Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Intraoperative Consultation and Macroscopic Handling: The International Society of Urological Pathology (ISUP) Testicular Cancer Consultation Conference Recommendations

Verrill, Clare, FRCPath*; Perry-Keene, Joanna, MD; Srigley, John, R., MD; Zhou, Ming, MD§; Humphrey, Peter, A., MD; Lopez-Beltran, Antonio, MD; Egevad, Lars, MD#; Ulbright, Thomas, M., MD**; Tickoo, Satish, K., MD††; Epstein, Jonathan, I., MD‡‡; Compérat, Eva, MD§§; Berney, Daniel, M., FRCPath∥∥the Members of the ISUP Testicular Tumor Panel

The American Journal of Surgical Pathology: June 2018 - Volume 42 - Issue 6 - p e33–e43
doi: 10.1097/PAS.0000000000001049
Special Article

The International Society of Urological Pathology held a conference on issues in testicular and penile pathology in Boston in March 2015, which included a presentation by the testis macroscopic features working group. The presentation focused on current published guidance for macroscopic handling of testicular tumors and retroperitoneal lymph node dissections with a summary of results from an online survey of members preceding the conference. The survey results were used to initiate discussions, but decisions on practice were made by expert consensus rather than voting. The importance of comprehensive assessment at the time of gross dissection with confirmation of findings by microscopic assessment was underscored. For example, the anatomic landmarks denoting the distinction of hilar soft tissue invasion (pT2) from spermatic cord invasion (pT3 category) can only be determined by careful macroscopic assessment in many cases. Other recommendations were to routinely sample epididymis, rete testis, hilar soft tissue, and tunica vaginalis in order to confirm macroscopic invasion of these structures or if not macroscopically evident, to exclude subtle microscopic invasion. Tumors 2 cm or less in greatest dimension should be completely embedded. If the tumor is >2 cm in greatest dimension, 10 blocks or a minimum of 1 to 2 additional blocks per centimeter should be taken (whichever is greater).

*Nuffield Department of Surgical Sciences and NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford

∥∥Department of Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK

Aquesta Specialised Uropathology and Department of Pathology, Sunshine Coast University Hospital, Sunshine Coast, Qld., Australia

Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada

§Department of Pathology, NYU School of Medicine

††Department of Pathology, Memorial Sloan Kettering Cancer Centre, New York, NY

Department of Pathology, Yale School of Medicine, New Haven, CT

Department of Pathology, University of Cordoba, Cordoba, Spain

#Department of Pathology and Cytology, Karolinska Hospital, Stockholm, Sweden

**Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN

‡‡Department of Pathology, John Hopkins Hospital, Baltimore, MD

§§Department of Pathology, Hopital Tenon, Université Pierre et Marie Curie, Paris VI, Paris, France

Members of the ISUP testicular tumor panel: Amin MB, Delahunt B, Magi-Galluzzi C, Algaba F, Montironi R, Young RH, Idrees MT, Williamson SR, Yilmaz A.

C.V. and J.P.-K. contributed equally to the manuscript.

Conflicts of Interest and Source of Funding: The International Society of Urological Pathology (ISUP) 2015 consultation on testis and penile cancer was generously supported by Orchid. Clare Verrill’s research time is supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC) (Molecular Diagnostics Theme/Multimodal Pathology Subtheme). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Correspondence: Clare Verrill, FRCPath, Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK (e-mail:

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.