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==Overview==
==Overview==
Seminoma is the most common testicular tumor and accounts for approximately 45% of all primary testicular tumors. However, seminoma can arise outside of the [[testicle]], most often within the [[anterior mediastinum]], e.g. anterior mediastinal germ cell tumor.<ref name=intreoductiontotesticularseminoma1>Testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 25, 2016</ref> Seminoma is the most common germ cell tumor of the testis. It is the male counterpart of the [[dysgerminoma]], which arise in the [[ovary]].<ref name=librepathologyoverviewseminoma1>Overview of seminoma. Libre pathology 2016. http://librepathology.org/wiki/Seminoma. Accessed on March 3, 2016</ref>
Seminoma is the most common testicular tumor and accounts for approximately 45% of all primary testicular tumors. However, seminoma can arise outside of the [[testicle]], most often within the [[anterior mediastinum]], e.g. anterior mediastinal germ cell tumor.<ref name=intreoductiontotesticularseminoma1>Testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 25, 2016</ref> Seminoma is the most common germ cell tumor of the testis. It is the male counterpart of the [[dysgerminoma]], which arise in the [[ovary]]. It should not be confused with the unrelated tumor called spermatocytic seminoma.<ref name=librepathologyoverviewseminoma1>Overview of seminoma. Libre pathology 2016. http://librepathology.org/wiki/Seminoma. Accessed on March 3, 2016</ref> Based on the histology, testicular seminoma may be classified into three subtypes: classic, anaplastic, and spermatocytic.<ref name=pathologyoftesticularseminoma1>Pathology of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 25, 2016</ref> On gross pathology, seminoma is characterized by pale gray to yellow nodules that are uniform or slightly lobulated and often bulge from the cut surface.<ref name=pathologyoftesticularseminoma1>Pathology of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiipaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 29, 2016</ref> On microscopic pathology, seminoma is characterized by the cells with fried egg appearance with clear cytoplasm and central nucleus with prominent nucleolus, with interspersed lymphocytes and [[syncytiotrophoblast]]s.<ref name=pathologyofseminoma1>Microscopic pathology of seminoma. Libre pathology 2016. http://librepathology.org/wiki/Seminoma. Accessed on March 3, 2016</ref> Approximately 24% of Stage I seminomas have lymphovascular invasion for stage I (Tx, N0, M0). Intertubular seminoma may not form a discrete mass and mimic a benign testis.<ref name=pathologyofseminoma1>Microscopic pathology of seminoma. Libre pathology 2016. http://librepathology.org/wiki/Seminoma. Accessed on March 3, 2016</ref> Seminoma  is demonstrated by positivity to [[tumor marker]]s, such as [[OCT4]], [[CD117]], D2-40, and [[CD117]].<ref name=IHCofseminoma1>IHC for seminoma. Libre pathology 2016. http://librepathology.org/wiki/Seminoma. Accessed on March 3, 2016</ref> There are no known direct causes for seminoma.<ref name=seminomariskfactorsmlmn1>Causes of seminoma. US National Library of Medicine 2016. https://www.nlm.nih.gov/medlineplus/ency/article/001288.htm. Accessed on February 29, 2016</ref> To view a comprehensive list of risk factors that increase the risk of seminoma, click [[Seminoma risk factors|'''here''']].<ref name=riskfactorsofseminoma1>Risk factors for testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 25, 2016></ref><ref name=riskfactorsfortesticulargermcelltumotrssnkjb>Risk factors for testicular germ cell tumors. Dr Matt A. Morgan and Dr Andrew Dixon et al. Radiopaedia 2016. Accessed on February 25, 2016</ref> Testicular germ cell tumor accounts for around 1-2% of all malignancies in males up to the age of 65, but they are the most common nonhematologic malignancy in males 15-49 years old. Approximately 50% of germ cell tumours are seminomas.<ref name=epidemiologyofseminoma>Epidemiology of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 25, 2016</ref> The mean age at diagnosis of testicular seminoma is between 15 and 35 years. This is about 5 to 10 years older than men with other germ cell tumors of the testis.