Objective: To investigate the possibility of a pre-invasive phase of adult germ cell tumours being detectable in childhood.
Patients and methods: Seventy testicular biopsies were examined which had been taken at orchidopexies from 57 patients aged 1 to 16 years during the period 1951-1973, and for whom follow-up data on cancers and deaths up to 1989 were available.
Results: Malignant germ cell tumours had developed in three testes from which biopsies were available: a right-sided teratoma and left-sided mixed germ cell tumour in one patient and a left-sided teratoma in a second patient. Carcinoma in situ was seen in only one of the 70 biopsies. This biopsy was taken from a patient aged 16 years and preceded the appearance of a teratoma by 4 years. Carcinoma in situ was not seen in a biopsy of this testis carried out 11 years before tumour diagnosis. Carcinoma in situ was also not seen in a biopsy of the contralateral testis in this patient carried out 22 years before tumour diagnosis in the testis, nor was it observed in a biopsy 17 years before the development of malignancy in the second patient.
Conclusion: These findings bring into question the extent to which the appearance of testicular biopsies taken during childhood orchidopexy can exclude the development of a tumour in adult life. No evidence has been found in this study for histological pre-malignant changes occurring before the onset of puberty.