Seminoma

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Seminoma
Other namesPure seminoma, classical seminoma
Histopathology of seminoma.png
Histopathology of classical seminoma, with typical features. [1]
Specialty Urology, oncology
Relative incidences of testicular tumors, showing seminoma at bottom left. Relative incidences of testicular tumors.png
Relative incidences of testicular tumors, showing seminoma at bottom left.

A seminoma is a germ cell tumor of the testicle or, more rarely, the mediastinum or other extra-gonadal locations. It is a malignant neoplasm and is one of the most treatable and curable cancers, with a survival rate above 95% if discovered in early stages. [3]

Contents

Testicular seminoma originates in the germinal epithelium of the seminiferous tubules. [4] About half of germ cell tumors of the testicles are seminomas. [5] Treatment usually requires removal of one testicle. However, fertility usually isn't affected. All other sexual functions will remain intact.

Signs and symptoms

The average age of diagnosis is between 35 and 50 years. This is about 5 to 10 years older than men with other germ cell tumors of the testes. In most cases, they produce masses that are readily felt on testicular self-examination; however, in up to 11 percent of cases, there may be no mass able to be felt, or there may be testicular atrophy. Testicular pain is reported in up to one fifth of cases. Low back pain may occur after metastasis to the retroperitoneum. [6]

Some cases of seminoma can present as a primary tumour outside the testis, most commonly in the mediastinum. [6] In the ovary, the tumor is called a dysgerminoma, and in non-gonadal sites, particularly the central nervous system, it is called a germinoma. [5]

Diagnosis

Ultrasound image of a seminoma Seminoma in ultrasound.jpg
Ultrasound image of a seminoma

Blood tests may detect the presence of placental alkaline phosphatase (ALP, ALKP, ALPase, Alk Phos) in fifty percent of cases. However, Alk Phos cannot usefully stand alone as a marker for seminoma and contributes little to follow-up, due to its rise with smoking. [7] Human chorionic gonadotropin (hCG) may be elevated in some cases, but this correlates more to the presence of trophoblast cells within the tumour than to the stage of the tumour. A classical or pure seminoma by definition does not cause an elevated serum alpha fetoprotein. [8] Lactate dehydrogenase (LDH) may be the only marker that is elevated in some seminomas. The degree of elevation in the serum LDH has prognostic value in advanced seminoma. [9]

The cut surface of the tumour is fleshy and lobulated, and varies in colour from cream to tan to pink. The tumour tends to bulge from the cut surface, and small areas of hemorrhage may be seen. These areas of hemorrhage usually correspond to trophoblastic cell clusters within the tumour. [5]

Microscopic examination shows that seminomas are usually composed of either a sheet-like or lobular pattern of cells with a fibrous stromal network. The fibrous septa almost always contain focal lymphocyte inclusions, and granulomas are sometimes seen. The tumour cells themselves typically have abundant clear to pale pink cytoplasm containing abundant glycogen, which is demonstrable with a periodic acid-Schiff (PAS) stain. The nuclei are prominent and usually contain one or two large nucleoli, and have prominent nuclear membranes. Foci of syncytiotrophoblastic cells may be present in varied amounts. The adjacent testicular tissue commonly shows intratubular germ cell neoplasia, and may also show variable spermatocytic maturation arrest. [5]

Relation to spermatocytic tumor

Spermatocytic tumors are not considered a subtype of seminoma and unlike other germ cell tumours do not arise from intratubular germ cell neoplasia. [11]

Treatment

Intratesticular masses that appear suspicious on an ultrasound should be treated with an inguinal orchiectomy. The pathology of the removed testicle and spermatic cord indicate the presence of the seminoma and assist in the staging. Tumors with both seminoma and nonseminoma elements or that occur with the presence of AFP should be treated as nonseminomas. Abdominal CT or MRI scans as well as chest imaging are done to detect for metastasis. The analysis of tumor markers also helps in staging. [12]

The preferred treatment for most forms of stage 1 seminoma is active surveillance. Stage 1 seminoma is characterized by the absence of clinical evidence of metastasis. Active surveillance consists of periodic history and physical examinations, tumor marker analysis, and radiographic imaging. Around 85-95% of these cases will require no further treatment. Modern radiotherapy techniques as well as one or two cycles of single-agent carboplatin have been shown to reduce the risk of relapse, but carry the potential of causing delayed side effects. Regardless of treatment strategy, stage 1 seminoma has nearly a 100% cure rate. [13]

Stage 2 seminoma is indicated by the presence of retroperitoneal metastasis. Cases require radiotherapy or, in advanced cases, combination chemotherapy. Large residual masses found after chemotherapy may require surgical resection. Second-line treatment is the same as for nonseminomas. [12]

Stage 3 seminoma is characterized by the presence of metastasis outside the retroperitoneum—the lungs in "good risk" cases or elsewhere in "intermediate risk" cases. This is treated with combination chemotherapy. Second-line treatment follows nonseminoma protocols. [12]

Related Research Articles

<span class="mw-page-title-main">Teratoma</span> Type of germ cell tumor

A teratoma is a tumor made up of several different types of tissue, such as hair, muscle, teeth, or bone. Teratomata typically form in the tailbone, ovary, or testicle.

