Editing Germ Cell Tumours (section)

====== Residual masses after chemotherapy for seminoma ======
* '''After first-line chemotherapy, 60-80% of patients have radiologically detectable residual masses.'''
* '''<span style="color:#ff0000">Histology of residual masses:</span>'''
** '''<span style="color:#ff0000">Necrosis 90%</span>'''
** '''<span style="color:#ff0000">Viable malignancy: 10%</span>'''
** '''Compared to NSGCT, residual masses after chemotherapy are much more likely to be necrosis (for NSGCT, histology of post-chemotherapy residual masses: necrosis in 40%, viable disease in 15%, and teratoma in 45% (see below)).'''
* '''<span style="color:#ff0000">Management</span>'''
** '''<span style="color:#ff0000">In seminoma, most residual masses do not need to be treated.</span>'''
*** '''Spontaneous resolution of post-chemotherapy residual masses is reported in 50-60% of cases, and the median time to resolution is 13-18 months.'''
*** <span style="color:#ff0000">'''Post-chemotherapy surgery for seminoma is technically difficult'''</span> (and frequently not feasible) because of the desmoplastic reaction that occurs after chemotherapy with resultant increased perioperative morbidity.
*** Teratoma and malignant transformation are much less of a concern with advanced seminoma.
** '''<span style="color:#ff0000">If residual masses > 3 cm, evaluate further with FDG-PET</span>'''
*** '''<span style="color:#ff0000">If FDG-PET positive: post-chemotherapy surgery</span>'''
*** '''<span style="color:#ff0000">If FDG-PET negative: observation.</span>'''
** '''<span style="color:#ff0000">If residual masses< 3 cm: observation.</span>'''
** Post-chemotherapy radiotherapy has no role in the management of residual masses