Histopathological Spectrum of Postchemotherapy Retroperitoneal Lymph Node Dissection in Testicular Cancer: The Impact of Sampling Adequacy and Viable Nonteratomatous Germ Cell Tumor

Objective: In advanced-stage testicular cancer, postchemotherapy retroperitoneal lymph node dissection (RPLND) is performed to manage residual retroperitoneal masses. This study evaluated the histopathological features and their associations with primary tumor and clinical outcomes.

Methods: Postchemotherapy RPLNDs performed between 2000 and 2024 were reviewed and classified as no tumor, teratoma, nonteratomatous germ cell tumor (NTGCT), or somatic malignancy. Corresponding orchiectomy pathology and clinical data were analyzed for primary tumor, treatment, and follow-up.

Results: A total of 151 RPLNDs were evaluated. Median age was 26 years (IQR: 24.7–28.4), and mean largest clinical mass diameter was 62.4 ± 38.6 mm. Diagnoses were teratoma in 87 (57.6%), no tumor in 34 (22.5%), NTGCT and teratoma in 11 (7.3%), NTGCT in 11 (7.3%), and somatic-type malignancy in 8 (5.3%). Embryonal carcinoma in orchiectomy was significantly more frequent in patients with malignancy in RPLND (P = .018). Mean number of paraffin blocks was 10.7 ± 6.62, and malignancy was significantly higher in specimens with ≥10 blocks compared to those with <10 (P = .014). Follow-up data were available for 101 (66.9%), with median follow-up of 85.5 months (IQR: 70.7–100.1); 24 (23.8%) patients died. Mortality was significantly higher in patients with malignant tumor in RPLND (50%) compared to those without malignancy (17.3%) (P = .002). In univariate logistic regression analyses, RPLND tumor diameter (odds ratio [OR]: 1.012, 95% CI: 1.004–1.021; P = .005), malignancy in RPLND (OR: 3.787, 95% CI: 1.669–8.594; P = .001), NTGCT in RPLND (OR: 3.451, 95% CI: 1.473–8.083; P = .004), and yolk sac tumor in orchiectomy (OR: 0.220, 95% CI: 0.049–0.985; P = .048) were associated with overall mortality. In multivariate analysis, only RPLND tumor diameter remained an independent predictor (OR: 1.018, 95% CI: 1.000–1.035; P = .045).

Conclusion: Postchemotherapy RPLND most frequently revealed teratoma, while larger tumor diameter independently predicted malignant findings and adequate sampling increased malignancy detection.

Cite this article as: Hürdoğan Ö, Cantürk Z, Ugar M, et al. Histopathological spectrum of postchemotherapy retroperitoneal lymph node dissection in testicular cancer: the impact of sampling adequacy and viable nonteratomatous germ cell tumor. Cerrahpaşa Med J, 2026, 50, 0037, doi: 10.5152/cjm.2026.26037.