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Elzeiny H, Agresta F, Stevens J, Gardner DK. A step closer to parenthood with non-obstructive azoospermia: Unveiling the impact of microdissection testicular sperm extraction in Australia's largest single-centre study. Aust N Z J Obstet Gynaecol 2024. [PMID: 38366682 DOI: 10.1111/ajo.13800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 01/21/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Non-obstructive azoospermia (NOA) diagnosis poses challenges for couples seeking parenthood. Microdissection testicular sperm extraction (MD-TESE) excels in retrieving testicular sperm cells for NOA cases. However, limited live birth data in Australian NOA patients hinders accurate counselling. AIMS This study aimed to determine the likelihood of infertile couples with a male partner diagnosed with NOA conceiving biological children using MD-TESE / intracytoplasmic sperm injection (ICSI). MATERIALS AND METHODS A retrospective cohort study included 108 NOA men treated at a public fertility unit and a private fertility centre (May 2009-May 2022). PRIMARY OUTCOME live birth rate (LBR); secondary outcomes: sperm retrieval rate, pregnancy rate, and neonatal outcomes. RESULTS Among 108 patients undergoing MD-TESE, the positive sperm retrieval rate (PSRR) was 64.8% (70/108). Histology best predicted sperm retrieval success, with hypo-spermatogenesis yielding a 94.1% PSRR. Age, testicular volume, and hormonal parameters had no significant impact. Mean male age: 35.4 years; mean partner age: 32.7 years. Fertilisation rate: 50.7%. LBR per initiated cycle: 58.7% (37/63); per embryo transfer: 63.8% (37/58); per initially diagnosed NOA man: 34.3% (37/108). Cumulative LBR: 74.1% (43/58); twin rate: 10.8% (4/37). No neonatal deaths or defects were observed among 47 live offspring. CONCLUSION This study provides valuable data for counselling NOA couples on the probability of conceiving biological offspring. MD-TESE and ICSI yielded favourable PSRR (64.8%) and LBR (63.8%). However, couples should be aware that once NOA is confirmed, the chance of taking home a baby is 34%.
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Affiliation(s)
- Hossam Elzeiny
- Melbourne IVF, East Melbourne, Melbourne, Victoria, Australia
- Reproductive Services Unit, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Franca Agresta
- Melbourne IVF, East Melbourne, Melbourne, Victoria, Australia
| | - John Stevens
- Melbourne IVF, East Melbourne, Melbourne, Victoria, Australia
| | - David K Gardner
- Melbourne IVF, East Melbourne, Melbourne, Victoria, Australia
- School of Bioscience, University of Melbourne, Melbourne, Victoria, Australia
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Cissen M, Meijerink AM, D'Hauwers KW, Meissner A, van der Weide N, Mochtar MH, de Melker AA, Ramos L, Repping S, Braat DDM, Fleischer K, van Wely M. Prediction model for obtaining spermatozoa with testicular sperm extraction in men with non-obstructive azoospermia. Hum Reprod 2016; 31:1934-41. [PMID: 27406950 DOI: 10.1093/humrep/dew147] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 05/02/2016] [Indexed: 11/15/2022] Open
Abstract
STUDY QUESTION Can an externally validated model, based on biological variables, be developed to predict successful sperm retrieval with testicular sperm extraction (TESE) in men with non-obstructive azoospermia (NOA) using a large nationwide cohort? SUMMARY ANSWER Our prediction model including six variables was able to make a good distinction between men with a good chance and men with a poor chance of obtaining spermatozoa with TESE. WHAT IS KNOWN ALREADY Using ICSI in combination with TESE even men suffering from NOA are able to father their own biological child. Only in approximately half of the patients with NOA can testicular sperm be retrieved successfully. The few models that have been developed to predict the chance of obtaining spermatozoa with TESE were based on small datasets and none of them have been validated externally. STUDY DESIGN, SIZE, DURATION We performed a retrospective nationwide cohort study. Data from 1371 TESE procedures were collected between June 2007 and June 2015 in the two fertility centres. PARTICIPANTS/MATERIALS, SETTING, METHODS All men with NOA undergoing their first TESE procedure as part of a fertility treatment were included. The primary end-point was the presence of one or more spermatozoa (regardless of their motility) in the testicular biopsies.We constructed a model for the prediction of successful sperm retrieval, using univariable and multivariable binary logistic regression analysis and the dataset from one centre. This model was then validated using the dataset from the other centre. The area under the receiver-operating characteristic curve (AUC) was calculated and model calibration was assessed. MAIN RESULTS AND THE ROLE OF CHANCE There were 599 (43.7%) successful sperm retrievals after a first TESE procedure. The prediction model, built after multivariable logistic regression analysis, demonstrated that higher male age, higher levels of serum testosterone and lower levels of FSH and LH were predictive for successful sperm retrieval. Diagnosis of idiopathic NOA and the presence of an azoospermia factor c gene deletion were predictive for unsuccessful sperm retrieval. The