<span class="mw-page-title-main">Testicular cancer</span> Medical condition

Testicular cancer is cancer that develops in the testicles, a part of the male reproductive system. Symptoms may include a lump in the testicle or swelling or pain in the scrotum. Treatment may result in infertility.

<span class="mw-page-title-main">Cryptorchidism</span> Medical condition

Cryptorchidism, also known as undescended testis, is the failure of one or both testes to descend into the scrotum. The word is from Greek κρυπτός 'hidden' and ὄρχις 'testicle'. It is the most common birth defect of the male genital tract. About 3% of full-term and 30% of premature infant boys are born with at least one undescended testis. However, about 80% of cryptorchid testes descend by the first year of life, making the true incidence of cryptorchidism around 1% overall. Cryptorchidism may develop after infancy, sometimes as late as young adulthood, but that is exceptional.

<span class="mw-page-title-main">Choriocarcinoma</span> Malignant, trophoblastic cancer, usually of the placenta

Choriocarcinoma is a malignant, trophoblastic cancer, usually of the placenta. It is characterized by early hematogenous spread to the lungs. It belongs to the malignant end of the spectrum in gestational trophoblastic disease (GTD). It is also classified as a germ cell tumor and may arise in the testis or ovary.

<span class="mw-page-title-main">Sex cord–gonadal stromal tumour</span> Medical condition

Sex cord–gonadal stromal tumour is a group of tumors derived from the stromal component of the ovary and testis, which comprises the granulosa, thecal cells and fibrocytes. In contrast, the epithelial cells originate from the outer epithelial lining surrounding the gonad while the germ cell tumors arise from the precursor cells of the gametes, hence the name germ cell. In humans, this group accounts for 8% of ovarian cancers and under 5% of testicular cancers. Their diagnosis is histological: only a biopsy of the tumour can make an exact diagnosis. They are often suspected of being malignant prior to operation, being solid ovarian tumours that tend to occur most commonly in post menopausal women.

<span class="mw-page-title-main">Dysgerminoma</span> Medical condition

A dysgerminoma is a type of germ cell tumor; it usually is malignant and usually occurs in the ovary.

<span class="mw-page-title-main">Germ cell tumor</span> Medical condition

Germ cell tumor (GCT) is a neoplasm derived from germ cells. Germ-cell tumors can be cancerous or benign. Germ cells normally occur inside the gonads. GCTs that originate outside the gonads may be birth defects resulting from errors during development of the embryo.

<span class="mw-page-title-main">Hydrocele</span> Accumulation of fluid in a body cavity

A hydrocele is an accumulation of serous fluid in a body cavity. A hydrocele testis, the most common form of hydrocele, is the accumulation of fluids around a testicle. It is often caused by fluid collecting within a layer wrapped around the testicle, called the tunica vaginalis, which is derived from peritoneum. Provided there is no hernia present, it goes away without treatment in the first year. Although hydroceles usually develop in males, rare instances have been described in females in the canal of Nuck.

<span class="mw-page-title-main">Embryonal carcinoma</span> Relatively uncommon type of germ cell tumour

Embryonal carcinoma is a relatively uncommon type of germ cell tumour that occurs in the ovaries and testes.

<span class="mw-page-title-main">Germinoma</span> Medical condition

A germinoma is a type of germ-cell tumor, which is not differentiated upon examination. It may be benign or malignant.

Mediastinal germ cell tumors are tumors that derive from germ cell rest remnants in the mediastinum. Germ cell tumors most commonly occur in the gonad but occasionally elsewhere.

<span class="mw-page-title-main">Spermatocytic tumor</span> Relatively benign tumour of the testis

Spermatocytic tumor, previously called spermatocytic seminoma, is a neoplasm of the testis, and classified as a germ cell tumour.

<span class="mw-page-title-main">Germ cell neoplasia in situ</span> Medical condition

Germ cell neoplasia in situ (GCNIS) represents the precursor lesion for many types of testicular germ cell tumors.

<span class="mw-page-title-main">Sertoli cell tumour</span> Medical condition

A Sertoli cell tumour, also Sertoli cell tumor, is a sex cord–gonadal stromal tumour of Sertoli cells. They can occur in the testis or ovary. They are very rare and generally peak between the ages of 35 and 50. They are typically well-differentiated, and may be misdiagnosed as seminomas as they often appear very similar.

<span class="mw-page-title-main">Leydig cell tumour</span> Medical condition

Leydig cell tumour, also Leydig cell tumor, (testicular) interstitial cell tumour and (testicular) interstitial cell tumor, is a member of the sex cord-stromal tumour group of ovarian and testicular cancers. It arises from Leydig cells. While the tumour can occur at any age, it occurs most often in young adults.

