Prevalence of intratubular germ cell neoplasia of the testis

Objective: Intratubular germ cell neoplasia has been described as a premali gnant state with the potential to progress to invasive carcinoma of the tes tis. We determined the prevalence of intratubular germ cell neoplasia in re lation to the associated pathology in testicular biopsies from infertile me n and in orchidectomies performed for both neoplastic and nonneoplastic con ditions. Methods: We reviewed all testicular biopsies performed for the investigatio n of infertility and orchidectomy specimens of non-neoplastic conditions an d testicular tumors seen during a period of 10 years at King Khalid Univers ity Hospital. Histopathological examination of all specimens to determine t he presence of intratubular germ cell neoplasia was carried out. Immunohist ochemistry for placental alkaline phosphatase was performed on formalin-fix ed and Bouin's-fixed specimens with intratubular germ cell neoplasia, posit ive and negative controls were also stained for comparison. Results: The review included a total of 548 male patients. The incidence of intra:tubular germ cell neoplasia in 244 testicular biopsies from infertil e 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 orchidec tomies performed for maldescended testes and in 2 cases of the androgen ins ensitivity syndrome. All cases of intratubular germ cell neoplasia identifi ed in this review were not described at the time of primary pathological ex amination of the biopsies and orchidectomy specimens. Conclusions: Awareness of this clinicopathological entity is essential to d escribe and detect this form of testicular cancer at the preinvasive state. The prevalence of intratubular germ cell neoplasia is low in Saudi patient s particularly in the high risk group of patients with cryptorchidism. Furt hermore our results do not support the need for routine biopsy of the testi s of infertile or cryptorchid patients unless sampling is indicated in prep aration of assisted fertilization technique or orchidopexy.