lymphoma
spermatocytic seminoma
adenocarcinoma
cystadenoma
A. lymphoma
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
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
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
peripheral neuropathy
renal failure
Raynaud phenomenon
hypogonadism
younger than 10 yrs.
older than 50 yrs.
between 20 27 yrs.
between 28 35 yrs.
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
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
fossa navicularis
bulbomembranous urethra
prostatic urethra
external urethral meatus
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
choriocarcinoma
yolk cell tumor
embryonal carcinoma
seminoma
unilateral hydrocele
dull ache or heavy sensation in the lower abdomen
painless swelling or a nodule in the testicle
incidental finding on scrotal ultrasonography
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
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
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 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
10 - 20%
20 - 60%
60 - 80%
80 - 90%
3 months
3 spermatogenic cycles
3 yrs.
damage is permanent
over 80%
over 85%
over 90 %
over 95 %
undergo laparoscopic lymph node sampling
receive induction chemotherapy
undergo extensive retroperitoneal lymph node dissection
go for palliative therapy
epididymo-orchitis
indirect inguinal hernia
testicular microlithiasis
syphilitic gumma
60%
70%
80%
90%
yolk cell tumors
spermatocytic seminoma
choriocarcinoma
embryonal carcinoma
lymphoma
spermatocytic seminoma
adenocarcinoma
cystadenoma
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
mature teratoma
immature teratoma
cystadenoma
adenomatoid tumor
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
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
polyembryoma
teratoma
embryonal carcinoma
mixed germ cell tumor