Examination of the removed testicle and its appendix in case of tumor pathology (PG053)

Pathomorphological examination in radical orchiectomy — is a fundamental analysis of the entire array of tissues (testis, appendix, membranes and spermatic cord) removed due to a confirmed or suspected malignant neoplasm. Code PG053 provides detailed tumor staging, which is critical for determining the further strategy: observation, chemotherapy or radiation treatment.

Research objective: The main task is to accurately identify the histological type of the tumor and assess risk factors. Because testicular cancer is often mixed (consisting of multiple types of cancer cells), the pathologist must examine multiple sections to ensure that the most aggressive component is not missed.

What does the pathologist evaluate:

• Histological subtype: determining whether the tumor is a seminoma or nonseminoma (embryonic carcinoma, teratoma, yolk sac tumor, choriocarcinoma).

• Size and location: measuring the maximum diameter of the tumor and its relationship to surrounding structures.

• Invasion of structures: whether the tumor has grown into the epididymis, appendix (epididymis), or spermatic cord tissue.

• Lymphovascular invasion (LVI): The presence of cancer cells in the lumen of blood vessels is a key prognostic marker indicating a high probability of metastasis.

• Condition of the resection margins: checking the spermatic cord cut line for the absence of tumor cells.

• GCNIS availability: detection of background intratubular germ cell neoplasia.

Clinical significance: The PG053 diagnosis forms the basis of the TNM staging system for cancer. For example, the presence of only a small seminoma without vascular invasion may allow the patient to be confined to active surveillance. On the other hand, the detection of choriocarcinoma or embryonal carcinoma with vascular invasion usually requires immediate chemotherapy.

When is it prescribed:

• after radical inguinal orchiectomy for suspected cancer;

• removal of the testicle when solid (dense) neoplasms are detected according to ultrasound data;

• the presence of elevated levels of tumor markers (AFP, hCG, LDH) in combination with a tumor in the scrotum;

• tumor recurrence after previous organ-sparing treatment.