fossa navicularis
bulbomembranous urethra
prostatic urethra
external urethral meatus
B. bulbomembranous urethra
choriocarcinoma
yolk cell tumor
embryonal carcinoma
seminoma
yolk cell tumors
choriocarcinomas
embryonal carcinomas
pure seminomas
peripheral neuropathy
renal failure
Raynaud phenomenon
hypogonadism
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
rete testis involvement
tumor size greater than 4 cm
all of the above
β-hCG of ≥ 10,000 mIU/mL on diagnosis
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
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
3 months
3 spermatogenic cycles
3 yrs.
damage is permanent
yolk cell tumors
spermatocytic seminoma
choriocarcinoma
embryonal carcinoma
greater than 90%
lesser than 40%
greater than 70%
lesser than 20%
environmental conditions exposing the testes to high temperature
47XXY genotype
prior testicular cancers
cryptorchidism
over 80%
over 85%
over 90 %
over 95 %
younger than 10 yrs.
older than 50 yrs.
between 20 27 yrs.
between 28 35 yrs.
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
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
lymphoma
spermatocytic seminoma
adenocarcinoma
cystadenoma
60%
70%
80%
90%
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
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
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
epididymo-orchitis
indirect inguinal hernia
testicular microlithiasis
syphilitic gumma
stem from the periphery of the testis
no non-pulmonary visceral metastases
normal α-FP, β-hCG, and LDH markers
all of the above
10 - 20%
20 - 60%
60 - 80%
80 - 90%
undergo laparoscopic lymph node sampling
receive induction chemotherapy
undergo extensive retroperitoneal lymph node dissection
go for palliative therapy
rhabdomyosarcoma
liposarcoma
sarcomatoid tumor
angiosarcoma
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 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
fossa navicularis
bulbomembranous urethra
prostatic urethra
external urethral meatus
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