclei may exhibit a presence of nuclear thread-like chromatin.

[djmac]

Clinics and Pathology


Disease Spermatocytic seminoma has a relatively mild clinical course. Most patients present with a painless swelling of one testis, but in some cases tenderness was reported. Metastases are very rare and have been basically reported only in cases with sarcomatous transformation.
Phenotype / cell stem origin The origin of spermatocytic seminoma from the germ cell lineage has been clearly demonstrated by a number of studies, however the cell of origin have been a matter of debate. The initial hypothesis suggested that the spermatocyte was the progenitor cell and the tumour might contain post-meiotic haploid cells. Subsequent studies failed to find haploid DNA values, thus arguing against a true meiotic-phase tumour. Other hypotheses stipulated that spermatocytic seminoma might be a better differentiated variant of classical seminoma (composed of cells differentiating in the direction of spermatocytes but which have not yet reached this stage) or may originate from type B (dark) spermatogonia, which are committed to enter meiosis. Finally, some researchers suggested that spermatocytic seminoma might be derived from primordial germ cells or gonocytes. The current consensus, based on comparative studies of the phenotypes of spermatocytic seminoma, normal germ cells and other germ cell derived tumours, is that spermatocytic seminoma is derived from spermatogonia that are committed to enter meiosis but have not yet done so.
Importantly, spermatocytic seminoma is not derived from carcinoma in situ (CIS), the gonocytes-like intratubular precursor lesion for germ cell tumours of adolescents and young adults (classical seminoma and non-seminoma).
Etiology Aetiology of spermatocytic seminoma is unknown.
Epidemiology Spermatocytic seminoma is rare and represents around 2-5% of seminomas. It occurs in patients at 45-80 years of age, and is extremely rare in young men under than 35. This is in contrast to the classical seminoma, which demonstrates the peak of age-specific incidence around 35 years of age.
Cytology A characteristic feature of spermatocytic seminoma is the presence of three types of cells with different nuclear size: large, small and intermediate. Some nuclei may exhibit a presence of nuclear thread-like chromatin.

leaffan-Dave, you should be absolutely psyched! You're a bit young for this type of tumor, but it's as close to benign as you can get with a malignant neoplasm. If you really have this type of cell type, then your chances of metastasis are approaching nil. Are they sure it's spermatocytic?

Intratubular Germ Cell Neoplasia is neoplastic cells within the spermatic tubules, which have not yet formed a tumor.

[leaffan-Dave]

The doctors did not say that it was this type. Urologist and oncologist both said pure seminoma. Same thing? I just really read over this report good and it says spermatocytic. It also says "showing the usual three cell types." Its supposed to be three cell types?

[Fed]

"the tumour is a spermatocytic seminoma showing the usual three cell types."

This does sound a lot like what clyde_on quoted, and that being the case, it sounds like you're in good shape. This quotation is quite detailed, so it doesn't sound like a coincidence to me. Was this from a second opinion or your original assessment?

[djmac]

The doctors did not say that it was this type. Urologist and oncologist both said pure seminoma. Same thing? I just really read over this report good and it says spermatocytic. It also says "showing the usual three cell types." Its supposed to be three cell types?

leaffan-Dave,

They are not the same thing... get this cleared up before you celebrate. If it's 'spermatocytic' and the pathologist is right, then you have a lot to celebrate. If the urologists are right in calling it 'pure', then you can still celebrate.. just a little more cautiously .

By the way, if path says spermatocytic... I would definitely get a second opinion (good idea regardless). If it is spermatocytic, you won't have much to worry about!

[Karen]

leaffan-Dave,

They are not the same thing... get this cleared up before you celebrate. If it's 'spermatocytic' and the pathologist is right, then you have a lot to celebrate. If the urologists are right in calling it 'pure', then you can still celebrate.. just a little more cautiously .

My money is on a correct path and confused urologists. Agree with djmac that a second opinion is always a good idea.

[Karen]

Soon to publish...will post to the research library when it does...

J Urol. 2007 Feb;177(2):734.
Spermatocytic seminoma.
Bomeisl PE, Maclennan GT.
Department of Pathology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio.

PMID: 17222671 [PubMed - in process]

[mikeygti]

Hey Dave

Amongst all the confusion,you are going to be fine !

PS

The Canucks sure gave the Leafs a "spanking" the other night !

[Fed]

By the way, if path says spermatocytic... I would definitely get a second opinion (good idea regardless). If it is spermatocytic, you won't have much to worry about!

Very true on both counts. A second opinion should clarify things considerably. When I was seeking mine, I found it useful to detail in writing the exact questions I had when I shipped the slides. That way, the pathologist doing the second review will know what to look for and will address concerns you might have more specifically.
Either way, you are in great shape, so you should be optimistic about the outcome. Cheers,

[leaffan-Dave]

Thanks for the replys. I am going to the cancer clinic in London Friday for another appointment. I will have the oncologist go over path report in detail with me to clarify my questions and I will let you know.

Dave

PS Mike, 42 years later, and i am still dreaming of a stanley cup win for my leafs. Depressing......

[leaffan-Dave]

update

I have been away for awhile, working too hard, trip to Mexico etc. but I just wanted to post what is going on in my life right now. I did get my doctor to seek a second opinion from from Dr. Jewetts office in Toronto. He reviewed my case files and reported back to my oncologist strongly recommending radiation "due to the inconsistencies" of my pathology report. I should have just gone to Toronto in the first place but..... I have now completed week 1 of four weeks of radiation. My new cancer team in London is great and I meet once a week with the nurse practitioner and the oncologist. I cannot say I am extremely happy having 4 weeks of rad. but glad that I requested the second opinion from a testicular cancer expert and not just go with the initial doctors word. Thats all for now.
Dave

[tccancercop]

Personally, I don't think that these pathology reports make a difference in treatment, so they are pretty much worthless other than knowing what type of cancer it is. Who cares if it has invaded this or that. Point being I had no invasion, no sign of anything outside the testicle but yet it spread a few months later. I think you should base treatment off of lymph nodes and tumor markers and not even think whether or not of any invasions!!!