<ref name=presentationofseminoma1>Presentation of seminoma. Wikipedia 2016. https://en.wikipedia.org/wiki/Seminoma. Accessed on February 25, 2016</ref> Testicular seminoma usually affects individuals of the Caucasian race. African american individuals are less likely to develop testicular seminoma.<ref name=epidemiologyofseminoma>Epidemiology of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 25, 2016</ref> Seminoma grows slower than non-seminomatous germ cell tumors.<ref name=seminomas1>Cancerous tumours of the testicle. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/testicular-cancer/cancerous-tumours/?region=on. Accessed on February 26, 2016</ref> Common complications of seminoma include recurrence, lymph node metastasis, distant metastasis, and secondary malignancies.<ref name=Testicularseminomaradiopaediafhg>Testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on March 3, 2016</ref> Prognosis of seminoma is good for all stages with greater than 90% cure rate.<ref name=progseminomabjhk>Treatment and prognosis of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on March 2, 2016</ref> The International Germ Cell Cancer Consensus Group divides seminoma into two prognosis groups: good and intermediate.<ref name=survivalkandprognosisoftesticularcancer>Prognosis and survival for testicular cancer. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/prognosis-and-survival/?region=on. Accessed on February 29, 2016</ref> Symptoms of seminoma include painless testicular mass with discomfort, [[back pain]], [[abdominal discomfort]], or [[abdominal mass]].<ref name=clinicslpresntatioontesticularseminoma1>Clinical presentation of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 25, 2016</ref> Laboratory findings consistent with the diagnosis of seminoma include abnormal serum tumor marker levels ([[LDH]], [[HCG]]).<ref name=Diagnosisoftesticularcancer1>Diagnosis of testicular cancer. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/diagnosis/?region=on. Accessed on March 2, 2016</ref><ref name=diagnosisoftesticularseminomawiki1>Diagnosis of seminoma. Wikipedia 2016. https://en.wikipedia.org/wiki/Seminoma. Accessed on March 3, 2016</ref> Abdominal and pelvic CT scans may be diagnostic of seminoma.<ref name=radiographicfeaturesofptesticularseminoma1>Radiographic features of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 29, 2016</ref> CT scan may detect metastases of seminoma to the para-aortic, inguinal, or iliac lymph nodes. Visceral metastasis may also be seen.<ref name=radiographicfeaturesofptesticularseminoma1>Radiographic features of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 29, 2016</ref> Pelvic MRI may be diagnostic of testicular seminoma. On MRI, seminoma is characterized by multinodular tumors of uniform signal intensity. Findings on MRI suggestive of seminoma include hypo- to isointense on T2-weighted images and inhomogenous enhancement on contrast enhanced T1-weighted images.<ref name=radiographicimagesofseminoma1>Radiographic features of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on March 7, 2016</ref> Other diagnostic studies for seminoma include [[biopsy]], [[PET|FDG-PET scan]], and [[bone scan]].<ref name=pathologyofseminoma1>Microscopic pathology of seminoma. Libre pathology 2016. http://librepathology.org/wiki/Seminoma. Accessed on March 3, 2016</ref> [[orchiectomy|Radical inguinal orchiectomy]] is the first treatment for any stage of testicular seminoma and it is usually done as part of diagnosis.<ref name=surgeryfortesticularcancer1>Surgery for testicular cancer. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/treatment/surgery/?region=on. Accessed on March 2, 2016</ref> Adjunctive radiotherapy and chemotherapy may be given.<ref name=surgeryfortesticularcancer1>Surgery for testicular cancer. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/treatment/surgery/?region=on. Accessed on March 2, 2016</ref>
==Classification==
Based on the histology, testicular seminoma may be classified into three subtypes: classic, anaplastic, and spermatocytic.<ref name=pathologyoftesticularseminoma1>Pathology of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 25, 2016</ref>


