Editing Germ Cell Tumours (section)

== Natural history ==

* '''<span style="color:#ff0000">Rapidly growing tumours</span>'''

=== Metastasis ===

==== <span style="color:#ff0000">Sites of metastasis</span> ====
* '''<span style="color:#ff0000">Lymph nodes</span>'''
** '''<span style="color:#ff0000">Retroperitoneal lymph nodes</span>'''
*** '''<span style="color:#ff0000">Most common site of metastasis</span>'''
**** '''70-80% of GCT metastasis occurs by lymphatic spread''' from the primary tumor to the retroperitoneal lymph nodes and subsequently to distant sites.
***** '''Exception: choriocarcinoma, with a propensity for hematogenous dissemination.'''
** '''<span style="color:#ff0000">Supraclavicular lymph nodes</span>'''
** '''<span style="color:#ff0000">Mediastinal lymph nodes</span>'''
** '''<span style="color:#ff0000">Inguinal lymph nodes in patients with previous scrotal violation</span>'''
* '''<span style="color:#ff0000">Visceral</span>'''
** '''<span style="color:#ff0000">Lung</span>'''
*** '''<span style="color:#ff0000">Second most common site of metastasis</span>'''
*** '''<span style="color:#ff0000">Most common site of visceral metastases</span>'''
***Pulmonary metastases of testicular GCT represents disease spread via the hematogenous route, whereas mediastinal and cervical metastases represent lymphatic spread.
*** '''Thoracic metastasis in the absence of retroperitoneal disease and/or elevated serum tumor markers is uncommon'''
** '''<span style="color:#ff0000">Liver</span>'''
*'''At the time of diagnosis, metastasis''' (regional or distant) '''is present in 33% of cases of NSGCT and 15% of cases of pure seminoma'''