Clinical Implications of the Different Histologic Subtypes of Testicular Tumors

Abstract

The clinical management of distinctive subtypes of testicular germ cell tumors is differentiated mainly on the basis of the presence or absence of nonseminomatous elements and, for disseminated disease, the level of serum tumor markers and the site of metastatic lesions. Seminomas have metastatic potential, but are generally less aggressive than nonseminomatous germ cell tumors. Many experts prefer surveillance for clinical stage I seminoma, while others favor a risk-adapted approach so that only high-risk patients are treated either with carboplatin chemotherapy or with radiation therapy. Among nonseminomatous tumors, embryonal carcinomas and choriocarcinomas are associated with a greater tendency to metastasize. The main prognostic feature for early stage disease remains lymphovascular invasion. The predominance of embryonal carcinoma is not generally taken into account when making treatment decisions, but does have some prognostic implications with regard to risk of relapse and nodal metastases among men with clinical stage I testicular cancer. Orchiectomy alone is the appropriate treatment for spermatocytic seminomas.