==Pathophysiology==
On gross pathology, seminoma is characterized by pale gray to yellow nodules that are uniform or slightly lobulated and often bulge from the cut surface.<ref name=pathologyoftesticularseminoma1>Pathology of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiipaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 29, 2016</ref> On microscopic pathology, seminoma is characterized by the cells with fried egg appearance with clear cytoplasm and central nucleus with prominent nucleolus, with interspersed lymphocytes and [[syncytiotrophoblast]]s.<ref name=pathologyofseminoma1>Microscopic pathology of seminoma. Libre pathology 2016. http://librepathology.org/wiki/Seminoma. Accessed on March 3, 2016</ref> Approximately 24% of Stage I seminomas have lymphovascular invasion for stage I (Tx, N0, M0). Intertubular seminoma may not form a discrete mass and mimic a benign testis.<ref name=pathologyofseminoma1>Microscopic pathology of seminoma. Libre pathology 2016. http://librepathology.org/wiki/Seminoma. Accessed on March 3, 2016</ref> Seminoma  is demonstrated by positivity to [[tumor marker]]s, such as [[OCT4]], [[CD117]], D2-40, and [[CD117]].<ref name=IHCofseminoma1>IHC for seminoma. Libre pathology 2016. http://librepathology.org/wiki/Seminoma. Accessed on March 3, 2016</ref>
==Causes==
There are no known direct causes for seminoma.<ref name=seminomariskfactorsmlmn1>Causes of seminoma. US National Library of Medicine 2016. https://www.nlm.nih.gov/medlineplus/ency/article/001288.htm. Accessed on February 29, 2016</ref> To view a comprehensive list of risk factors that increase the risk of seminoma, click [[Seminoma risk factors|'''here''']].<ref name=riskfactorsofseminoma1>Risk factors for testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 25, 2016></ref><ref name=riskfactorsfortesticulargermcelltumotrssnkjb>Risk factors for testicular germ cell tumors. Dr Matt A. Morgan and Dr Andrew Dixon et al. Radiopaedia 2016. Accessed on February 25, 2016</ref>
==Differentiating Primary Central Nervous System Lymphoma from other Diseases==
Seminoma must be differentiated from other diseases that cause testicular mass, such as [[germ cell tumor|non seminomatous germ cell tumor]], sex cord tumors, [[orchitis|focal orchitis]], [[hemorrhage|focal intratesticular hemorrhage]], [[testicular torsion]], [[tuberculosis]], and [[polyorchidism]].<ref name=clinicslpresntatioontesticularseminoma1>Clinical presentation of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 25, 2016</ref><ref name=differentialdiagnopsisoftesticulartyeratoma1>Differential diagnosis of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 25, 2016</ref>
==Epidemiology and Demographics==
Testicular germ cell tumor accounts for around 1-2% of all malignancies in males up to the age of 65, but they are the most common nonhematologic malignancy in males 15-49 years old. Approximately 50% of germ cell tumours are seminomas.<ref name=epidemiologyofseminoma>Epidemiology of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 25, 2016</ref> The mean age at diagnosis of testicular seminoma is between 15 and 35 years. This is about 5 to 10 years older than men with other germ cell tumors of the testis.<ref name=presentationofseminoma1>Presentation of seminoma. Wikipedia 2016. https://en.wikipedia.org/wiki/Seminoma. Accessed on February 25, 2016</ref> Testicular seminoma usually affects individuals of the Caucasian race. African american individuals are less likely to develop testicular seminoma.<ref name=epidemiologyofseminoma>Epidemiology of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 25, 2016</ref>
==Risk Factors==
Common risk factors for testicular seminoma include undescended testis, caucasian race, previous tumor in the contralateral testis, and family history of testicular germ cell tumor.<ref name=riskfactorsofseminoma1>Risk factors for testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 25, 2016></ref><ref name=riskfactorsfortesticulargermcelltumotrssnkjb>Risk factors for testicular germ cell tumors. Dr Matt A. Morgan and Dr Andrew Dixon et al. Radiopaedia 2016. Accessed on February 25, 2016</ref><ref name=seminomariskfactorsmlmn1>Causes of seminoma. US National Library of Medicine 2016. https://www.nlm.nih.gov/medlineplus/ency/article/001288.htm. Accessed on February 29, 2016</ref>
==Screening==
There is insufficient evidence to recommend routine screening for seminoma.<ref name=screeningofseminoma1>Screening of seminoma. U.S. preventive services task force 2016. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=seminoma. Accessed on March 3, 2016</ref>
==Natural History, Complications and Prognosis==
Seminoma grows slower than non-seminomatous germ cell tumors.<ref name=seminomas1>Cancerous tumours of the testicle. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/testicular-cancer/cancerous-tumours/?region=on. Accessed on February 26, 2016</ref> Common complications of seminoma include recurrence, lymph node metastasis, distant metastasis, and secondary malignancies.<ref name=Testicularseminomaradiopaediafhg>Testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on March 3, 2016</ref> Prognosis of seminoma is good for all stages with greater than 90% cure rate.<ref name=progseminomabjhk>Treatment and prognosis of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on March 2, 2016</ref> The International Germ Cell Cancer Consensus Group divides seminoma into two prognosis groups: good and intermediate.<ref name=survivalkandprognosisoftesticularcancer>Prognosis and survival for testicular cancer. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/prognosis-and-survival/?region=on. Accessed on February 29, 2016</ref>
==Diagnosis==
