AJSP2504 - CME/CMLE - Factors Impacting Tumor Displacement Artifact and Pseudo- Lymphovascular Invasion in Testicular Germ Cell Tumors-Factors Impacting Tumor Displacement Artifact and Pseudo- Lymphovascular Invasion in Testicular Germ Cell Tumors

Factors Impacting Tumor Displacement Artifact and Pseudo- Lymphovascular Invasion in Testicular Germ Cell Tumors

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The study, published in the American Journal of Clinical Pathology, addresses the challenges in evaluating testicular germ cell tumors due to tumor displacement artifact (TDA) and pseudo-lymphovascular invasion (pseudo-LVI), particularly in seminomas. The research, conducted by Reem O. Ahmed and Debra L. Zynger of The Ohio State University, underscores the susceptibility of these tumors to TDA, complicating the identification of true lymphovascular invasion (LVI).<br /><br />Key findings indicate that both seminomas and larger germ cell tumors exhibit a higher propensity for TDA and pseudo-LVI. The study analyzed 121 orchiectomy cases retrospectively, revealing that seminomas showed significantly more TDA (68%) and pseudo-LVI (53%) than mixed germ cell tumors (45% and 19%, respectively). Notably, tumors with a higher seminoma composition displayed increased rates of TDA and pseudo-LVI.<br /><br />The research emphasizes that extended formalin fixation improves histologic quality, reducing these artifacts. Results demonstrated that a fixation period of more than one night significantly decreased TDA in seminomas. The findings advocate for a minimum of two nights of formalin fixation for orchiectomy specimens, especially for larger tumors, to enhance diagnostic accuracy and avoid the risk of misdiagnosis, which can lead to incorrect therapeutic interventions.<br /><br />The study also underscores the importance of proper specimen handling, recommending increased specimen container sizes to ensure adequate fixation, aiming for a formalin to tissue volume ratio of at least 15:1 to optimize morphologic preservation. This research contributes to improving testicular germ cell tumor evaluations, guiding pathological practices to minimize artifact-related discrepancies and supporting more accurate clinical decision-making.

Keywords

testicular germ cell tumors

tumor displacement artifact

pseudo-lymphovascular invasion

seminomas

formalin fixation

orchiectomy

diagnostic accuracy

specimen handling

pathological practices

clinical decision-making