Testis

• No
  • Non-routine fixation (not formalin), describe.

• Yes
  • Special studies required, describe.
  • Ensure samples are taken prior to fixation.

• Not performed
• Performed, describe type and result
  • Frozen section
  • Imprints
  • Other, describe

Record additional orientation or designation provided by operating clinician:

• Absent
• Present
  • Method of designation (e.g. suture, incision)
  • Featured denoted

• Needle biopsy –see Genitourinary small biopsies protocol
• Partial orchidectomy
• Simple orchidectomy
  • Unilateral
  • Bilateral –designate each testis numerically (correlating with ink markings) and describe separately
• Radical orchidectomy
• Retroperitoneal lymph node dissection
• Other, describe

Paint the tunica with ink, if adherent and record the colours applied.

Take a transverse section of the proximal and mid-spermatic cord together with a shave section from the spermatic cord resection margin before opening the testis. This is essential to prevent contamination with displaced tumour from the tumour on the surgical blade. Transversely section the whole length of the cord and examine for tumour.

Open the tunica vaginalis along the anterior border, noting any adherence to the tunica albuginea away from the cord that might indicate tumour invasion. Any abnormalities of the surface of the tunica vaginalis or tunica albuginea should be recorded. Describe the quantity and nature of any intratunical fluid.

Orientate the testis (epididymis is located on posterior surface of testis with head of epididymis at superior pole). Bisect the testis in the longitudinal plane, through the epididymis.

After bisecting, leave the specimen in larger quantity of formalin for further fixation.

Ink is not generally necessary. Dissect in a similar manner to orchidectomy for tumour and process as described below.

Retrieved from resection specimen

• Describe site(s)
• Number retrieved

Separately submitted

• For each specimen container, record specimen number and designation
• Collective size of tissue in three dimensions (mm)
• Number of grossly identified lymph nodes submitted
• Maximum diameter of each (mm)

Tumour sampling should be generous to ensure documentation of all tumour types present. This is important, as the finding of other tumour types may alter the clinical management of the patient. It is important that blocks include the adjacent testicular parenchyma to allow for the assessment of lymphovascular invasion and germ cell neoplasia in situ.

Extratesticular extension is most likely to occur at the hilum and can be unidentifiable macroscopically. Even if tumour is distant, it is recommended to include a section of hilum to show that it is free from tumour.⁵ The sample needs to be thoroughly examined with all nodes submitted for microscopic examination. If performed carefully, there should be at least 50 nodes identified. All lymph node tissue should be included for histologic examination.

Different areas of the tumour must be sampled, particularly including haemorrhagic and necrotic areas and solid/fleshy areas. All of the haemorrhagic tumour must be blocked, as choriocarcinoma is often haemorrhagic with little residual viable tumour.

Sections of tumour should include at least one section showing the relation of the tumour to the testicular hilum. If the tumour is well away from the hilum, there should be a separate section of the hilum clearly showing this region is free of tumour. Sections of tumour should include the adjacent tunica albuginea and adjacent testicular parenchyma. Sections of uninvolved testicular parenchyma and a longitudinal section of the epididymis should be included. Specifically, in the case of partial orchidectomy specimens, it is important that the intratesticular surgical margin is carefully evaluated to ensure that no residual tumour is present in the remaining testis.

In adjuvant chemotherapy specimens, sampling can be more difficult because necrosis is frequently (but not always) present.

As a general rule, one block per 10mm of lesional tissue should be submitted, and all variegated areas should be sampled.

Submit representative sections of:

• Spermatic cord
  • Shave section of surgical margin
  • Mid and proximal spermatic cord
• Tumour
  • Submit all if <20mm
  • Submit all if fibrosis/an area of scarring is present
  • 1 section per 10mm of tumour
  • All haemorrhagic areas
  • Sections including rete and epididymis
  • Section of tumour closest to tunica albuginea/vaginalis
  • Interface with background testicular parenchyma⁵

Submit all lymph nodes, recording the number in each cassette

No focal lesions present

Submit one representative section from each testis.

Abnormalities present

Submit representative sections of:

• Lesion, 2-3 sections
• Paratesticular structures involved
• Interface with uninvolved testis