Testicular seminoma and non-seminoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up

摘要

Germ cell tumours (GCT) represent a rare malignancy affecting mostly Caucasian males aged between 15 and 40 years. Among these young men, testicular GCT (TGCT) is the most common cancer with noted geographic differences [1]. Cure rates approximate 100% in stage I disease and exceed 80% in metastatic cases.Approximately 50% of the TGCTs are pure seminomas and 50% are non-seminomas. The vast majority of GCT arise in the testicles with ~5% occurring outside of the gonads, i.e. extragonadal germ cell tumour (EGGCT). EGGCTs are usually found in the body's mid-line, e.g. retroperitoneum, mediastinum or cerebrum, sometimes posing diagnostic difficulties.diagnosis In patients with a testicular mass, testicular sonography (7.5 MHz transducer) should be carried out, also noting the size and any structural alterations of the contralateral testis. Diagnosis of a testicular germ cell cancer (TGCC) is based on histology of the testicular mass. Elevation of'tumour markers', i.e. serum levels of oc-fetoprotein (AFP) and/or human chorionic gonadotropin (HCG) support the diagnosis. Biopsy of mid-line extragonadal tumours is mandatory, unless the patient is very sick and has high tumour markers. The biopsy should be preceded by testicular sonography to exclude a TGCT. Histology of GCT should be reported according to the World Health Organisation (WHO) classification, specifying tumour size, multiplicity, extension of tumour (e.g. in rete testis or other tissue), pT category (according to the American Joint Committee on Cancer, AJCC, Union for International Cancer Control, UICC), all histological components with corresponding percentages, and presence or absence of vascula invasion and testicular intraepithelial neoplasia (TIN). In seminomas, the presence of syncytiotrophoblasts should be reported. Increased copy numbers of iso-chromosome 12p are found in both TGCT and EGGCT and provide a pathognomonic test, which might be useful in challenging histologic diagnoses, e.g. somatically transformed teratoma.