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
C. 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 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
unilateral hydrocele
dull ache or heavy sensation in the lower abdomen
painless swelling or a nodule in the testicle
incidental finding on scrotal ultrasonography
choriocarcinoma
yolk cell tumor
embryonal carcinoma
seminoma
rhabdomyosarcoma
liposarcoma
sarcomatoid tumor
angiosarcoma
60%
70%
80%
90%
undergo laparoscopic lymph node sampling
receive induction chemotherapy
undergo extensive retroperitoneal lymph node dissection
go for palliative therapy
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
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
younger than 10 yrs.
older than 50 yrs.
between 20 27 yrs.
between 28 35 yrs.
greater than 90%
lesser than 40%
greater than 70%
lesser than 20%
lymphoma
spermatocytic seminoma
adenocarcinoma
cystadenoma
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
rhabdomyosarcoma
liposarcoma
sarcomatoid tumor
angiosarcoma
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
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
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
10 - 20%
20 - 60%
60 - 80%
80 - 90%
over 80%
over 85%
over 90 %
over 95 %
environmental conditions exposing the testes to high temperature
47XXY genotype
prior testicular cancers
cryptorchidism
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
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
mature teratoma
immature teratoma
cystadenoma
adenomatoid tumor
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
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
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
3 months
3 spermatogenic cycles
3 yrs.
damage is permanent
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
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
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
yolk cell tumors
spermatocytic seminoma
choriocarcinoma
embryonal carcinoma