Germ Cell Tumours: Difference between revisions

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** US 2021: 440[https://seer.cancer.gov/statfacts/html/testis.html]

*** 5-year relative survival: 94.9% (compared to prostate 97.5%, bladder 77.1%, and kidney/renal pelvis 75.6%)[https://seer.cancer.gov/statfacts/html/testis.html]

== Risk ~~factors~~ ==

== Risk Factors ==

* '''~~Established risk factors~~ (5):'''

* '''Inherited (3):'''

*# '''Cryptorchidism'''

*#* '''Ipsilateral testis: relative risk 4-6x; relative risk decreases to 2-3x if orchidopexy is performed before puberty'''

*#* '''Contralateral testis: slightly increased risk''' (relative risk 1.74x)

*# '''Family history of GCT'''

*# '''Personal history of GCT'''

*# '''Germ Cell Neoplasia In-Situ (GCNIS)'''

*# '''Germ Cell Neoplasia In-Situ (GCNIS)~~, previously~~ referred to as intratubular germ cell neoplasia (ITGCN) unclassified~~'''~~

*#* Previously referred to as intratubular germ cell neoplasia (ITGCN) unclassified

*#* '''All adult invasive GCTs arise from GCNIS, except spermatocytic seminoma.'''

*#*'''All adult invasive GCTs arise from GCNIS, except spermatocytic seminoma.'''

*#* Among males with GCNIS, the risk of developing invasive GCT is ≈50% at 5 years

*#* '''GCNIS develops before birth from an arrested gonocyte'''

*# '''Race'''

*#* '''Caucasian risk > African-American'''

*'''Acquired (2):'''

*#'''Cryptorchidism'''

*#* '''Ipsilateral testis: relative risk 4-6x; relative risk decreases to 2-3x if orchidopexy is performed before puberty'''

*#* '''Contralateral testis: slightly increased risk''' (relative risk 1.74x)

*#'''Personal history of GCT'''

== Genetics ==

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* '''Uses (2):'''

*# '''Support initial diagnosis'''

*#* '''Should not be used to guide decision making about whether or not to perform a radical orchiectomy''' ~~because~~ AFP or hCG levels in the normal range do not rule out GCT.

*#* '''Should not be used to guide decision making about whether or not to perform a radical orchiectomy'''

*# '''Interpret tumor marker levels after orchiectomy.'''

*#** AFP or hCG levels in the normal range do not rule out GCT

*# '''Interpret tumor marker levels after orchiectomy'''

*#* '''Essential to know whether persistently elevated post-orchiectomy tumour markers are declining compared to pre-orchiectomy levels by their respective half-lives or not, or whether they are rising, as this impacts subsequent treatment decisions.'''

* '''Should not be used for clinical staging and risk stratification'''

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* '''Imaging findings'''

** '''Typical GCT is hypoechoic'''

** 2 or more discrete lesions may be identified

** 2 or more discrete lesions may be identified[[File:Ultrasound images of seminomas.jpg|none|thumb|493x493px|Source: [[commons:File:Ultrasound_images_of_seminomas.jpg|Wikipedia]] (a) Seminoma usually presents as a homogeneous hypoechoic nodule confined within the tunica albuginea. (b) Sonography shows a large heterogeneous mass occupying nearly the whole testis but still confined within the tunica albuginea, it is rare for seminoma to invade to peritesticular structures.]][[File:Ultrasonography of embryonal cell carcinoma.jpg|none|thumb|Embryonal cell carcinoma. Longitudinal ultrasound image of the testis shows an irregular heterogeneous mass that forms an irregular margin with the tunica albuginea. Source: [[wikipedia:Scrotal_ultrasound#/media/File:Ultrasonography_of_embryonal_cell_carcinoma.jpg|Wikipedia]]]]

** INSERT IMAGE

** '''Testicular microlithiasis'''

*** '''Unclear significance''' '''in the general population'''

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**** '''No further evaluation or screening in incidentally detected microlithiasis'''

**** '''If established risk factor and testicular microlithiasis, counsel patient about the potential increased risk of GCT, need for periodic self-examination and follow-up with a medical professional'''

*** insert image

[[File:Testicular microlithiasis 131206091733625.gif|thumb|Testicular microlithiasis in a patient with contralateral orchiectomy due to testicular malignancy. Echogenic foci viewed in testis as small white spots. Source: [[commons:File:Testicular_microlithiasis_131206091733625.gif|Wikipedia]]|center]]

