This tumour has an identical morphology, immunochemistry, molecular features and behaviour to its counterpart in the testis, seminoma, and other germ cell sites germinoma. Initial therapy of early stage testicular germ cell tumors gcts is based on histology and tumor extent. Metastatic symptoms are the most common initial presentation. Unlike most solid tumors, these tumors peak in incidence in young adults, indicating that the tumors initiate early in life. An overview of testicular germ cell tumors archives of pathology.
However, they grow and spread like nonseminomas, and for this reason, they are treated as nonseminomas. Testicular germ cell tumors tgcts are a heterogeneous group of neoplasms derived from neoplastic transformation of germ cells in the testis, but with different epidemiological, biological and clinical settings, from early life to adulthood. Between 1985 and 1991, 63 patients with disseminated germ cell tumors of the testis were treated with initial cisplatin based combination chemotherapy. An increasing incidence of testis tumors has been noted over the second half of the 20th century. Germ cell tumors gcts are the most common tumors of the testis and arise from germinal epithelium cells in the seminiferous tubules. These mixed germ cell tumors are treated as nonseminomas. Two of the most common germ cell tumors are seminoma and nonseminoma. The treatment of nonseminomatous germ cell tumors is more controversial. Although consensus was reached on many issues, there are still areas of practice that need further. Testicular germ cell tumours alberta health services. Germ cell tumors gcts occur most frequently in the gonads and are.
Pagetoid involvement of the rete testis epithelium must be distinguished from rete testis stromal invasion, with only the latter being prognostically useful. Germ cells normally occur inside the gonads ovary and testis. Based on ajccuicc tnm, 7th edition protocol web posting date. Ovarian germ cell tumors ogcts are heterogeneous tumors that are derived from the primitive germ cells of the embryonic gonad, which accounts for about 2. Approximately 50% of germ cell tumors are seminomas, and approximately 50% are nsgcts. Management of germ cell tumors of the testis lasop scientific program tuesday, february 8, 2011 mahul b. Congenital malformation of the male genitalia, prenatal risk factors, nonspecific and specific exposures in adulthood, and male infertility have all been associated with. Testicular cancer tc represents 5% of urological tumours affecting mostly younger males. Reporting and staging of testicular germ cell tumors.
An overview of therapy for men with testicular gcts is presented here. Pdf brain metastasis from nonseminomatous germ cell. The majority of testis tumors originate from the germ cell, which is the principal cell type of the testis. Germ cell tumours gcts are the most common malignancy in men aged 1534 years.
Childhood extracranial germ cell tumors treatment pdq. Therefore, onethird of the tumors have mixed patterns, and tumors arising from germ cells at different stages of their development should exhibit different features 47. The genetic events leading to genesis of testicular germ cell tumors in men appear to be related to aneuploidization followed by the formation of an i12p isochromosome, the latter characterizing. The germ cells which are present outside the gonads are the birth defects during the development of embryo. The specific types of ovarian germ cell tumour will now be discussed. They make up less than 5% of adult testicular tumors, but up to 20% of childhood testicular tumors. Testicular germ cell tumours are highly sensitive to radiotherapy and chemotherapy and hence have among the best outcomes of all tumours. It can be characterized into cancerous or noncancerous cell. The main issue with dysgerminoma figure 2 is purely one of nomenclature. Mixed germ cell tumor of the testis is made up of 2 or more different types of germ cell tumors. Germ cell tumors can spread metastasize to other parts of the body. Among the nonseminomatous germ cell tumors in this study, the yolk sac tumors appeared to occur the most frequently the ratio of yolk sac tumor occurrence to embryonal carcinoma occurrence was 6.
Nonseminomatous germ cell tumors are cancer and are found in the brain. Commonly seen as a painless mass in the scrotum the skin that holds the testicles, parents are most likely to notice the development of these tumors in small boys. Treatment options for testicular cancer, by type and stage. Surveillance in stage i nonseminomatous germ cell tumours. Get a printable copy pdf file of the complete article 3. Handbook for children with germ cell tumors american pediatric. While these tumors typically start in the testicles they also occasionally arise in the abdomen, chest, or other areas of the body, even if theres no evidence of cancer in or near the testicles.
Guidelines for the diagnosis and staging of testicular cancer. About 95% of all tcs are represented by testicular germ cell tumors tgcts, which include seminoma and nonseminoma histological. An aggressive approach, however, with retroperitoneal lymph node dissection and adjuvant chemotherapy has resulted in an overall 78 percent survival rate. It deals with the clinical presentations, treatment modalities, the biology and genetics of germ cell tumors in children and adults. It is found in virtually all cases in which residual seminiferous tubules are identified around an. Originally presented on january, 2014 in salt lake city, utah. The clinical manifestations, diagnosis, and staging are presented separately, as are more. The 111 trial aimed to exclude a 2yr recurrence rate of 5% with adjuvant one cycle of bleomycin, etoposide 500 mgm2, and cisplatin be500px1 in stage 1, highrisk nonseminomatous germ cell testis tumours. Protocol applies to all malignant germ cell and malignant. Testicular seminoma in a 51yearold man with a palpable mass in the right testis. Testicular cancer tc is the most common cancer in males aged 2040 years, with a worldwide incidence of 7. Intratubular germ cell neoplasia, unclassified is the precursor lesion of all invasive germ cell tumors with the possible exceptions of spermatocytic seminoma, pediatric yolk sac tumor, and pediatric teratoma.