AUC was 0.69 (95% confidence interval (CI): 0.66-0.72). The difference between the mean observed chance and the mean predicted chance was <2.0% in all groups, indicating good calibration. In validation, the model had moderate discriminative capacity (AUC 0.65, 95% CI: 0.62-0.72) and moderate calibration: the predicted probability never differed by more than 9.2% of the mean observed probability. LIMITATIONS, REASONS FOR CAUTION The percentage of men with Klinefelter syndrome among men diagnosed with NOA is expected to be higher than in our study population, which is a potential selection bias. The ability of the sperm retrieved to fertilize an oocyte and produce a live birth was not tested. WIDER IMPLICATIONS OF THE FINDINGS This model can help in clinical decision-making in men with NOA by reliably predicting the chance of obtaining spermatozoa with TESE. STUDY FUNDING/COMPETING INTEREST This study was partly supported by an unconditional grant from Merck Serono (to D.D.M.B. and K.F.) and by the Department of Obstetrics and Gynaecology of Radboud University Medical Center, Nijmegen, The Netherlands, the Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, Den Bosch, The Netherlands, and the Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands. Merck Serono had no influence in concept, design nor elaboration of this study. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- M Cissen
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, PO Box 90153, 5200 ME 's-Hertogenbosch, The Netherlands Department of Obstetrics and Gynaecologie, Center for Reproductive Medicine, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands
| | - A M Meijerink
- Department of Obstetrics and Gynaecology, Division of Reproductive Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - K W D'Hauwers
- Department of Urology, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - A Meissner
- Department of Obstetrics and Gynaecologie, Center for Reproductive Medicine, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands Department of Urology, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands
| | - N van der Weide
- Department of Obstetrics and Gynaecologie, Center for Reproductive Medicine, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands
| | - M H Mochtar
- Department of Obstetrics and Gynaecologie, Center for Reproductive Medicine, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands
| | - A A de Melker
- Department of Obstetrics and Gynaecologie, Center for Reproductive Medicine, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands
| | - L Ramos
- Department of Obstetrics and Gynaecology, Division of Reproductive Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - S Repping
- Department of Obstetrics and Gynaecologie, Center for Reproductive Medicine, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands
| | - D D M Braat
- Department of Obstetrics and Gynaecology, Division of Reproductive Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - K Fleischer
- Department of Obstetrics and Gynaecology, Division of Reproductive Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - M van Wely
- Department of Obstetrics and Gynaecologie, Center for Reproductive Medicine, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands
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Meijerink AM, Cissen M, Mochtar MH, Fleischer K, Thoonen I, de Melker AA, Meissner A, Repping S, Braat DDM, van Wely M, Ramos L. Prediction model for live birth in ICSI using testicular extracted sperm. Hum Reprod 2016; 31:1942-51. [PMID: 27406949 DOI: 10.1093/humrep/dew146] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 05/26/2016] [Indexed: 01/09/2023] Open
Abstract
STUDY QUESTION Which parameters have a predictive value for live birth in couples undergoing ICSI after successful testicular sperm extraction (TESE-ICSI)? SUMMARY ANSWER Female age, a first or subsequent started TESE-ICSI cycle, male LH, male testosterone, motility of the spermatozoa during the ICSI procedure and the initial male diagnosis before performing TESE were identified as relevant and independent parameters for live birth after TESE-ICSI. WHAT IS KNOWN ALREADY In reproductive medicine prediction models are used frequently to predict treatment success, but no prediction model currently exists for live birth after TESE-ICSI. STUDY DESIGN, SIZE, DURATION A retrospective cohort study between 2007 and 2015 in two academic hospitals including 1559 TESE-ICSI cycles. The prediction model was developed using data from one centre and validation was performed with data from the second centre. PARTICIPANTS/MATERIALS, SETTING, METHODS We included couples undergoing ICSI treatment with surgically retrieved sperm from the testis for the first time. In the development set we included 526 couples undergoing 1006 TESE-ICSI cycles. In the validation set we included 289 couples undergoing 553 TESE-ICSI cycles. Multivariable logistic regression models were constructed in a stepwise fashion (P < 0.2 for entry). The external validation was based on discrimination and calibration. MAIN RESULTS AND THE ROLE OF CHANCE We included 224 couples (22.3%) with a live birth in the development set. The occurrence of a live birth was associated with lower female age, first TESE-ICSI cycle, lower male LH, higher male