===== MRI =====

@@ Line 23: / Line 23: @@
 ** US 2021: 440[https://seer.cancer.gov/statfacts/html/testis.html]
 *** 5-year relative survival: 94.9% (compared to prostate 97.5%, bladder 77.1%, and kidney/renal pelvis 75.6%)[https://seer.cancer.gov/statfacts/html/testis.html]
-== Risk factors ==
+== Risk Factors ==
-* '''<span style="color:#ff0000">Established risk factors (5):</span>'''
+* '''<span style="color:#ff0000">Inherited (3):</span>'''
-*# '''<span style="color:#ff0000">Cryptorchidism</span>'''
-*#* '''Ipsilateral testis: relative risk 4-6x; relative risk decreases to 2-3x if orchidopexy is performed before puberty'''
-*#* '''Contralateral testis: slightly increased risk''' (relative risk 1.74x)
 *# '''<span style="color:#ff0000">Family history of GCT</span>'''
-*# '''<span style="color:#ff0000">Personal history of GCT</span>'''
+*# '''<span style="color:#ff0000">Germ Cell Neoplasia In-Situ (GCNIS)</span>'''
-*# '''<span style="color:#ff0000">Germ Cell Neoplasia In-Situ (GCNIS)</span>, previously referred to as intratubular germ cell neoplasia (ITGCN) unclassified'''
+*#* Previously referred to as intratubular germ cell neoplasia (ITGCN) unclassified
-*#* '''All adult invasive GCTs arise from GCNIS, except spermatocytic seminoma.'''
+*#*'''All adult invasive GCTs arise from GCNIS, except spermatocytic seminoma.'''
 *#* Among males with GCNIS, the risk of developing invasive GCT is ≈50% at 5 years
 *#* '''GCNIS develops before birth from an arrested gonocyte'''
 *# '''<span style="color:#ff0000">Race</span>'''
 *#* '''Caucasian risk > African-American'''
+*'''<span style="color:#ff0000">Acquired (2):</span>'''
+*#'''<span style="color:#ff0000">Cryptorchidism</span>'''
+*#* '''Ipsilateral testis: relative risk 4-6x; relative risk decreases to 2-3x if orchidopexy is performed before puberty'''
+*#* '''Contralateral testis: slightly increased risk''' (relative risk 1.74x)
+*#'''<span style="color:#ff0000">Personal history of GCT</span>'''
 == Genetics ==
@@ Line 201: / Line 203: @@
 * '''<span style="color:#ff0000">Uses (2):</span>'''
 *# '''<span style="color:#ff0000">Support initial diagnosis</span>'''
-*#* '''<span style="color:#ff0000">Should not be used to guide decision making about whether or not to perform a radical orchiectomy''' because AFP or hCG levels in the normal range do not rule out GCT.
+*#* '''<span style="color:#ff0000">Should not be used to guide decision making about whether or not to perform a radical orchiectomy'''
-*# '''<span style="color:#ff0000">Interpret tumor marker levels after orchiectomy.</span>'''
+*#** AFP or hCG levels in the normal range do not rule out GCT
+*# '''<span style="color:#ff0000">Interpret tumor marker levels after orchiectomy</span>'''
 *#* '''Essential to know whether persistently elevated post-orchiectomy tumour markers are declining compared to pre-orchiectomy levels by their respective half-lives or not, or whether they are rising, as this impacts subsequent treatment decisions.'''
 * '''Should not be used for clinical staging and risk stratification'''
@@ Line 236: / Line 239: @@
 * '''Imaging findings'''
 ** '''Typical GCT is hypoechoic'''
-** 2 or more discrete lesions may be identified
+** 2 or more discrete lesions may be identified[[File:Ultrasound images of seminomas.jpg|none|thumb|493x493px|Source: [[commons:File:Ultrasound_images_of_seminomas.jpg|Wikipedia]] (a) Seminoma usually presents as a homogeneous hypoechoic nodule confined within the tunica albuginea. (b) Sonography shows a large heterogeneous mass occupying nearly the whole testis but still confined within the tunica albuginea, it is rare for seminoma to invade to peritesticular structures.]][[File:Ultrasonography of embryonal cell carcinoma.jpg|none|thumb|Embryonal cell carcinoma. Longitudinal ultrasound image of the testis shows an irregular heterogeneous mass that forms an irregular margin with the tunica albuginea. Source: [[wikipedia:Scrotal_ultrasound#/media/File:Ultrasonography_of_embryonal_cell_carcinoma.jpg|Wikipedia]]]]
-** INSERT IMAGE
 ** '''<span style="color:#ff0000">Testicular microlithiasis</span>'''
 *** '''Unclear significance''' '''in the general population'''
@@ Line 245: / Line 247: @@
 **** '''<span style="color:#ff0000">No further evaluation or screening in incidentally detected microlithiasis</span>'''
 **** '''<span style="color:#ff0000">If established risk factor and testicular microlithiasis, counsel patient about the potential increased risk of GCT, need for periodic self-examination and follow-up with a medical professional</span>'''
-*** insert image
+[[File:Testicular microlithiasis 131206091733625.gif|thumb|Testicular microlithiasis in a patient with contralateral orchiectomy due to testicular malignancy. Echogenic foci viewed in testis as small white spots. Source: [[commons:File:Testicular_microlithiasis_131206091733625.gif|Wikipedia]]|center]]
 ===== MRI =====