Login to Access Video or Poster Abstract: MP07-07
Sources of Funding: None

Introduction

Testicular cancer is the most common malignancy affecting men in their fertile years. One in ten are azoospermic, when banking sperm, at initial presentation. Knowledge of patients' fertility potential and sperm count, prior to orchidectomy, may allow potential sperm retrieval from the testis removed during surgery. We assessed orchidectomy specimens to identify whether spermatogenesis was present in malignant testes, and what features affected spermatogenesis.

Methods

A retrospective review of 103 radical orchidectomy specimens for germ cell tumours, from 2011 to 2016, by a single expert pathologist (CH), was conducted. Tumour stage, type, volume, presence of testicular microlithiasis (TML) and the relationship to spermatogenesis (focal/widespread) were assessed and compared using Chi Square (significance p<0.0.5).

Results

Overall spermatogeneis was seen in 72/103 (70%), it was focal in 27/72 (38%) and it was widespread in 45/72 (62%). Neither tumour type (seminoma vs. non seminoma, p=0.87), stage (T1 vs. T3, p=0.09), nor presence of TML (p=0.12) were significantly related to spermatogenesis. The percentage volume of testis affected by tumours did significantly correlate with spermatogenesis (28.3% with sperm vs. 48.4% when no sperm found, p=0.05)._x000D_ _x000D_ _x000D_ _x000D_

Conclusions

Spermatogeneis is present in the majority of testes affected by germ cell tumours (70%), and it does not appear to be related to any tumour pathology, apart from percentage tumour volume. Sperm extraction at the time of orchidectomy is a sensible approach, as testis specimens, destined for the pathology lab, would otherwise be a waste of functionally viable tissue. Given that spermatogenesis was focal in 38%, sperm retrieval is best performed with a microTESE (onco microTESE) to allow identification of these small foci. In our own experience, we have found sperm in 60% of patients with testicular tumour and azoospermia, at first presentation, using this technique. A change in focus to identify the azoospermic patient, prior to orchidecotmy, is vital to allow such an approach to be adopted.

Funding

None