testosterone, the use of motile spermatozoa for ICSI and having obstructive azoospermia as an initial suspected diagnosis. The area under the receiver operating characteristic (ROC) curve was 0.62. From validation data, the model had moderate discriminative capacity (c-statistic 0.67, 95% confidence interval: 0.62-0.72) but calibrated well, with a range from 0.06 to 0.56 in calculated probabilities. LIMITATIONS, REASONS FOR CAUTION We had a lack of data about the motility of spermatozoa during TESE, therefore, we used motility of the spermatozoa used for ICSI after freeze-thawing, information which is only available during treatment. We had to exclude data on paternal BMI in the model because too many missing values in the validation data hindered testing. We did not include a histologic diagnosis, which would have made our data set less heterogeneous and, finally, our model may not be applicable in centres which have a different policy for the indication for performing sperm extraction. The prognostic value of the model is limited because of a low 'area under the curve'. WIDER IMPLICATIONS OF THE FINDINGS This model enables the differentiation between couples with a low or high chance to reach a live birth using TESE-ICSI. As such it can aid in the counselling of patients and in clinical decision-making. STUDY FUNDING/COMPETING INTERESTS This study was partly supported by an unconditional grant from Merck Serono (to D.D.M.B. and K.F.) and by the Department of Obstetrics and Gynaecology of Radboud University Medical Center, Nijmegen, The Netherlands, the Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, Den Bosch, The Netherlands, and the Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands. Merck Serono had no influence in concept, design, nor elaboration of this study. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- A M Meijerink
- Department of Obstetrics and Gynaecology, Division of Reproductive Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - M Cissen
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, PO Box 90153, 5200 ME 's-Hertogenbosch, The Netherlands
| | - M H Mochtar
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands
| | - K Fleischer
- Department of Obstetrics and Gynaecology, Division of Reproductive Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - I Thoonen
- Department of Obstetrics and Gynaecology, Division of Reproductive Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - A A de Melker
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands
| | - A Meissner
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands Department of Urology, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands
| | - S Repping
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands
| | - D D M Braat
- Department of Obstetrics and Gynaecology, Division of Reproductive Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - M van Wely
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, PO Box 22660, 1100 DE Amsterdam, The Netherlands
| | - L Ramos
- Department of Obstetrics and Gynaecology, Division of Reproductive Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
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Kleiman SE, Yogev L, Lehavi O, Yavetz H, Hauser R. Distinctive pattern of expression of spermatogenic molecular markers in testes of azoospermic men with non-mosaic Klinefelter syndrome. J Assist Reprod Genet 2016; 33:807-14. [PMID: 26995389 DOI: 10.1007/s10815-016-0698-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 03/07/2016] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Mature sperm cells can be found in testicular specimens extracted from azoospermic men with non-mosaic Klinefelter syndrome (KS). The present study evaluates the expression of various known molecular markers of spermatogenesis in a population of men with KS and assesses the ability of those markers to predict spermatogenesis. METHODS Two groups of men with non-obstructive azoospermia who underwent testicular sperm-retrieval procedures were included in the study: 31 had non-mosaic KS (KS group) and 91 had normal karyotype (NK group). Each group was subdivided into mixed atrophy (containing some mature sperm cells) or Sertoli cell only syndrome according to testicular histology and cytology observations. Semi-quantitative histological morphometric analysis (interstitial hyperplasia and hyalinization, tubules with cells and abnormal thickness of the basement membrane) and expression of spermatogenetic markers (DAZ, RBM, BOLL, and CDY1) were evaluated and compared among those subgroups. RESULTS Clear differences in the histological morphometry and spermatogenetic marker expression were noted between the KS and NK groups. There was a significant difference in the expression of spermatogenetic markers between the subgroups of the NK group (as expected), while no difference could be discerned between the two subgroups in the KS group. CONCLUSION We conclude that molecular spermatogenetic markers have a pattern of expression in men with KS that is distinctively different from that of men with NK, and that it precludes and limits their use for predicting spermatogenesis in the former. It is suggested that this difference might be due to the specific highly abnormal histological morphometric parameters in KS specimens.