===Staging===
Seminoma grows slower than non-seminomatous germ cell tumors.<ref name=seminomas1>Cancerous tumours of the testicle. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/testicular-cancer/cancerous-tumours/?region=on. Accessed on February 26, 2016</ref> Common complications of seminoma include recurrence, lymph node metastasis, distant metastasis, and secondary malignancies.<ref name=Testicularseminomaradiopaediafhg>Testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on March 3, 2016</ref> Prognosis of seminoma is good for all stages with greater than 90% cure rate.<ref name=progseminomabjhk>Treatment and prognosis of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on March 2, 2016</ref> The International Germ Cell Cancer Consensus Group divides seminoma into two prognosis groups: good and intermediate.<ref name=survivalkandprognosisoftesticularcancer>Prognosis and survival for testicular cancer. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/prognosis-and-survival/?region=on. Accessed on February 29, 2016</ref>
===Symptoms===
Symptoms of seminoma include painless testicular mass with discomfort, [[back pain]], [[abdominal discomfort]], or [[abdominal mass]].<ref name=clinicslpresntatioontesticularseminoma1>Clinical presentation of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 25, 2016</ref>
===Physical Examination===
Common physical examination findings of seminoma include unilateral, nontender mass with or without retroperitoneal or inguinal lymphadenopathy.<ref name="BoujelbeneCosinschi2011">{{cite journal|last1=Boujelbene|first1=Noureddine|last2=Cosinschi|first2=Adrien|last3=Boujelbene|first3=Nadia|last4=Khanfir|first4=Kaouthar|last5=Bhagwati|first5=Shushila|last6=Herrmann|first6=Eveleyn|last7=Mirimanoff|first7=Rene-Olivier|last8=Ozsahin|first8=Mahmut|last9=Zouhair|first9=Abderrahim|title=Pure seminoma: A review and update|journal=Radiation Oncology|volume=6|issue=1|year=2011|pages=90|issn=1748-717X|doi=10.1186/1748-717X-6-90}}</ref>
===Laboratory Findings===
Common laboratory tests performed in seminoma include complete blood count and blood chemistry tests.<ref name=Diagnosisoftesticularcancer1>Diagnosis of testicular cancer. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/diagnosis/?region=on. Accessed on March 2, 2016</ref> Laboratory findings consistent with the diagnosis of seminoma include abnormal serum tumor marker levels ([[LDH]], [[HCG]]).<ref name=Diagnosisoftesticularcancer1>Diagnosis of testicular cancer. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/diagnosis/?region=on. Accessed on March 2, 2016</ref><ref name=diagnosisoftesticularseminomawiki1>Diagnosis of seminoma. Wikipedia 2016. https://en.wikipedia.org/wiki/Seminoma. Accessed on March 3, 2016</ref>
===CT===
Abdominal and pelvic CT scans may be diagnostic of seminoma.<ref name=radiographicfeaturesofptesticularseminoma1>Radiographic features of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 29, 2016</ref> CT scan may detect metastases of seminoma to the para-aortic, inguinal, or iliac lymph nodes. Visceral metastasis may also be seen.<ref name=radiographicfeaturesofptesticularseminoma1>Radiographic features of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 29, 2016</ref>
===MRI===
Pelvic MRI may be diagnostic of testicular seminoma. On MRI, seminoma is characterized by multinodular tumors of uniform signal intensity. Findings on MRI suggestive of seminoma include hypo- to isointense on T2-weighted images and inhomogenous enhancement on contrast enhanced T1-weighted images.<ref name=radiographicimagesofseminoma1>Radiographic features of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on March 7, 2016</ref>
===Other Imaging Findings===
There are no other imaging findings associated with seminoma.
===Other Diagnostic Studies===
Other diagnostic studies for seminoma include [[biopsy]], [[PET|FDG-PET scan]], and [[bone scan]].<ref name=pathologyofseminoma1>Microscopic pathology of seminoma. Libre pathology 2016. http://librepathology.org/wiki/Seminoma. Accessed on March 3, 2016</ref>
==Treatment==
===Medical Therapy===
The optimal therapy for seminoma depends on the stage at diagnosis.<ref name=treatmentsoftesticularcancer>Treatments for testicular cancer. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/treatment/?region=on. Accessed on March 1, 2016</ref>
===Surgery===
[[orchiectomy|Radical inguinal orchiectomy]] is the first treatment for any stage of testicular seminoma and it is usually done as part of diagnosis.<ref name=surgeryfortesticularcancer1>Surgery for testicular cancer. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/treatment/surgery/?region=on. Accessed on March 2, 2016</ref>
===Primary Prevention===
There are no primary preventive measures available for seminoma.<ref name=preventionofseminoma>Prevention of seminoma. Embrace 2016. http://www.embracepetinsurance.com/health/seminoma. Accessed on March 3, 2016</ref>
===Secondary Prevention===
Secondary prevention strategies following seminoma include regular follow-ups for every 2–6 months for the first 3 years and every 6–12 months after 3 years.<ref name=Followupafterreatmentfortesticularcancer1>Follow-up after treatment for testicular cancer. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/treatment/follow-up/?region=on. Accessed on March 2, 2016</ref> Tests are often part of follow-up care include blood tests to check [[tumor marker|serum tumor marker levels]], chest x-rays, and CT scans of the abdomen and pelvis.<ref name=Followupafterreatmentfortesticularcancer1>Follow-up after treatment for testicular cancer. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/treatment/follow-up/?region=on. Accessed on March 2, 2016</ref>


