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                                                                         Chapter 6: Genitourinary oncology 283



                              Stage I     Stage IIA  Stage IIB   Stage III           Stage IV


















                            Confined to testis  Para-aortic lymph nodes  Mediastinal and/or  Visceral metastases
                            and its coverings                 supraclavicular lymph nodes
                                           A–Radiological evidence
                                           B–Large, palpable

                  Figure 6.12 Staging of testicular tumours.


                  (I or IIA) disease, as CT scan is often falsely negative.  Clinical features
                  Howeverin higher stage disease, this may be postponed  As for testicular tumours. Bilateral involvement is rare.
                  until the response to chemotherapy has been assessed.
                  Chemotherapy and radiotherapy are both used in treat-
                  ment. Seminomas are more radiosensitive.      Macroscopy/microscopy
                                                                The tumour appears as a homogeneous firm white mass,
                                                                amidst normal, brown testis. Usually there is no evi-
                  Seminoma                                      dence of haemorrhage or necrosis. There are three his-
                                                                tological subtypes of seminoma, termed classic, anaplas-
                  Definition
                                                                tic and spermatocytic (British Testicular Tumour Panel)
                  These are testicular tumours of germ-cell origin which
                                                                depending on the microscopic features:
                  have differentiated along the spermatocytic line.
                                                                 Classic seminoma (85% of seminomas). Sheets of

                                                                 large, polygonal cells with clear cytoplasm (vacuo-
                  Incidence/prevalence                           latedandglycogencontaining)andsmallcentraldark-
                  Mostcommontesticulartumour(40%);∼2/100,000p.a.  staining nuclei. The presence of fibrous septa contain-
                                                                 ing prominent lymphocytic infiltration is a favourable
                  Age
                                                                 prognostic factor.
                  Peak age 35–50 years.                            Anaplastic seminoma (5–10% of seminomas). This
                                                                 type is more aggressive than classical seminoma. It
                  Sex
                                                                 shows marked pleomorphism and increased mitotic
                  Male
                                                                 activity.
                                                                 Spermatocytic seminoma (4–6% of seminomas). This

                  Aetiology                                      is a rare neoplasm which occurs in slightly older pa-
                  As for testicular tumours. Seminoma is the most com-  tients. It is not associated with intratubular germ cell
                  mon type to occur in maldescended testes.      neoplasia. The cells are pleomorphic, have a high
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