The main types are leydig cell tumors and sertoli cell tumors. Be500px1 should replace be360px2 as standard care for such patients. Pathology of germ cell tumors of the testis isabell a. Among the different stages of germ cell tumors, pure seminomas tend to be treated one way, and nonseminomas and mixed germ cell tumors are treated another way. Childhood gcts are rare in children younger than 15 years, accounting for approximately 3% of cancers in this age group. Carcinoma testicular no seminomatoso pdf many testicular cancers contain both seminoma and nonseminoma cells. This conference focused on controversies related to sta. Brain metastases from nonseminomatous germ cell tumors nsgcts are rare and mainly occur in young men whose clinical condition is unimpaired. The book aims to provide an overview of current knowledge regarding germ cell tumors. Germ cell tumors includes seminoma and variants, all nonseminomatous germ cell tumors, mixed germ cell tumors, leydig cell tumors, sertoli cell tumors. Most teratomatous elements in the testis occur as a component of mixed germ cell tumors, which represent about onethird of all testicular germ cell tumors and contain teratoma in about 50% of the cases. The aim of these guidelines is to present the current evidence for the diagnosis and treatment of patients with cancer of the testis. Testicular germ cell tumors gcts are a heterogeneous group of neoplasms with diverse his topathology and clinical behavior.
Histologic type the protocol mainly applies to malignant tumors of the testis, the vast majority of which are of germ cell origin. In the uk, there were 2109 new cases of gct diagnosed in 2005 and 78 deaths from testicular cancer in 2006 2, 3. In this stage, the cancer has not spread outside the. Treatment for testicular cancer is based mainly on the type and stage of the cancer. The lecture will also provide immunohistochemical profiles that aid in the diagnosis and classification of germ cell tumors. All gcts show malignant behavior and frequently metastasize.
In teenaged boys, testicular tumors may be more difficult to detect if parents and teens are uncomfortable discussing such intimate matters. Several placental and fetal proteins are secreted by these tumors. Most chapters are focused on testicular germ cell tumors whose incidence has been increasing in young males. Clinically they may present as an enlarging testicular mass, or with symptoms resulting from metastases or hormonal secretions. Variants in kitlg predispose to testicular germ cell. Introduction primary germ cell tumors gcts arise by the malignant transformation of primordial germ cells primary gcts of testes constitute 95% of all testicular tumors infrequently, gcts arise from an extragonadal site 3. January 2005 based on ajccuicc tnm, 6th edition procedures radical orchiectomy retroperitoneal lymphadenectomy rplnd authors mahul b. Igcnu intratubular germ cell neoplasm unclassified in 2004 who. This article covers germ cell tumours, often abbreviated gct, which classically arise in the gonads ovary, testis. The presentation will discuss the diagnostic difficulties encountered in germ cell tumors including classification. Pdf teratoma with somatictype malignant components in.
An increasing incidence of testis tumors,particularly in men of european. Germ cell tumors of the male testis account for 95% of testicular tumors and represent a unique type of human cancer from several different perspectives. The cause of mixed germ cell tumor of the testis is unknown. There is a geographical variation in the incidence of gct. Yolk sac tumors, also called endodermal sinus tumors are usually cancer. The incidence of this disease is increasingthe lifetime risk for a man is now about one in 200 in the united kingdom. Pdf testicular tumors are the most common tumors in adolescent and young men and germ cell tumors tgcts account for most of all testicular cancers.
Percentages of different tumor elements in mixed germ cell tumors should be reported. Germ cell tumors account for about 2 to 4 percent of all cancers in children and adolescents younger than age 20. Intratubular germ cell neoplasia is now considered to be the precursor of most germ cell tumors. Tumors can also start in the supportive and hormoneproducing tissues, or stroma, of the testicles. It is known that having a testicular germ cell tumor predisposes men to a second germ cell tumor in the contralateral testis, with the second tumor occurring in 15% of such patients. There are four main types of ogcts, namely dysgerminomas, yolk sac tumor, teratoma, and choriocarcinoma dygerminomas are the most common type and are particularly prominent in patients diagnosed with. The most common sites for metastasis are the lungs. Clinical stage i nonseminomatous germ cell tumors of the. Malignant germ cell and sex cordstromal tumors of the testis protocol applies to all malignant germ cell and sex cordstromal tumors of the testis. Testicular germ cell tumors radiology reference article. The records of 15 patients with brain metastasis from nonseminomatous germ cell tumors of the testis, who. If the tumour is diagnosed early, more than 95% of men are cured and treatment can be less intensive. Testicular germ cell cancer affects mainly young men, with 85% presenting between 15 and 44 years of age.
Protocol for the examination of specimens from patients. They are also found in the midline and make appearances in neuropathology e. Thirtyone patients with clinical stage i nsgctt were seen between 1980 and 2000. Testicular germ cell tumors account for 90% of primary tumors of the testes. Germ cell tumors is a neoplasm which obtained from germ cells. Gcts that originate outside the gonads may be birth defects resulting from errors during development of the embryo. Diagnosis and treatment of germ cell neoplasia in situ gcnis. Testis protocol applies to all malignant germ cell and malignant sex cordstromal tumors of the testis, exclusive of paratesticular malignancies. June 2012 procedures radical orchiectomy retroperitoneal lymphadenectomy rplnd authors.
Most malignant testicular neoplasms are of germ cell origin. They are the most common nonhaematologic malignancy in men 1549 years old. The international society of urological pathology held a conference devoted to issues in testicular and penile pathology in boston in march 2015, which included a presentation and discussion led by the testis microscopic features working group. A germcell tumor gct is a neoplasm derived from germ cells. Protocol for the examination of radical orchiectomy. Us is used to distinguish between intratesticular masses, which are more commonly malignant, and extratesticular masses, which are more commonly benign.
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