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Affiliation(s)
- Sandra E Kleiman
- Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, 6423906, Israel.
| | - Leah Yogev
- Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, 6423906, Israel
| | - Ofer Lehavi
- Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, 6423906, Israel
| | - Haim Yavetz
- Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, 6423906, Israel
| | - Ron Hauser
- Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, 6423906, Israel
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Hessel ML, Ramos L, D'Hauwers KWM, Braat DDM, Hulsbergen-van de Kaa CA. Beneficial value of testicular sperm extraction-AgarCyto in addition to the standard testicular biopsy for diagnosis of testicular germ cell tumors in nonobstructive azoospermia. Fertil Steril 2015; 105:308-14.e1. [PMID: 26493121 DOI: 10.1016/j.fertnstert.2015.09.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/29/2015] [Accepted: 09/29/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study whether immunohistochemical detection of germ cell neoplasia in situ (GCNIS) in AgarCytos, made of the remnants of the testicular sperm extraction (TESE) specimen, is equally accurate as in a standard testicular biopsy. DESIGN Prospective cohort study performed between January 2013 and May 2014. SETTING University hospital. PATIENT(S) All men with nonobstructive azoospermia (n = 197) undergoing a urological work-up followed by a unilateral or bilateral TESE for fertility treatment were consecutively included. INTERVENTION(S) An AgarCyto was made of the remnants of these TESE biopsies. Simultaneously a standard testicular biopsy was performed. For all cases a routine hematoxylin-eosin (H & E) staining was performed as well as immunohistochemistry (PLAP and OCT3/4) to detect GCNIS. MAIN OUTCOME MEASURE(S) The presence or absence of GCNIS in the TESE-AgarCyto and standard testicular biopsy. RESULT(S) Six men (3.0%) were diagnosed with a germ cell (pre)malignancy by immunohistochemistry. No cases were encountered in which the TESE-AgarCyto was negative, whereas the standard testicular biopsy was positive for GCNIS. In one case the TESE-AgarCyto detected a premalignancy that was missed by standard testicular biopsy. Unfortunately a standard testicular biopsy was not available for direct comparison in 50% of the GCNIS-positive patients due to various reasons. CONCLUSION(S) Because GCNIS is heterogeneously distributed in the testis, the TESE-AgarCyto can diagnose GCNIS even when the standard testicular biopsy is negative. Direct comparison of accuracy, however, is not reliable due to the low prevalence of GCNIS and the lack of a standard biopsy when an orchidectomy was performed simultaneously with TESE.
