Most often, patients present with a painless nodule or swelling of the testis. This document addresses germcell tumours and sex cordgonadal stromal tumours. Epigenetics and testicular germ cell tumors sciencedirect. Nov 30, 2010 the treatment of testicular germ cell tumors has been called one of the success stories of modern medicine, with sustained response to treatment in 90% of cases, regardless of clinical stage. In context of regressed germ cell tumor with metastasis, pure seminoma has a more favorable prognosis j urol 2009. The book aims to provide an overview of current knowledge regarding germ cell tumors. Diagnostic staging further includes an abdominopelvic and. They may consist of one predominant histologic pattern or represent a mix of multiple histologic types. Within the ovaries, germ cell tumors can usually be distinguished from ovarian cysts, which are much more common, using ultrasound. While testicular germ cell tumors tgcts make up only 0. Testicular tumors knowledge for medical students and physicians.
Over these years, the incidence of tgcts has risen markedly. Although consensus was reached on many issues, there are still areas of practice that need further evidence on which to base firm recommendations. Doctors can tell what type of testicular cancer you have by looking at the cells under a microscope. Germ cell tumors in the testes of an adolescent male commonly present as an enlarging, solid mass, which may be painful.
The main types of germ cell tumors gcts in the testicles are seminomas and nonseminomas. More than half of mediastinal germ cell tumors are mature teratomas. Most chapters are focused on testicular germ cell tumors whose incidence has been increasing in young males. It deals with the clinical presentations, treatment modalities, the biology and genetics of germ cell tumors in children and adults. If the tumour is diagnosed early, more than 95% of men are cured and treatment can be less intensive. Introduction testicular germ cell tumours account for most of the testicular cancers. Refer to the pdq summary on childhood central nervous system germ cell tumors treatment for information about the treatment of intracranial gcts. Sep 01, 2018 testicular germ cell tumor tgct is the most common tumor usually occuring in males between 2040 years old. Testicular cancers represent only 1% of male tumors and 5% of genitourinary malignancies. Management of recurrent testicular germ cell tumors.
The most common type is germ cell tumors which are. The aim of these guidelines is to present the current evidence for the diagnosis and treatment of patients with cancer of the testis. Adolescent and young adult testicular germ cell tumors. Testicular germ cell cancer affects mainly young men, with 85% presenting between 15 and 44 years of age. Testicular germ cell tumors also undergo spontaneous differentiation in vivo into mature cell types that, in general, behave less aggressively.
A 70% increasing incidence in the last 20 years is probably due to combined action of. The exact causes of testicular germ cell tumours are unknown. Us is used to distinguish between intratesticular masses, which are more commonly malignant, and extratesticular masses. Jan 22, 2019 testicular tumors are the most common tumors in adolescent and young men and germ cell tumors tgcts account for most of all testicular cancers. However, there are a few factors that increase the risk failed testicular descent. Approximately 95% of testicular tumors are germ cell tumors. Seminomas are the most frequent kind of testicular germ cell tumors tgcts, accounting for 50% of tumor diagnosis in young men, whereas nonseminomas account for 40% and mixed forms for 10% of cases. Testicular germ cell cancers can start as a noninvasive form of the disease called carcinoma in situ cis or intratubular germ cell neoplasia.
Testicular germ cell cancer tgct is the most common malignancy among young adult males, which has become important due to its increased incidence and mortality in the population worldwide. Typical presentation is with painless scrotal swelling. Testicular germ cell tumor presenting with spontaneous complete or partial regression j ultrasound med 2003. Testicular germ cell tumors tgcts are frequently diagnosed solid tumors in young adult males. However, testicular stromal tumors are often benign not cancerous. Purpose the efficacy of paclitaxel was evaluated in combination with ifosfamide and cisplatin as secondline chemotherapy for patients with relapsed testicular germ cell tumors gcts. Teratocarcinoma refers to a germ cell tumor that is a mixture of teratoma with embryonal carcinoma, or with choriocarcinoma, or with both. Malignant testicular germ cell tumors tgcts are the most frequent testicular cancers in caucasian males which make a total of 95% of all testicular tumors. Mouse models of testicular germ cell tumors 79 section 3. Testicular germ cell tumors account for 90% of primary tumors of the testes.
