Diagnosis and follow-up of testicular carcinoma in situ by DNA image cytometry.

Abstract

Carcinoma in situ (CIS) of the testis has been described as precursor of all types of germ cell cancer except spermatocytic seminoma. At present the diagnosis of CIS is based on light microscopic examination of a testis biopsy specimen. A series of 50 infertile patients underwent both surgical testis biopsy and aspiration biopsy as part of a study protocol in order to assess spermatogenesis. In 1 patient embryonal carcinoma and contralateral CIS was diagnosed, in 1 patient bilateral CIS was discovered. Diagnosis of CIS was made by DNA image cytometry of the testis aspiration biopsy: a typical aneuploid cell population was shown consistent with malignancy. Follow-up was performed by repeated aspiration testis biopsies: DNA histograms showed complete absence of haploid cells consistent with Sertoli-cell-only syndrome in the patient with unilateral germ cell cancer and contralateral CIS treated with localized radiation. In the other patient no treatment was performed and DNA histograms continuously showed an aneuploid cell population consistent with persistent CIS. No invasive cancer developed within 4 years after diagnosis. Our results underline the potential use of DNA cytometry in the diagnosis and follow-up, of CIS of the testis offering the advantage of an objective and rapid technique.