suspected germ cell tumor (GCT) with a normal contralateral testis
in case of bilateral synchronous testicular GCT
suspected benign testicular lesions
suspected GCT of < 2 cm tumor size in a solitary testis
A. suspected germ cell tumor (GCT) with a normal contralateral testis
choriocarcinoma
yolk cell tumor
embryonal carcinoma
seminoma
greater than 90%
lesser than 40%
greater than 70%
lesser than 20%
adult choriocarcinoma arise from ITGCN
spermatocytic seminoma arises from ITGCN
typically, pediatric germ cell tumors (GCT) do not arise from ITGCN
ITGCN is the common precursor for most of adult male GCT
is considered based on a histologic evidence
should not be performed through a scrotal incision
preoperative biopsy is required for histologic examination
entails early clamping of the cord at the external inguinal ring level
3 months
3 spermatogenic cycles
3 yrs.
damage is permanent
fossa navicularis
bulbomembranous urethra
prostatic urethra
external urethral meatus
occurs in men over 60 yrs.
does not contain an isochromosome 12p
constitutes a considerable part of mixed germ cell tumors
rarely metastasizes without sarcomatous differentiation
in approximately 60% of patients, post-chemotherapy residual masses are either viable cancer cells or teratoma
nearly one half will be azoospermic after 2 years of therapy
in seminoma stage II-B, primary chemotherapy with 3 cycles of bleomycin, etoposide and cisplatin (BEP), and 4 cycles of chemotherapy with etoposide and cisplatin (EP) are recommended
in seminoma stage II-B, II-C, III after primary treatment with chemotherapy, surveillance is recommended for residual masses of 3 cm or less detected by PET scan
patients in whom retroperitoneal LN dissection (RPLND) reveals viable cancer cells after chemotherapy, subsequent chemotherapy is recommended
surgical resection is recommended for patients with residual disease after chemotherapy
open nerve-sparing RPLND might lead to premature ejaculation
in non-seminoma patients stage I-A, I-B, 1S on long-term surveillance, relapses are expected in 80% of cases within the first year after orchiectomy
in a patient with a history of GCTs, the finding of testicular microlithiasis on ultrasonography poses a higher risk of intratubular germ cell neoplasia
occur bilaterally approximately 2% of cases
are extragonadal in 1 - 5%
are more likely to contain embryonal tumor cells than tumors arising in the testis
60%
70%
80%
90%
active surveillance is recommended for patients with horseshoe kidney
adjuvant chemotherapy with a single dose of carboplatin is recommended as an alternative to radiation therapy
the number of positive nodes dissected dictates the number of chemotherapy cycles to be given
cure is possible after radical orchiectomy alone
left testicular tumors spread to the periaortic lymph nodes
right testicular tumors spread to the interaortocaval lymph nodes
the fashion of further spread in the retroperitoneum is from right to left
all of the above
polyembryoma
teratoma
embryonal carcinoma
mixed germ cell tumor
should be suspected in any patient with a very high hCG level on diagnosis
the commonest subtype that causes brain metastases is choriocarcinoma
these patients should receive 4 cycles of bleomycin-etoposide-cisplatin as first-line chemotherapy
early initiation of chemotherapy ensures a good prognosis
in pure seminoma α-FP is normal
if syncytiotrophoblastic giant cells are present, β-hCG may be elevated
spermatocytic seminomas rarely metastasize without sarcomatous differentiation
pure seminoma constitutes approximately 90% of pure germ cell tumors
epididymo-orchitis
indirect inguinal hernia
testicular microlithiasis
syphilitic gumma
evaluates post chemotherapy residual masses in pure seminoma cases
helps stage non-seminomatous germ cell tumors
all of the above
used for active surveillance in non-operable cases
rete testis involvement
tumor size greater than 4 cm
all of the above
β-hCG of ≥ 10,000 mIU/mL on diagnosis
α-FP and/or β-hCG are elevated in approximately 80% to 85% of patients with non-seminomatous germ cell tumors
β-hCG increases in either seminoma or non-seminoma
LDH increases in 30% to 80% of pure seminoma patients and in 60% of non-seminoma patients
high levels of α-FP might induce nipple tenderness or gynecomastia
yolk cell tumors
spermatocytic seminoma
choriocarcinoma
embryonal carcinoma
environmental conditions exposing the testes to high temperature
47XXY genotype
prior testicular cancers
cryptorchidism
mature teratoma
immature teratoma
cystadenoma
adenomatoid tumor
over 80%
over 85%
over 90 %
over 95 %
high levels of α-FP are found only in non-seminomas
high levels of α-FP may result from marijuana use
β-hCG levels above 10,000 mIU/mL are seen only in germ cell tumors and hepatocellular carcinoma
LDH is a useful marker for surveillance after tumor extirpation
stem from the periphery of the testis
no non-pulmonary visceral metastases
normal α-FP, β-hCG, and LDH markers
all of the above
younger than 10 yrs.
older than 50 yrs.
between 20 27 yrs.
between 28 35 yrs.
there is no clinical distinction between mature and immature teratoma
has no biological markers
is sensitive to chemotherapy
when large in size can be infiltrative and difficult to resect
the risk of developing germ cell tumor when an undescended testis is in the abdomen is greater than when it is in the inguinal canal
orchiopexy for boys younger than 6 yrs. lowers the risk of cancer development
a normally descended testis carries 5-20% risk of developing cancer when its mate is undescended
the risk of cancer increases in cryptorchid patients over 33 yrs. of age
lymphoma
spermatocytic seminoma
adenocarcinoma
cystadenoma