Oglucopyranoside pg in tgcts, and to explore the underlying anti. Calls for wgd or inferred i12p status could not be made for six lowpurity samples. Symptoms may include a lump in the testicle, or swelling or pain in the scrotum. In adults, extragonadal germ cell tumors account for 15% of primary anterior mediastinal tumors 12. A 70% increasing incidence in the last 20 years is probably due to combined action of epi genetic and microenvironmental factors. An overview of testicular germ cell tumors request pdf. In testicular cis, the cells look abnormal under the microscope, but they have not yet spread outside the walls of the seminiferous tubules where sperm cells are formed. International germ cell cancer collaborative group. The majority of germ cell tumors contain a unique chromosomal rearrangement that is rarely found in other tumor types. Understanding the molecular biology of tgct could help improve treatment of other. Testicular germ cell tumors gct are the commonest solid tumors in young men. During these checkups, your doctor will examine the unaffected testicle for any lumps or abnormalities and possibly recommend periodic blood tests to look for tumor markers and order regular chest xrays or ct scans to detect any tumors. Testicular germ cell tumor tgct is the most common tumor which usually occurs in males between 2040 years old 1,2. Percentages of different tumor elements in mixed germ cell tumors should be reported.
A clinicopathological study of 543 testicular germ cell tumor cases. Approximately 50% of germ cell tumors are seminomas, and approximately 50% are nonseminomatous germ cell tumors nsgcts 14. This study was a retrospective analysis of the clinicopathological and immunohistochemical of 145 tgcts. It must be emphasised that clinical guidelines present the best evidence available to the experts but following guideline recommendations will not necessarily result in. Gastrointestinal gi metastasis is seen in about 5% of patients with germ cell tumors and presentation is commonly with gi bleed. It excludes the management of germ cell testicular tumours in children, germ cell tumours in women and extragonadal tumours.
Fortunately, almost all patients with early gcts and 70% 80% of men with advanced malignancy are cured by front. Testicles, or testes, make male hormones and sperm. Testicular germ cell tumours tgcts represent the model of a curable malignancy. So, it is necessary to discuss the clinical characters. A stromal cell tumor could also be a cancer that has spread from another part of the body called a secondary cancer.
Combination of paclitaxel, ifosfamide, and cisplatin is an. Pdf epigenetic and risk factors of testicular germ cell. Testicular cancer tc represents 5% of urological tumours affecting mostly younger males. Although testicular cancer can be derived from any cell type found in the testicles, more than 95% of testicular cancers are germ cell tumors gcts. Testicular cancer represents 5% of urological tumours affecting mostly younger males. The incidence of this disease is increasingthe lifetime risk for a man is now about one in 200 in the united kingdom.
It was recognized in the 1960s that testicular germ cell tumors were curable with chemotherapeutic drugs. Among men diagnosed with an invasive testicular germ cell tumor stages, 0. Testicular germ cell tumors radiology reference article. Approximately 8,000 new cases and 400 deaths from testicular cancer are expected in the united states in 2006. Integrated molecular characterization of testicular germ cell. Testicular tumors are the most common tumors in adolescent and young men and germ cell tumors tgcts account for most of all testicular cancers. Childhood gcts are rare in children younger than 15 years, accounting for approximately 3% of cancers in this age group. We also summarise the consensus on how to treat testicular germ cell tumours and focus on a few controversies and improvements in the understanding of late e.
Among these, a common form is teratoma with endodermal sinus tumor. Primary mediastinal germ cell tumor the mediastinum is the most common site of extragonadal germ cell tumors 11, constituting 5070% of all extragonadal germ cell tumors. This document addresses germ cell tumours gcts and sex cordgonadal stromal tumours. The differential diagnosis includes congenital adrenal hyperplasia, adrenal adenoma or carcinoma, andro. Increasing incidence of tgcts among males provides strong motivation to understand its biological and genetic basis. Increase in testicular germ cell tumor incidence among hispanic adolescents and young adults in the united states. Germ cell tumors can spread to lymph nodes, lung, liver, and brain. Cryptorchidism status, family history of testicular germ cell tumor tgct or other cancer, and presence of double primaries are displayed. Of the nsgcts, 33% are mixed germ cell tumors, 10% are pure embryonal carcinomas, 4% are teratomas, 1% are yolk sac. Gains of chromosome arm 12p and aneuploidy are nearly universal in tgcts, but tgcts have.
Testicular tumors knowledge for medical students and. Testicular germ cell tumor incidence increased for all. The transition in incidence at this age is also accompanied by a transition in tumor histology with adolescents having mostly pure embryonal. Diagnosis is made primarily based on palpation and findings on testicular ultrasound. Treatment options for cisplatinresistant disease are sparse. Since that time, newer drugs including cisplatin have increased the cure rate of these tumors to over 80%, even in patients with metastatic disease. They are two eggshaped organs inside the scrotum, the loose sac of skin behind the penis. Testicular tumors most commonly occur in men between 20 and 35 years of age, and are the most common solid malignancy in this group. Reporting and staging of testicular germ cell tumors. Integrated molecular characterization of testicular germ. The world health organization 2016 classification of. The treatment of testicular germ cell tumors has been called one of the success stories of modern medicine, with sustained response to treatment in.
