O3278: Pathology Evaluation of Tissue Removed for Fertility Preservation: The Standard of Care?

Background: Pediatric patients at risk for infertility are candidates for fertility preservation (FP) procedures. Options include the surgical removal and cryopreservation of ovarian and testicular tissue for future fertility and hormone restoration. At our institution, a biopsy is taken for routine pathology from all gonadal tissue removed for FP, however this is not done at all centers. We reviewed our experience with biopsy for pathology evaluation of ovarian and testicular specimens in FP cases to determine clinical utility.

Methods: The medical records of individuals who underwent ovarian tissue cryopreservation (OTC) or testicular tissue cryopreservation (TTC) between 2011 and 2023 were retrospectively reviewed under an IRB-approved study at a free-standing tertiary care children’s hospital. Patient demographics, diagnosis, operative characteristics, and pathology results were collected.

Results: A total of 353 patients were included in this study: 182 underwent OTC and 134 underwent TTC. For OTC, 101 patients (55.5%) and for TTC, 64 patients (47.8%) underwent gonadotoxic treatment prior to their FP procedure. For OTC, 178 patients (97.8%) had germ cells present in their biopsy specimen, and 4 (2.2%) did not. For TTC, 133 patients (99.3%) had germ cells present in their biopsy specimen and 1 (0.7%) did not. All 4 of the OTC patients who did not have germ cells on biopsy underwent gonadotoxic treatment prior to their OTC. The one TTC patient who did not have germ cells on biopsy had TTC performed during orchiopexy for undescended testes.

Most patients had a diagnosed malignancy prior to their FP procedure (OTC: 155 patients (84.7%) and TTC: 106 patients (79.1%)). Four OTC patients (2.2%) were found to have malignancy on routine pathologic examination of a biopsy of their ovary. Two TTC patients (1.5%) were found to have malignancy on routine pathology of their testicular biopsy. All 6 of the OTC and TTC patients who had malignancy on their biopsies had a malignancy diagnosed preoperatively. None of the patients undergoing FP for benign conditions had malignancies in their biopsy specimens. All OTC and TTC patients and families, including those who were found to have malignancy on biopsy, elected to continue storing tissue removed for FP after discussion of pathology findings.

Conclusion: The rate of malignancy identified on biopsy of specimens removed for FP was low in our study sample. No malignancies were seen on samples from patients undergoing FP for benign conditions. Additionally, the vast majority of specimens had identifiable germ cells regardless of prior gonadotoxic treatment. Pathology results provide another data point to help inform patients and their families when making decisions on ovarian or testicular tissue storage and on how tissue may be utilized in the future to restore fertility and/or hormones.