undergo laparoscopic lymph node sampling
receive induction chemotherapy
undergo extensive retroperitoneal lymph node dissection
go for palliative therapy
B. receive induction chemotherapy
greater than 90%
lesser than 40%
greater than 70%
lesser than 20%
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
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
rhabdomyosarcoma
liposarcoma
sarcomatoid tumor
angiosarcoma
rete testis involvement
tumor size greater than 4 cm
all of the above
β-hCG of ≥ 10,000 mIU/mL on diagnosis
yolk cell tumors
choriocarcinomas
embryonal carcinomas
pure seminomas
younger than 10 yrs.
older than 50 yrs.
between 20 27 yrs.
between 28 35 yrs.
polyembryoma
teratoma
embryonal carcinoma
mixed germ cell tumor
yolk cell tumors
spermatocytic seminoma
choriocarcinoma
embryonal carcinoma
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
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
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
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
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
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
elevation of only α-FP indicates pure non-seminoma
elevation of α-FP might occur in chronic liver disease, hepatitis, and alcohol abuse
elevation of LDH indicates tumor burden and growth rate
elevation of β-hCG above 10,000 mIU/mL is seen only in germ cell tumors
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
mature teratoma
immature teratoma
cystadenoma
adenomatoid tumor
3 months
3 spermatogenic cycles
3 yrs.
damage is permanent
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
pure embryonal carcinoma may increase serum α-FP and hCG levels
pure seminoma increases serum hCG levels in 15% of cases but not α-FP
typically, endodermal sinus tumors dont increase any tumor marker
pure choriocarcinoma is associated with high hCG levels but not α-FP
undergo laparoscopic lymph node sampling
receive induction chemotherapy
undergo extensive retroperitoneal lymph node dissection
go for palliative therapy
10 - 20%
20 - 60%
60 - 80%
80 - 90%
fossa navicularis
bulbomembranous urethra
prostatic urethra
external urethral meatus
stem from the periphery of the testis
no non-pulmonary visceral metastases
normal α-FP, β-hCG, and LDH markers
all of the above
peripheral neuropathy
renal failure
Raynaud phenomenon
hypogonadism
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
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
rhabdomyosarcoma
liposarcoma
sarcomatoid tumor
angiosarcoma