Seminoma (also known as pure seminoma or classical seminoma ) is a testicular germ cell tumor or, more rarely, mediastinum or other extras. location -gonadal. It is a malignant neoplasm and is one of the most treatable and curable cancers, with a survival rate above 95% if found at an early stage.
Testicular seminomas are derived from the germinal epithelium of the seminiferous tubules. About half of testicular germ cell tumors are seminomas. Treatment usually requires removal of one testicle. However, fertility is usually unaffected. All other sexual functions will remain intact.
Video Seminoma
Presentations
The mean age of diagnosis is between 15 and 35 years. It's about 5 to 10 years older than men with other germ cell tumors. In most cases, they produce an easily perceived mass in self-examination of the testes; However, up to 11 percent of cases, there may not be a mass that can be felt, or there may be testicular atrophy. Testicular pain is reported to a fifth of cases. Lower back pain may occur after metastasis to the retroperitoneum.
Some cases of seminoma may present as a primary tumor outside the testes, most commonly in the mediastinum. In the ovary, a tumor is called dysgerminoma, and in a non-gonad site, especially the central nervous system, it's called germinoma.
Maps Seminoma
Diagnosis
Blood tests can detect the presence of placental alkaline phosphatase (ALP, ALKP, ALPase, Alk Phos) in fifty percent of cases. However, Alk Phos can not stand alone as a marker for seminoma and contribute little to follow-up, as it increases with smoking. Human chorionic gonadotropin (hCG) may be elevated in some cases, but this is more correlated with the presence of trophoblast cells in the tumor than to the tumor stage. A classical or pure seminoma with a definition does not cause an increase in serum alpha fetoprotein. Lactate dehydrogenase (LDH) may be the only increased marker in some seminomas. The elevated level of serum LDH has a prognostic value in advanced seminomas.
The wound surface of this tumor is fleshy and dizzy, and varies in color from cream to brown to pink. The tumor tends to swell from the cut surface, and a small bleeding area may be visible. These bleeding areas are usually associated with trophoblast cell groups in the tumor.
Microscopic examination shows that seminomas are usually composed of a sheet-shaped or lobular sheet with fibrous stromal tissue. Fibrous septa almost always contains focal inclusion of lymphocytes, and granulomas are sometimes seen. The tumor cells themselves usually have a lot of clear for pale pink cytoplasm containing abundant glycogen, which is evidenced by periodic acid-Schiff (PAS) stains. The nucleus stands out and usually contains one or two large nucleoli, and has a prominent nuclear membrane. The focus of syncytiotrophoblastic cells can be present in varying amounts. The adjacent testicular tissue in general shows intratubular germ cell gland, and may also show the capture of variable spermatocytic maturation.
POU2AF1 and PROM1 have been proposed as possible markers.
Treatment
An intratesticular mass that looks suspicious on ultrasound should be treated with inguinal orchiectomy. The pathology of the testes and the raised spermatic strap indicates the presence of seminomas and helps in staging. Tumors with both seminoma and nonseminoma elements or those occurring in the presence of AFP should be treated as nonseminomas. Abdominal CT scan or MRI as well as chest imaging are performed to detect metastasis. Tumor marker analysis also helps in staging.
The preferred treatment for most forms of seminoma stage 1 is active supervision. Stage 1 seminoma is characterized by the absence of clinical evidence of metastasis. Active surveillance consists of periodic history and physical examination, tumor marker analysis, and radiographic imaging. Approximately 85-95% of these cases require no further treatment. Modern radiotherapy techniques as well as one or two single-agent carboplatin cycles have been shown to reduce the risk of recurrence, but carry the potential of causing delayed side effects. Regardless of the treatment strategy, stage 1 seminoma has a cure rate of almost 100%.
Stage 2 seminoma is demonstrated by the presence of retroperitoneal metastasis. Cases require radiotherapy or, in advanced cases, a combination of chemotherapy. Large residual mass found after chemotherapy may require surgical resection. Second line treatment is similar to nonseminoma.
Stage 3 seminomas are characterized by the presence of metastases outside the retroperitoneum - the lungs in the case of "good risk" or elsewhere in the case of "medium risk". It is treated with combination chemotherapy. Second-line treatment follows the nonseminoma protocol.
Relationship with spermatocytic seminoma
Spermatocytic seminomas are not considered as subtypes of seminoma and unlike other germ cell tumors that do not arise from intratubular germ cell gland.
Additional images
References
Source of the article : Wikipedia
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