TESTIS (ICD‐O‐3 C62) (Fig. 489)

Rules for Classification

The classification applies only to germ cell tumours of the testis. There should be histological confirmation of the disease and division of cases by histological type. Histopathological grading is not applicable.

Schematic illustration of Testis. — **Fig. 489**

Regional Lymph Nodes (Fig. 490)

The regional lymph nodes are the abdominal para‐aortic (periaortic), preaortic, interaortocaval, precaval, paracaval, retrocaval, and retroaortic nodes. Nodes along the spermatic vein should be considered regional. Laterality does not affect the N classification. The intrapelvic nodes and the inguinal nodes are considered regional after scrotal or inguinal surgery.

Schematic illustration of The regional lymph nodes are the abdominal para-aortic (periaortic), preaortic, interaortocaval, precaval, paracaval, retrocaval, and retroaortic nodes. — **Fig. 490**

TNM Clinical Classification

T – Primary Tumour

Except for pTis and pT4, where radical orchiectomy is not always necessary for classification purposes, the extent of the primary tumour is classified after radical orchiectomy; see pT. In other circumstances, TX is used if no radical orchiectomy has been performed.

N – Regional Lymph Nodes

NX	Regional lymph nodes cannot be assessed
N0	No regional lymph node metastasis
N1	Metastasis with a lymph node mass 2 cm or less in greatest dimension or multiple lymph nodes, none more than 2 cm in greatest dimension (Figs. 491, 492, 493, 494, 495)
N2	Metastasis with a lymph node mass more than 2 cm but not more than 5 cm in greatest dimension, or multiple lymph nodes, any one mass more than 2 cm but not more than 5 cm in greatest dimension (Figs. 496, 497)
N3	Metastasis with a lymph node mass more than 5 cm in greatest dimension (Figs. 498, 499, 500, 501)

Schematic illustration of Metastasis with a lymph node mass 2 cm or less in greatest dimension or multiple lymph nodes, none more than 2 cm in greatest dimension. — **Fig. 491**

Schematic illustration of Metastasis with a lymph node mass more than 2 cm but not more than 5 cm in greatest dimension, or multiple lymph nodes, any one mass more than 2 cm but not more than 5 cm in greatest dimension. — **Fig. 496**

Schematic illustration of Metastasis with a lymph node mass more than 5 cm in greatest dimension. — **Fig. 498**

M – Distant Metastasis

M0	No distant metastasis
M1	Distant metastasis
	M1a	Non‐regional lymph node(s) or lung metastasis
	M1b	Distant metastasis other than non‐regional lymph nodes and lung

pTNM Pathological Classification

pT – Primary Tumour

pTX	Primary tumour cannot be assessed (see T – Primary Tumour, above)
pT0	No evidence of primary tumour (e.g., histologic scar in testis)
pTis	Intratubular germ cell neoplasia (carcinoma in situ)
pT1	Tumour limited to testis and epididymis without vascular/lymphatic invasion; tumour may invade tunica albuginea but not tunica vaginalis (Fig. 502)
pT2	Tumour limited to testis and epididymis with vascular/lymphatic invasion (Fig. 502), or tumour extending through tunica albuginea with involvement of tunica vaginalis (Fig. 503)
pT3	Tumour invades spermatic cord with or without vascular/lymphatic invasion (Fig. 504)
pT4	Tumour invades scrotum with or without vascular/ lymphatic invasion (Fig. 505)

Schematic illustration of tumour limited to testis and epididymis without vascular/lymphatic invasion. — **Fig. 502**

Schematic illustration of tumour extending through tunica albuginea with involvement of tunica vaginalis. — **Fig. 503**

Schematic illustration of tumour invades spermatic cord with or without vascular or lymphatic invasion. — **Fig. 504**

Schematic illustration of tumour invades scrotum with or without vascular or lymphatic invasion. — **Fig. 505**

pN – Regional Lymph Nodes

pNX	Regional lymph nodes cannot be assessed
pN0	No regional lymph node metastasis
pN1	Metastasis with a lymph node mass 2 cm or less in greatest dimension and 5 or fewer positive nodes, none more than 2 cm in greatest dimension (Figs. 491, 492, 493, 494)
pN2	Metastasis with a lymph node mass (Figs. 495, 496, 497) more than 2 cm but not more than 5 cm in greatest dimension; or more than 5 nodes positive, none more than 5 cm; or evidence of extranodal extension of tumour (Fig. 495)
pN3	Metastasis with a lymph node mass more than 5 cm in greatest dimension (Figs. 498, 499, 500, 501)