Seminoma overview

Seminoma Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Seminoma from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Staging TNM Stage Grouping
History and Symptoms
Physical Examination
Laboratory Findings
Chest X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy Treatment - Stage I Treatment - Stage II Treatment - Stage III Treatment - Recurrent
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Seminoma overview On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Seminoma overview All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Seminoma overview
CDC on Seminoma overview
Seminoma overview in the news
Blogs on Seminoma overview
Directions to Hospitals Treating Seminoma
Risk calculators and risk factors for Seminoma overview

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. 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.

Classification

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

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. 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. 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. Seminoma is demonstrated by positivity to tumor markers, such as OCT4, CD117, D2-40, and CD117.

Causes

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

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.

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. 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. Testicular seminoma usually affects individuals of the Caucasian race. African american individuals are less likely to develop testicular seminoma.

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.

Screening

There is insufficient evidence to recommend routine screening for seminoma.

Natural History, Complications and Prognosis

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

Diagnosis

Staging

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

Symptoms

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

Physical Examination

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

Laboratory Findings

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

CT

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

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.

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.

Treatment

Medical Therapy

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

Surgery

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

Primary Prevention

There are no primary preventive measures available for seminoma.

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. 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.