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Affiliation(s)
- Marie-Louise Hessel
- Department of Obstetrics and Gynecology, Division of Reproductive Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Liliana Ramos
- Department of Obstetrics and Gynecology, Division of Reproductive Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Didi D M Braat
- Department of Obstetrics and Gynecology, Division of Reproductive Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
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Hessel M, Robben JC, D'Hauwers KW, Braat DD, Ramos L. The influence of sperm motility and cryopreservation on the treatment outcome after intracytoplasmic sperm injection following testicular sperm extraction. Acta Obstet Gynecol Scand 2015; 94:1313-21. [DOI: 10.1111/aogs.12769] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 08/12/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Marloes Hessel
- Department of Obstetrics and Gynecology; Radboud University Medical Center; Nijmegen The Netherlands
| | - Johanna C.M. Robben
- Department of Obstetrics and Gynecology; Radboud University Medical Center; Nijmegen The Netherlands
| | | | - Didi D.M. Braat
- Department of Obstetrics and Gynecology; Radboud University Medical Center; Nijmegen The Netherlands
| | - Liliana Ramos
- Department of Obstetrics and Gynecology; Radboud University Medical Center; Nijmegen The Netherlands
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Hessel M, de Vries M, D'Hauwers KWM, Fleischer K, Hulsbergen-van de Kaa CA, Braat DDM, Ramos L. Cytological evaluation of spermatogenesis: a novel and simple diagnostic method to assess spermatogenesis in non-obstructive azoospermia using testicular sperm extraction specimens. Andrology 2015; 3:481-90. [DOI: 10.1111/andr.12023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 12/15/2014] [Accepted: 02/04/2015] [Indexed: 11/29/2022]
Affiliation(s)
- M. Hessel
- Department of Obstetrics and Gynaecology; Radboud University Medical Centre; Nijmegen the Netherlands
| | - M. de Vries
- Department of Obstetrics and Gynaecology; Radboud University Medical Centre; Nijmegen the Netherlands
| | - K. W. M. D'Hauwers
- Department of Urology; Radboud University Medical Centre; Nijmegen the Netherlands
| | - K. Fleischer
- Department of Obstetrics and Gynaecology; Radboud University Medical Centre; Nijmegen the Netherlands
| | | | - D. D. M. Braat
- Department of Obstetrics and Gynaecology; Radboud University Medical Centre; Nijmegen the Netherlands
| | - L. Ramos
- Department of Obstetrics and Gynaecology; Radboud University Medical Centre; Nijmegen the Netherlands
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Rijlaarsdam MA, Looijenga LHJ. An oncofetal and developmental perspective on testicular germ cell cancer. Semin Cancer Biol 2014; 29:59-74. [PMID: 25066859 DOI: 10.1016/j.semcancer.2014.07.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 07/17/2014] [Indexed: 12/19/2022]
Abstract
Germ cell tumors (GCTs) represent a diverse group of tumors presumably originating from (early fetal) developing germ cells. Most frequent are the testicular germ cell cancers (TGCC). Overall, TGCC is the most frequent malignancy in Caucasian males (20-40 years) and remains an important cause of (treatment related) mortality in these young men. The strong association between the phenotype of TGCC stem cell components and their totipotent ancestor (fetal primordial germ cell or gonocyte) makes these tumors highly relevant from an onco-fetal point of view. This review subsequently discusses the evidence for the early embryonic origin of TGCCs, followed by an overview of the crucial association between TGCC pathogenesis, genetics, environmental exposure and the (fetal) testicular micro-environment (genvironment). This culminates in an evaluation of three genvironmentally modulated hallmarks of TGCC directly related to the oncofetal pathogenesis of TGCC: (1) maintenance of pluripotency, (2) cell cycle control/cisplatin sensitivity and (3) regulation of proliferation/migration/apoptosis by KIT-KITL mediated receptor tyrosine kinase signaling. Briefly, TGCC exhibit identifiable stem cell components (seminoma and embryonal carcinoma) and progenitors that show large and consistent similarities to primordial/embryonic germ cells, their presumed totipotent cells of origin. TGCC pathogenesis depends crucially on a complex interaction of genetic and (micro-)environmental, i.e. genvironmental risk factors that have only been partly elucidated despite significant effort. TGCC stem cell components also show a high degree of similarity with embryonic stem/germ cells (ES) in the regulation of pluripotency and cell cycle control, directly related to their exquisite sensitivity to DNA damaging agents (e.g. cisplatin). Of note, (ES specific) micro-RNAs play a pivotal role in the crossover between cell cycle control, pluripotency and chemosensitivity. Moreover, multiple consistent observations reported TGCC to be associated with KIT-KITL mediated receptor tyrosine kinase signaling, a pathway crucially implicated in proliferation, migration and survival during embryogenesis including germ cell development. In conclusion, TGCCs are a fascinating model for onco-fetal developmental processes especially with regard to studying cell cycle control, pluripotency maintenance and KIT-KITL signaling. The knowledge presented here contributes to better understanding of the molecular characteristics of TGCC pathogenesis, translating to identification of at risk individuals and enhanced quality of care for TGCC patients (diagnosis, treatment and follow-up).
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Affiliation(s)
- Martin A Rijlaarsdam
- Department of Pathology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Leendert H J Looijenga
- Department of Pathology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.
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