Testicular Nonseminomatous Germ Cell Tumor

Kristin Janson Redmond and Thomas J. Guzzo

 Background

Approximately how many cases of germ cell tumor (GCT) are diagnosed annually in the U.S.?

~8,000 cases/yr in the U.S.

What % of testicular malignancies are GCTs?

~95% of testicular malignancies are GCTs.

What is the most common solid tumor in men age 15–34 yrs?

GCT is the most common solid tumor in men age 15–34 yrs.

How has the incidence of GCTs changed in the past 40 yrs?

The incidence of GCTs has more than doubled in the past 40 yrs.

Name 5 risk factors for GCTs.

Risk factors for GCTs:

1. 
   

   Prior personal Hx of GCT

   
   
2. 
   

   Positive family Hx

   
   
3. 
   

   Cryptorchidism

   
   
4. 
   

   Testicular dysgenesis

   
   
5. 
   

   Klinefelter syndrome

How are GCTs classified?

GCTs are classified as seminomatous or nonseminomatous.

What % of testicular GCTs are nonseminomatous germ cell tumors (NSGCTs)?

40% of testicular GCTs are NSGCTs.

Name 5 histologic types of NSGCTs.

Histologic types of NSGCTs:

1. 
   

   Embryonal cell carcinoma

   
   
2. 
   

   Choriocarcinoma

   
   
3. 
   

   Yolk sac tumor

   
   
4. 
   

   Teratoma

   
   
5. 
   

   Mixed

In what 2 ways are teratomas classified?

Teratomas are classified as either mature or immature depending on whether it contains adult-type differentiated cell types (mature) or partial somatic differentiation similar to that found in a fetus (immature).

What is a teratoma with malignant transformation?

A teratoma with malignant transformation is a teratoma that histologically resembles a somatic cancer, such as an adenocarcinoma or sarcoma.

How does the presence of a seminoma component influence outcomes in pts with histologically confirmed NSGCTs?

The presence of a seminoma component within a histologically confirmed NSGCT has no major impact on the clinical outcome. Such pts are treated based on the NSGCT algorithm.

What is the median age of presentation for pts with NSGCTs, and how does this compare to the median age of presentation for pts with seminomatous germ cell tumors (SGCTs)?

The median age of presentation for NSGCTs is 27 yrs vs. age 36 yrs for SGCTs and 33 yrs for mixed tumors.

How does the presence of pure choriocarcinoma affect the prognosis?

Pure choriocarcinoma typically presents with widespread mets and a very high β-HCG and has a poor prognosis. Note that elements of choriocarcinoma are found in 10% of NSGCTs and do not affect the prognosis.

Which histology of NSGCTs is most commonly associated with an elevated AFP?

Yolk sac tumors are composed of cells that produce AFP.

What is the most common GCT histology in childhood?

Yolk sac tumors are the most common histology in childhood.

 Workup/Staging

Per NCCN 2010, what 3 blood tests should be performed in the workup of a suspicious testicular mass?

There are 3 blood tests that should be performed in a man with a suspicious testicular mass: AFP, β-HCG, and a chemistry panel including LDH.

What is the half-life of AFP?

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