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Diagnosis of testicular carcinoma in situ ‘(intratubular and microinvasive)’ seminoma and embryonal carcinoma using direct enzymatic alkaline phosphatase reactivity on frozen histological sections
Author(s) -
Stoop Hans,
Kirkels Wim,
Dohle Gert R,
Gillis Ad J M,
den Bakker Michael A,
Biermann Katharina,
Oosterhuis Wolter,
Looijenga Leendert H J
Publication year - 2011
Publication title -
histopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.626
H-Index - 124
eISSN - 1365-2559
pISSN - 0309-0167
DOI - 10.1111/j.1365-2559.2011.03767.x
Subject(s) - seminoma , placental alkaline phosphatase , pathology , embryonal carcinoma , alkaline phosphatase , staining , immunohistochemistry , carcinoma , carcinoma in situ , h&e stain , biology , medicine , cellular differentiation , biochemistry , chemotherapy , gene , enzyme
Stoop H, Kirkels W, Dohle G R, Gillis A J M, den Bakker M A, Biermann K, Oosterhuis W & Looijenga L H J
(2011) Histopathology 58 , 440–446
Diagnosis of testicular carcinoma in situ ‘(intratubular and microinvasive)’ seminoma and embryonal carcinoma using direct enzymatic alkaline phosphatase reactivity on frozen histological sections Aims: Testis‐sparing surgery might benefit quality of life, but can only be applied with histological examination for the presence of invasive germ cell tumour components, and the precursor carcinoma in situ (CIS). Currently, diagnosis is based on paraffin‐embedded tissue, therefore a delay in further surgery is mainly unavoidable. The aim was to develop an intraoperative assessment technique using alkaline phosphatase as a marker. Methods and results: A total of 4093 snap‐frozen samples and matched paraffin‐embedded tissue of 1500 patients were included. Besides standard haematoxylin and eosin (H&E) staining, the direct enzymatic alkaline phosphatase reactivity (dAP) test (duration 15 min) was applied on frozen sections, while H&E and immunohistochemistry for detection of OCT3/4, α‐fetoprotein, human chorionic gonadotrophin (hCG) and cytokeratin was performed on the paraffin‐embedded slides. Endothelial cells served as control for the dAP test. Positive staining was found in all CIS ( n = 965), seminoma ( n = 1035) and embryonal carcinoma ( n = 584), either intratubular, microinvasive or invasive. Differentiated non‐seminomas ( n = 1238) showed variable staining. No staining was identified in spermatocytic seminomas ( n = 5), testicular lymphomas ( n = 42), testicular rhabdomyosarcomas ( n = 7), Leydig cell tumours ( n = 31), Sertoli‐cell‐only nodules ( n = 4), (epi) dermoid cyst ( n = 16), normal testicular parenchyma ( n = 116), testicular torsion ( n = 32) and inflammation of the epididymis ( n = 19). The dAP test results matched H&E‐stained parallel sections, as well paraffin‐embedded tissue analysis, including immunohistochemistry. Conclusions: The dAP test is an informative, reproducible and easy tool to diagnose CIS, (intratubular and microinvasive) seminoma and embryonal carcinoma on frozen tissue sections, being of great value in the context of sparing surgery.