Prevalence of intratubular germ cell neoplasia of the testis

Intratubular germ cell neoplasia has been described as a premalignant state with the potential to progress to invasive carcinoma of the testis. We determined the prevalence of intratubular germ cell neoplasia in relation to the associated pathology in testicular biopsies from infertile men and in orchidectomies performed for both neoplastic and non-neoplastic conditions. We reviewed all testicular biopsies performed for the investigation of infertility and orchidectomy specimens of non-neoplastic conditions and testicular tumors seen during a period of 10 years at King Khalid University Hospital. Histopathological examination of all specimens to determine the presence of intratubular germ cell neoplasia was carried out. Immunohistochemistry for placenta alkaline phosphatase was performed on formalin-fixed and Bouin's-fixed specimens with intratubular germ cell neoplasia, positive and negative controls were also stained for comparison. The review included a total of 548 male patients. The incidence of intratubular germ cell neoplasia in 244 testicular biopsies from infertile men was 0.82%. The percentage of intratubular germ cell neoplasia seen in 17 orchidectomies performed for invasive germ cell tumors was, however, 47%. Intratubular germ cell neoplasia was not detected in 109 of the orchidectomies performed for maldescended testes and in 2 cases of the androgen insensitivity syndrome. All cases of intratubular germ cell neoplasia identified in this review were not described at the time of primary pathological examination of the biopsies and orchidectomy specimens. Awareness of this clinicopathological entity is essential to describe and detect this form of testicular cancer at the preinvasive state. The prevalence of intratubular germ cell neoplasia is low in Saudi patients particularly in the high risk group of patients with cryptorchidism. Furthermore, our results do not support the need for routine biopsy of the testis of infertile or cryptorchid patients unless sampling is indicated in preparation of assisted fertilization technique or orchidopexy