1. ¹Department of Histopathology, Barts and The London School of Medicine and Dentistry, St Bartholomew's Hospital, West Smithfield, London, UK
2. ²Department of Histopathology, Addenbrooke's Hospital, Cambridge, UK
3. ³Department of Medical Oncology, Addenbrooke's Hospital, Cambridge, UK
4. ⁴Department of Urology, Addenbrooke's Hospital, Cambridge, UK
5. ⁵Department of Medical Oncology, Barts and The London School of Medicine and Dentistry, St Bartholomew's Hospital, West Smithfield, London, UK

Correspondence: Dr DM Berney, FRCPath, Department of Histopathology, The Royal London Hospital, 80 Newark Street, London E1 2ES, UK. E-mail: danberney@hotmail.com

Received 12 June 2007; Revised 22 August 2007; Accepted 5 September 2007; Published online 2 November 2007.

Abstract

Malignant testicular germ cell tumours in the elderly are extremely rare with anecdotal accounts of their aggressive behaviour. Fifty cases of germ cell tumour, diagnosed at the age of 60 years or above, were pathologically reviewed. The oldest patient was 86 years of age, with 78% of cases presenting in men in their 60s. Forty-one (82%) of the tumours were seminomas with only nine cases (18%) of mixed or non-seminomatous germ cell tumour. However, all non-seminomatous types of tumour were represented in the series. The macroscopic tumour size was significantly larger (median=6 cm, range=2–11 cm) than comparable series in younger men. They were also of higher stage with more frequent vascular invasion and rete testis invasion than is typically seen in a younger population. The tumours were less associated with intratubular germ cell neoplasia than in younger men as it was present in only 47% of assessable cases. We conclude that germ cell tumours, in man aged 60 years or above, present at a later stage than in younger men, and although most are seminomas, non-seminomatous tumours may occur with a wide spectrum of morphology.