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JU Insight: Malignancy Yield of Testis Pathology in Older Boys and Adolescents with Cryptorchidism
By: Rena Xu, MD, MBA; Joseph W. McQuaid, MD, MPH; Vera A. Paulson, MD, PhD; Michael P. Kurtz, MD, MPH; Tanya Logvinenko, PhD; Richard N. Yu, MD, PhD; Richard S. Lee, MD; Caleb P. Nelson, MD, MPH | Posted on: 01 Mar 2022
Xu R, McQuaid JW, Paulson VA et al: Malignancy yield of testis pathology in older boys and adolescents with cryptorchidism. J Urol 2021; 207:220. https://doi.org/10.1097/JU.0000000000002345.
Study Need and Importance: Cryptorchidism is associated with an increased risk of testis cancer, and the risk of malignancy has been shown to increase with age at the time of orchiopexy. Data on the prevalence of malignant changes in older boys and adolescents, however, are limited. This retrospective study aimed to characterize the pathological findings of testis biopsy and orchiectomy specimens from older boys and adolescent males who underwent surgery for cryptorchidism.
What We Found: Seventy-one patients who underwent orchiopexy with testis biopsy or orchiectomy for cryptorchidism from 1994 to 2016 at a pediatric hospital were included in the study. All patients were age 10 years or older (median age 15.3 years). None had a history of testicular malignancy or differences of sexual development. Malignancy was detected in 2 of 71 patients (2.8%); both cases were in patients undergoing unilateral orchiectomy for intra-abdominal testes. No evidence of malignancy was observed in specimens from the 55 patients with extra-abdominal testes (see figure).
Limitations: Our study is limited by its single-institution, retrospective design. All patients underwent tissue sampling, which introduces some selection bias. Further, the study does not distinguish between primary undescended testes and ascending testes; these 2 populations likely carry different malignancy risks. In practice, however, differentiating between these 2 groups is challenging, so aggregated data may be the most clinically relevant. Finally, this study does not predict future malignancy risk; additional prospective studies with long-term followup will be valuable in this regard.
Interpretations for Patient Care: Our findings suggest that, for older boys and adolescent males with intra-abdominal testes, biopsy or orchiectomy should be considered, as these may demonstrate malignancy. In contrast, for patients of comparable age with inguinal or scrotal undescended testes, biopsy is likely to be very low yield and may not be necessary.