Androgenproducing testicular germ cell tumors introduction male hyperandrogenism is a clinical entity characterized by precocious puberty, increased weight and muscle mass, prominent acne vulgaris, and polycythemia. If the tumour is diagnosed early, more than 95% of men are cured and treatment can be. An exceptional event is the spontaneous regression sr of the primary tumor. Childhood extracranial germ cell tumors treatment pdq. Testicular germ cell tumors tgcts are a heterogeneous group of neoplasms derived from neoplastic transformation of germ cells in the testis, but with different epidemiological, biological and clinical settings, from early life to adulthood. Gains of chromosome arm 12p and aneuploidy are nearly universal in tgcts, but tgcts have low point mutation rate. Spontaneous regression as a burnedout nonseminomatous. This kind of mixed germ cell tumor may be known simply as a teratoma with elements of embryonal carcinoma or. A number of recommendations emerged from the conference, including that lymphovascular invasion lvi should always be reported and no. Germ cell tumors also exhibit a unique biology and genetics that distinguish them from other solid tumors and might. Germ cell neoplasiain situgcnis the lesion that is most widely accepted as the precursor of adult malignant testicular germ cell tumours is composed of seminomalike cells with enlarged hyperchromatic nuclei, clumped chromatin, and often prominent nucleoli, aligned along the basement membrane of seminiferous tubules within the spermatogo. The survey results were used to initiate discussions, but decisions were made by expert consensus rather than voting. After testicular cancer, lifelong surveillance is crucial.
Initial therapy of early stage testicular germ cell tumors gcts is based on histology and tumor extent. Germ cell tumors gcts account for 95 percent of testicular cancers. The outcome depends on its pathologic type and tumor stage. These tumors demonstrate a bimodal distribution in occurrence, and they are most often seen in 1525 yearold men with a second, smaller peak at about age 60. Germ cell tumors more than 90% of cancers of the testicle start in cells known as germ cells. Most of the remaining 5% are sex cordgonadal stromal tumours derived from leydig cells or sertoli cells.
Jun 03, 2019 testicular germ cell tumors tgcts are a heterogeneous group of neoplasms derived from neoplastic transformation of germ cells in the testis, but with different epidemiological, biological and clinical settings, from early life to adulthood. About 5 percent of testicular cancers start in stromal cells, which make testosterone. Gastrointestinal involvement of testicular germ cell tumor. Whole genome doubling wgd and i12p status are using the absolute algorithm. In recentyears, the incidence of tgcts has risen markedly. Nevertheless, our ability to predict metastases in earlystage disease and responders to chemotherapy in advanced disease is limited. Testicular cancer is cancer that develops in the testicles, a part of the male reproductive system. Highly specific for germ cell tumors but also seen in ovarian germ cell neoplasms. The transition in incidence at this age is also accompanied by a transition in tumor histology with adolescents having mostly pure embryonal carcinoma. An overview of therapy for men with testicular gcts is presented here.
Testicular cancer mainly affects young men between the ages of 20 and 39. Testicular cancer is the most common solid malignancy affecting males between the ages of 15 and 35, although it accounts for only 1 percent of all cancers in men. Testicular germ cell tumors tgct are a model for curable cancer due to exquisite chemosensitivity and incorporation of multimodal therapy. How are germ cell tumors in testicular cancer categorized. Testicular germ cell tumors are divided into two groups, seminomas and nonseminomas, with nonseminomas being subdivided further into 4 distinct histologies yolk sac tumor, choriocarcinoma, embryonal cell carcinoma, and teratoma. Patients and methods fortysix patients with progressive metastatic gcts were treated with paclitaxel and ifosfamide plus cisplatin tip as secondline therapy. Testicular germcell tumours tgcts represent the model of a curable malignancy. Treatment may result in infertility risk factors include an undescended testis, family history of the disease, and previous history of testicular cancer. Testicular germ cell tumors tgcts are the most frequent type of cancer in young adults. They are the most common nonhaematologic malignancy in men 1549 years old. Difficult differential diagnoses in testicular pathology. Problematic differential diagnoses include seminoma versus nonseminomatous germ cell. Region iv contains the fbox only protein 15 gene, one of the few known targets of the stem cell pluripotent fact or oct34 tokuzawa et al.
Testicular cancer testicular cancer symptoms medlineplus. The clinical manifestations, diagnosis, and staging are presented separately, as are more detailed discussions of specific clinical scenarios. Approximately 50% of germ cell tumors are seminomas, and approximately 50% are nsgcts. In men 1535 years old, testicular germ cell tumors gcts are the most common solid tumors.
Understanding the molecular biology of tgct could help improve treatment of other cancers. In young men, approximately 95% of testicular cancers are germ cell tumors, and 5% are sex cordstromal tumors. More cases of benign testicular teratomas are detected in adults than in children. During these checkups, your doctor will examine the unaffected testicle for any lumps or abnormalities and possibly recommend periodic blood tests to look for tumor markers and order regular chest x.
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