==References==
==References==
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Overview

Seminoma is the most common testicular tumor and accounts for approximately 45% of all primary testicular tumors. However, seminoma can arise outside of the testicle, most often within the anterior mediastinum, e.g. anterior mediastinal germ cell tumor.[1] Seminoma is the most common germ cell tumor of the testis. It is the male counterpart of the dysgerminoma, which arise in the ovary. It should not be confused with the unrelated tumor called spermatocytic seminoma.[2] Based on the histology, testicular seminoma may be classified into three subtypes: classic, anaplastic, and spermatocytic.[3] On gross pathology, seminoma is characterized by pale gray to yellow nodules that are uniform or slightly lobulated and often bulge from the cut surface.[3] On microscopic pathology, seminoma is characterized by the cells with fried egg appearance with clear cytoplasm and central nucleus with prominent nucleolus, with interspersed lymphocytes and syncytiotrophoblasts.[4] Approximately 24% of Stage I seminomas have lymphovascular invasion for stage I (Tx, N0, M0). Intertubular seminoma may not form a discrete mass and mimic a benign testis.[4] Seminoma is demonstrated by positivity to tumor markers, such as OCT4, CD117, D2-40, and CD117.[5] There are no known direct causes for seminoma.[6] To view a comprehensive list of risk factors that increase the risk of seminoma, click here.[7][8] Testicular germ cell tumor accounts for around 1-2% of all malignancies in males up to the age of 65, but they are the most common nonhematologic malignancy in males 15-49 years old. Approximately 50% of germ cell tumours are seminomas.[9] The mean age at diagnosis of testicular seminoma is between 15 and 35 years. This is about 5 to 10 years older than men with other germ cell tumors of the testis.[10] Testicular seminoma usually affects individuals of the Caucasian race. African american individuals are less likely to develop testicular seminoma.[9] Seminoma grows slower than non-seminomatous germ cell tumors.[11] Common complications of seminoma include recurrence, lymph node metastasis, distant metastasis, and secondary malignancies.[12] Prognosis of seminoma is good for all stages with greater than 90% cure rate.[13] The International Germ Cell Cancer Consensus Group divides seminoma into two prognosis groups: good and intermediate.[14] Symptoms of seminoma include painless testicular mass with discomfort, back pain, abdominal discomfort, or abdominal mass.[15] Laboratory findings consistent with the diagnosis of seminoma include abnormal serum tumor marker levels (LDH, HCG).[16][17] Abdominal and pelvic CT scans may be diagnostic of seminoma.[18] CT scan may detect metastases of seminoma to the para-aortic, inguinal, or iliac lymph nodes. Visceral metastasis may also be seen.[18] Pelvic MRI may be diagnostic of testicular seminoma. On MRI, seminoma is characterized by multinodular tumors of uniform signal intensity. Findings on MRI suggestive of seminoma include hypo- to isointense on T2-weighted images and inhomogenous enhancement on contrast enhanced T1-weighted images.[19] Other diagnostic studies for seminoma include biopsy, FDG-PET scan, and bone scan.[4] Radical inguinal orchiectomy is the first treatment for any stage of testicular seminoma and it is usually done as part of diagnosis.[20] Adjunctive radiotherapy and chemotherapy may be given.[20]

