Angiogenesis and lymphangiogenesis in stage 1 germ cell tumours of the testis

Objective To determine whether angiogenesis can be used as an additional pr ognostic indicator in patients with stage 1 germ cell tumours of the testis . Patients and methods Paraffin sections were assessed immunohistochemically from 51 patients with clinical stage I germ cell tumours of the testis (28 seminoma, 23 teratoma) treated by orchidectomy and surveillance only. Secti ons were analysed for microvascular density (MVD). and expression of the an giogenic factors vascular endothelial growth factor (VEGF) and thymidine ph osphorylase (TP). In addition, in the seminoma cases the presence of mRNA f or the lymphangiogenic factor VEGF-C was examined bg in situ hybridization, and its corresponding receptor VEGFR-3 by immunohistochemistry. Results Teratoma specimens had a significantly higher mean (range) MVD (85, 26-163; P < 0.01) than both seminoma (37, 16-91) and four normal specimens (26, 18-30). Teratoma specimens also had significantly higher VEGF express ion than both seminoma and normal specimens (P < 0.01). Despite these diffe rences between groups, and indeed individual tumours, there was no signific ant correlation between MVD and VEGF, or between either MVD or VEGF and rel apse-free survival. TP expression was significantly greater in tumours than in normal specimens (P < 0.02) but with very little inter-tumour variation . VEGF-C mRNA and VEGFR-3 protein were detected in a third to a half of cas es, with expression mostly around endothelial vessels. Conclusions The marked differences between normal testis and tumours implic ate angiogenesis in the biology of germ cell tumours of the testis, In addi tion, the detection of factors involved in lymphangiogenesis in some semino mas, tumours which initially metastasize primarily to lymph nodes, indicate that although not prognostic in this study, further studies are warranted in both these areas in the search for further prognostic indicators and the rapeutic targets.