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Flashcards in Testis neoplasm Deck (42):
1

What are the two major types of testis tumors

1. Germ Cell
2. Sex cord/stromal tumors (Leydig/Sortoli)

2

Into which two categories are germ cell tumors divided?

1. Seminoma
2. Non-seminoma germ cell tumors

3

Classic seminoma: characteristics?

1. peak incidence 35-40 years of age
2. 15% contain syncytiotrophoblasts (bHCG production)
3. arises from ITGCN
4. Most common germ cell tumor

4

Name 4 NSGCTs

1. Embryonal Carcinoma
2. Yolk Sac/Endodermal Sinus Tumor
3. Choriocarcinoma
4. Teratoma

5

Characteristics of embryonal carcinoma

1. Poorly differentiated,
2. able to differentiate into other NSGCTs
3. peak incidence 25-35 years of age
4. Aggressive tumor with high rates of metasatsis

6

Characteristics of yolk sac (endodermal sinus tumor)

1. Pure tumors are rare
2. MC germ cell tumor in children/infants
3. Present in 40% of mixed GCTs
4. Make AFP
5. Never make bHCG
6. Schiller-duvall bodies on pathology

7

Characteristics of Choriocarcinoma

1. Rare
2. Aggressive
3. Peak incidence 20-30 yo
4. early hematogenous spread (including brain)
5. High bHCG common
6. No AFP

8

Characteristics of Teratoma

1. Contains endoderm, mesoderm or ectoderm
2. No AFP or bHCG
3. Rare in adults, more common in peds
4. half of mixed GCT contain teratoma elements
5. Chemoresistant
6. morbidity related to local growth and malignant transformation

9

AFP is elevated in which NSGCT

Embryonal and yolk sac

10

What is normal AFP

< 20-25 ng/ml

11

What is the half life of AFP

5-7 days

12

What is the half life of bHCG

24-26 h

13

Which tumors make bHCG

seminoma, embryonal, choriocarcinoma

14

LDH-1 half life

24 h

15

Primary left testis tumor lymph drainage?

Para-aortic lymph nodes

16

Primary right testis tumor lymph drainage?

Infrarenal interaortocaval lymph nodes, followed by paracaval and para-aortic regions

17

What is the initial site of metastasis in 70-80% of testis cancer?

retroperitoneum

18

What percentage of patients will be understaged on imaging with a LN cut off of 1 cm?

30% will harbor occult metastatic disease

19

What is pTis?

intratubular germ cell neoplasia

20

what is pT1

limited to testis and epi, may involve albuginea but not vaginalis NO LVI

21

what is pT2

tumor limited to testis and epi, with LVI, or tumor involving TVaginalis

22

whats pT3

tumor invades spermatic cord

23

whats pT4

tumor invades scrotum

24

Clinical N0

no regional nodes

25

Clinical N1

mets within 1-5 LN, all less than 2 cm

26

Clinical N2

Mets within a LN > 2 cm, < 5 cm, or more than 5 nodes involved, no that have extranodal extension

27

Clinical N3

mets in one or more nodes > 5 cm

28

M0

no distant mets

29

M1a

non regional distant metastatis, or pumonary mets

30

M1b

Distant met in a site other than non regional LN or lung

31

S0

Tumor markers WNL

32

S1

LDH < 1.5x normal, bHCG < 5000, AFP < 1000

33

S2

LDH 1.5-10x normal, HCG 5000-50,000; AFP 1000-10,000

34

S3

LDH > 10x normal
HCG > 5,0000
LDH > 10,000

35

Non seminoma good prognosis, risk group

1. Testicular/Retroperitoneal primary
2. No non pulmonary visceral met
3. < = S1

36

Non seminoma intermediate prognosis, risk group

1. Testicular/Retroperitoneal primary
2. No non pulmonary visceral met
3. S2

37

Non seminoma poor prognosis, risk group

1. Mediastinal primary
2. Non pulmonary visceral met
3. S3

38

Seminoma good prognosis risk group

1. Any primary
2. No non pulmonary visceral mets

39

Seminoma intermediate prognosis risk group

1. Any primary
2. Non pulmonary visceral mets

40

What factors predict relapse in seminoma

rete testis involvement
tumors ≥ 4 cm

41

What percent of stage I seminoma patients relapse with surveillance? When is relapse most common

13%
2-3 years

42

For stage I seminoma men who cannot adhere to surveillance, what treatment options are there?

1. Single does of carboplatinum
2. Radiotherapy 20 gy