Classification

Based on the histology, testicular seminoma may be classified into three subtypes: classic, anaplastic, and spermatocytic.[3]

Pathophysiology

On gross pathology, seminoma is characterized by pale gray to yellow nodules that are uniform or slightly lobulated and often bulge from the cut surface.[3] On microscopic pathology, seminoma is characterized by the cells with fried egg appearance with clear cytoplasm and central nucleus with prominent nucleolus, with interspersed lymphocytes and syncytiotrophoblasts.[4] Approximately 24% of Stage I seminomas have lymphovascular invasion for stage I (Tx, N0, M0). Intertubular seminoma may not form a discrete mass and mimic a benign testis.[4] Seminoma is demonstrated by positivity to tumor markers, such as OCT4, CD117, D2-40, and CD117.[5]

Causes

There are no known direct causes for seminoma.[6] To view a comprehensive list of risk factors that increase the risk of seminoma, click here.[7][8]

Differentiating Primary Central Nervous System Lymphoma from other Diseases

Seminoma must be differentiated from other diseases that cause testicular mass, such as non seminomatous germ cell tumor, sex cord tumors, focal orchitis, focal intratesticular hemorrhage, testicular torsion, tuberculosis, and polyorchidism.[15][21]

Epidemiology and Demographics

Testicular germ cell tumor accounts for around 1-2% of all malignancies in males up to the age of 65, but they are the most common nonhematologic malignancy in males 15-49 years old. Approximately 50% of germ cell tumours are seminomas.[9] The mean age at diagnosis of testicular seminoma is between 15 and 35 years. This is about 5 to 10 years older than men with other germ cell tumors of the testis.[10] Testicular seminoma usually affects individuals of the Caucasian race. African american individuals are less likely to develop testicular seminoma.[9]

Risk Factors

Common risk factors for testicular seminoma include undescended testis, caucasian race, previous tumor in the contralateral testis, and family history of testicular germ cell tumor.[7][8][6]

Screening

There is insufficient evidence to recommend routine screening for seminoma.[22]

Natural History, Complications and Prognosis

Seminoma grows slower than non-seminomatous germ cell tumors.[11] Common complications of seminoma include recurrence, lymph node metastasis, distant metastasis, and secondary malignancies.[12] Prognosis of seminoma is good for all stages with greater than 90% cure rate.[13] The International Germ Cell Cancer Consensus Group divides seminoma into two prognosis groups: good and intermediate.[14]

Diagnosis

Staging

Seminoma grows slower than non-seminomatous germ cell tumors.[11] Common complications of seminoma include recurrence, lymph node metastasis, distant metastasis, and secondary malignancies.[12] Prognosis of seminoma is good for all stages with greater than 90% cure rate.[13] The International Germ Cell Cancer Consensus Group divides seminoma into two prognosis groups: good and intermediate.[14]

Symptoms

Symptoms of seminoma include painless testicular mass with discomfort, back pain, abdominal discomfort, or abdominal mass.[15]

Physical Examination

Common physical examination findings of seminoma include unilateral, nontender mass with or without retroperitoneal or inguinal lymphadenopathy.[23]

Laboratory Findings

Common laboratory tests performed in seminoma include complete blood count and blood chemistry tests.[16] Laboratory findings consistent with the diagnosis of seminoma include abnormal serum tumor marker levels (LDH, HCG).[16][17]

CT

Abdominal and pelvic CT scans may be diagnostic of seminoma.[18] CT scan may detect metastases of seminoma to the para-aortic, inguinal, or iliac lymph nodes. Visceral metastasis may also be seen.[18]

MRI

Pelvic MRI may be diagnostic of testicular seminoma. On MRI, seminoma is characterized by multinodular tumors of uniform signal intensity. Findings on MRI suggestive of seminoma include hypo- to isointense on T2-weighted images and inhomogenous enhancement on contrast enhanced T1-weighted images.[19]

Other Imaging Findings

There are no other imaging findings associated with seminoma.