<span class="mw-page-title-main">Orchiectomy</span> Surgical removal of one or both testicles

Orchiectomy is a surgical procedure in which one or both testicles are removed. The surgery can be performed for various reasons:

<span class="mw-page-title-main">Endodermal sinus tumor</span> Medical condition

Endodermal sinus tumor (EST) is a member of the germ cell tumor group of cancers. It is the most common testicular tumor in children under three, and is also known as infantile embryonal carcinoma. This age group has a very good prognosis. In contrast to the pure form typical of infants, adult endodermal sinus tumors are often found in combination with other kinds of germ cell tumor, particularly teratoma and embryonal carcinoma. While pure teratoma is usually benign, endodermal sinus tumor is malignant.

<span class="mw-page-title-main">Scrotal ultrasound</span> Medical ultrasound examination of the scrotum.

Scrotalultrasound is a medical ultrasound examination of the scrotum. It is used in the evaluation of testicular pain, and can help identify solid masses.

<span class="mw-page-title-main">Extracranial germ cell tumor</span> Type of tumor

An extracranial germ cell tumor (EGCT) occurs in the abnormal growth of germ cells in the gonads and the areas other than the brain via tissue, lymphatic system, or circulatory system. The tumor can be benign or malignant (cancerous) by its growth rate. According to the National Cancer Institute and St. Jude Children's Research Hospital, the chance of children who are under 15 years old having EGCTs is 3%, in comparison to adolescents, a possibility of 14% with aged 15 to 19 can have EGCTs. There is no obvious cut point in between children and adolescents. However, common cut points in researches are 11 years old and 15 years old.

Ovarian germ cell tumors (OGCTs) are heterogeneous tumors that are derived from the primitive germ cells of the embryonic gonad, which accounts for about 2.6% of all ovarian malignancies. There are four main types of OGCTs, namely dysgerminomas, yolk sac tumor, teratoma, and choriocarcinoma.

References

  1. By Mikael Häggström, MD. Reference for findings: Michelle R. Downes, M.D. "Testis & paratestis - Seminoma". Pathology Outlines. Last author update: 7 January 2020. Last staff update: 19 April 2022
  2. Gill MS, Shah SH, Soomro IN, Kayani N, Hasan SH (2000). "Morphological pattern of testicular tumors". J Pak Med Assoc. 50 (4): 110–3. PMID   10851829.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  3. "Testicular cancer". Medline Plus. Retrieved 13 December 2012.
  4. " Seminoma " at Dorland's Medical Dictionary
  5. 1 2 3 4 Stacey E. Mills (2009). Sternberg's Diagnostic Surgical Pathology. LWW. ISBN   978-0-7817-7942-5.
  6. 1 2 Weidner N (February 1999). "Germ-cell tumors of the mediastinum". Seminars in Diagnostic Pathology. 16 (1): 42–50. PMID   10355653.
  7. Nielsen OS, Munro AJ, Duncan W, Sturgeon J, Gospodarowicz MK, Jewett MA, Malkin A, Thomas GM (January 1990). "Is placental alkaline phosphatase (PLAP) a useful marker for seminoma?". European Journal of Cancer and Clinical Oncology. 26 (10): 1049–54. doi:10.1016/0277-5379(90)90049-Y. PMID   2148879.
  8. Yuasa T, Yoshiki T, Ogawa O, Tanaka T, Isono T, Mishina M, et al. (May–June 1999). "Detection of alpha-fetoprotein mRNA in seminoma". Journal of Andrology. 20 (3): 336–40. doi: 10.1002/j.1939-4640.1999.tb02526.x . PMID   10386812. S2CID   7015398.
  9. Mencel PJ, Motzer RJ, Mazumdar M, Vlamis V, Bajorin DF, Bosl GJ (January 1994). "Advanced seminoma: treatment results, survival, and prognostic factors in 142 patients". Journal of Clinical Oncology. 12 (1): 120–6. doi:10.1200/jco.1994.12.1.120. PMID   7505805.(registration required)
  10. Michelle R. Downes, M.D. "Testis & epididymis - Germ cell tumors - Seminoma". Pathology Outlines. Topic Completed: 7 January 2020. Minor changes: 26 January 2021
  11. Müller J, Skakkebaek NE, Parkinson MC (February 1987). "The spermatocytic tumor: views on pathogenesis". International Journal of Andrology. 10 (1): 147–56. doi: 10.1111/j.1365-2605.1987.tb00176.x . PMID   3583416.
  12. 1 2 3 "NCCN Testicular Cancer Guidelines". NCCN Clinical Practice Guidelines in Oncology.
  13. Nichols CR, Roth B, Albers P, Einhorn LH, Foster R, Daneshmand S, et al. (October 2013). "Active surveillance is the preferred approach to clinical stage I testicular cancer". Journal of Clinical Oncology. 31 (28): 3490–3. doi: 10.1200/JCO.2012.47.6010 . PMID   24002502.