Other Diagnostic Studies

Other diagnostic studies for seminoma include biopsy, FDG-PET scan, and bone scan.[4]

Treatment

Medical Therapy

The optimal therapy for seminoma depends on the stage at diagnosis.[24]

Surgery

Radical inguinal orchiectomy is the first treatment for any stage of testicular seminoma and it is usually done as part of diagnosis.[20]

Primary Prevention

There are no primary preventive measures available for seminoma.[25]

Secondary Prevention

Secondary prevention strategies following seminoma include regular follow-ups for every 2–6 months for the first 3 years and every 6–12 months after 3 years.[26] Tests are often part of follow-up care include blood tests to check serum tumor marker levels, chest x-rays, and CT scans of the abdomen and pelvis.[26]

References

  1. ↑ Testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 25, 2016
  2. ↑ Overview of seminoma. Libre pathology 2016. http://librepathology.org/wiki/Seminoma. Accessed on March 3, 2016
  3. ↑ 3.0 3.1 3.2 3.3 Pathology of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 25, 2016
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Microscopic pathology of seminoma. Libre pathology 2016. http://librepathology.org/wiki/Seminoma. Accessed on March 3, 2016
  5. ↑ 5.0 5.1 IHC for seminoma. Libre pathology 2016. http://librepathology.org/wiki/Seminoma. Accessed on March 3, 2016
  6. ↑ 6.0 6.1 6.2 Causes of seminoma. US National Library of Medicine 2016. https://www.nlm.nih.gov/medlineplus/ency/article/001288.htm. Accessed on February 29, 2016
  7. ↑ 7.0 7.1 7.2 Risk factors for testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 25, 2016>
  8. ↑ 8.0 8.1 8.2 Risk factors for testicular germ cell tumors. Dr Matt A. Morgan and Dr Andrew Dixon et al. Radiopaedia 2016. Accessed on February 25, 2016
  9. ↑ 9.0 9.1 9.2 9.3 Epidemiology of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 25, 2016
  10. ↑ 10.0 10.1 Presentation of seminoma. Wikipedia 2016. https://en.wikipedia.org/wiki/Seminoma. Accessed on February 25, 2016
  11. ↑ 11.0 11.1 11.2 Cancerous tumours of the testicle. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/testicular-cancer/cancerous-tumours/?region=on. Accessed on February 26, 2016
  12. ↑ 12.0 12.1 12.2 Testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on March 3, 2016
  13. ↑ 13.0 13.1 13.2 Treatment and prognosis of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on March 2, 2016
  14. ↑ 14.0 14.1 14.2 Prognosis and survival for testicular cancer. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/prognosis-and-survival/?region=on. Accessed on February 29, 2016
  15. ↑ 15.0 15.1 15.2 Clinical presentation of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 25, 2016
  16. ↑ 16.0 16.1 16.2 Diagnosis of testicular cancer. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/diagnosis/?region=on. Accessed on March 2, 2016
  17. ↑ 17.0 17.1 Diagnosis of seminoma. Wikipedia 2016. https://en.wikipedia.org/wiki/Seminoma. Accessed on March 3, 2016
  18. ↑ 18.0 18.1 18.2 18.3 Radiographic features of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 29, 2016
  19. ↑ 19.0 19.1 Radiographic features of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on March 7, 2016
  20. ↑ 20.0 20.1 20.2 Surgery for testicular cancer. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/treatment/surgery/?region=on. Accessed on March 2, 2016
  21. ↑ Differential diagnosis of testicular seminoma. Dr Marcin Czarniecki and Dr Andrew Dixon et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-seminoma-1. Accessed on February 25, 2016
  22. ↑ Screening of seminoma. U.S. preventive services task force 2016. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=seminoma. Accessed on March 3, 2016
  23. ↑ Boujelbene, Noureddine; Cosinschi, Adrien; Boujelbene, Nadia; Khanfir, Kaouthar; Bhagwati, Shushila; Herrmann, Eveleyn; Mirimanoff, Rene-Olivier; Ozsahin, Mahmut; Zouhair, Abderrahim (2011). "Pure seminoma: A review and update". Radiation Oncology. 6 (1): 90. doi:10.1186/1748-717X-6-90. ISSN 1748-717X.
  24. ↑ Treatments for testicular cancer. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/treatment/?region=on. Accessed on March 1, 2016
  25. ↑ Prevention of seminoma. Embrace 2016. http://www.embracepetinsurance.com/health/seminoma. Accessed on March 3, 2016
  26. ↑ 26.0 26.1 Follow-up after treatment for testicular cancer. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/treatment/follow-up/?region=on. Accessed on March 2, 2016

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