WordNet

malignant tumor of the testis; usually occurring in older men (同)testicular_cancer

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/04/22 00:58:16」(JST)

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Seminoma (also known as pure seminoma or classical seminoma) is a germ cell tumor of the testicle or, more rarely, the mediastinum or other extra-gonadal locations. It is a malignant neoplasm and is one of the most treatable and curable cancers, with a survival rate above 95% if discovered in early stages.^[1]

Testicular seminoma originates in the germinal epithelium of the seminiferous tubules.^[2] About half of germ cell tumors of the testicles are seminomas.^[3] Treatment usually requires removal of one testicle, but this does not affect fertility or other sexual functioning.

Presentation

The average age of diagnosis is between 15 and 35 years. This is about 5 to 10 years older than men with other germ cell tumors of the testes. In most cases, they produce masses that are readily felt on testicular self-examination; however, in up to 11 percent of cases, there may be no mass able to be felt, or there may be testicular atrophy. Testicular pain is reported in up to one fifth of cases. Low back pain may occur after metastasis to the retroperitoneum.^[4]

Some cases of seminoma can present as a primary tumour outside the testis, most commonly in the mediastinum.^[4] In the ovary, the tumor is called a dysgerminoma, and in non-gonadal sites, particularly the central nervous system, it is called a germinoma.^[3]

Diagnosis

Ultrasound image of a seminoma

Blood tests may detect the presence of placental alkaline phosphatase (PLAP) in fifty percent of cases. However, PLAP cannot usefully stand alone as a marker for seminoma and contributes little to follow-up, due to its rise with smoking.^[5] Human chorionic gonadotropin (hCG) may be elevated in some cases, but this correlates more to the presence of trophoblast cells within the tumour than to the stage of the tumour. A classical or pure seminoma by definition do not cause an elevated serum alpha fetoprotein .^[6] Lactate dehydrogenase (LDH) may be the only marker that is elevated in some seminomas. The degree of elevation in the serum LDH has prognostic value in advanced seminoma.^[7]

The cut surface of the tumour is fleshy and lobulated, and varies in colour from cream to tan to pink. The tumour tends to bulge from the cut surface, and small areas of hemorrhage may be seen. These areas of hemorrhage usually correspond to trophoblastic cell clusters within the tumour.^[3]

Microscopic examination shows that seminomas are usually composed of either a sheet-like or lobular pattern of cells with a fibrous stromal network. The fibrous septa almost always contain focal lymphocyte inclusions, and granulomas are sometimes seen. The tumour cells themselves typically have abundant clear to pale pink cytoplasm containing abundant glycogen, which is demonstrable with a periodic acid-Schiff (PAS) stain. The nuclei are prominent and usually contain one or two large nucleoli, and have prominent nuclear membranes. Foci of syncytiotrophoblastic cells may be present in varied amounts. The adjacent testicular tissue commonly shows intratubular germ cell neoplasia, and may also show variable spermatocytic maturation arrest.^[3]

POU2AF1 and PROM1 have been proposed as possible markers.^[8]

Treatment

Intratesticular masses that appear suspicious on an ultrasound should be treated with an inguinal orchiectomy. The pathology of the removed testicle and spermatic cord indicate the presence of seminoma and assist in the staging. Tumors with both seminoma and nonseminoma elements or that occur with the presence of AFP should be treated as nonseminomas. Abdominal CT or MRI scans as well as chest imaging are done to detect for metastasis. The analysis of tumor markers also helps in staging.^[9]

The preferred treatment for most forms of stage 1 seminoma is active surveillance. Stage 1 seminoma is characterized by the absence of clinical evidence of metastasis. Active surveillance consists of periodic history and physical examinations, tumor marker analysis, and radiographic imaging. Around 85-95% of these cases will require no further treatment. Modern radiotherapy techniques as well as one or two cycles single-agent carboplatin have been shown to reduce the risk of relapse, but carry the potential of causing delayed side-effects. Regardless of treatment strategy, stage 1 seminoma has nearly a 100% cure rate.^[10]

Stage 2 seminoma is indicated by the presence of retroperitoneal metastasis. cases require radiotherapy or, in advanced cases, combination chemotherapy. Large residual masses found after chemotherapy may require surgical resection. Second line treatment is the same as for nonseminomas.^[9]

Stage 3 seminoma is characterized by the presence of metastasis outside the retroperitoneum—the lungs in "good risk" cases or elsewhere in "intermediate risk" cases. This is treated with combination chemotherapy. Second line treatment follows nonseminoma protocols.^[9]

Relation to spermatocytic seminoma

Spermatocytic seminomas are not considered a subtype of seminoma and unlike other germ cell tumours do not arise from intratubular germ cell neoplasia.^[11]

Additional images

Histopathological image of metastatic seminoma in the inguinal lymph node. Hematoxylin & eosin stain.
Histopathological image of metastatic seminoma in the inguinal lymph node. At higher magnification. Hematoxylin & eosin stain.
Micrograph (high magnification) of a seminoma. H&E stain.
Testicular seminoma, showing a typically prominent lymphocytic infiltrate in the fibrous stroma separating the clusters of tumor cells.
Orchidectomy specimen showing seminoma

References

^ "Testicular cancer". Medline Plus. Retrieved 2012-12-13.
^ "Seminoma" at Dorland's Medical Dictionary
^ ^a ^b ^c ^d Stacey E. Mills (2009). Sternberg's Diagnostic Surgical Pathology. LWW. ISBN 978-0-7817-7942-5.
^ ^a ^b Weidner N (February 1999). "Germ-cell tumors of the mediastinum". Seminars in Diagnostic Pathology (Ncbi.nlm.nih.gov) 16 (1): 42–50. PMID 10355653.
^ Nielsen et al, Eur J Cancer. 1990;26(10):1049-54
^ Yuasa T, Yoshiki T, Ogawa O et al. (May–June 1999). "Detection of alpha-fetoprotein mRNA in seminoma". Journal of Andrology (Ncbi.nlm.nih.gov) 20 (3): 336–40. doi:10.1002/j.1939-4640.1999.tb02526.x. PMID 10386812. Retrieved 2013-12-13.
^ Mencel PJ, Motzer RJ, Mazumdar M et al. (January 1994). "Advanced seminoma: treatment results, survival, and prognostic factors in 142 patients". Journal of Clinical Ocology : Official Journal of the American Society of Clinical Oncology (Ncbi.nlm.nih.gov) 12 (1): 120–126. PMID 7505805. Retrieved 2013-12-13. (registration required)
^ Gashaw I, Dushaj O, Behr R et al. (October 2007). "Novel germ cell markers characterize testicular seminoma and fetal testis". Molecular Human Reproduction 13 (10): 721–7. doi:10.1093/molehr/gam059. PMID 17785371.
^ ^a ^b ^c "NCCN Testicular Cancer Guidelines". NCCN Clinical Practice Guidelines in Oncology.
^ Nichols et al. (2013). "Active Surveillance Is the Preferred Approach to Clinical Stage I Testicular Cancer". Journal of Clinical Oncology.
^ Müller J, Skakkebaek NE, Parkinson MC (February 1987). "The spermatocytic seminoma: views on pathogenesis". International Journal of Andrology 10 (1): 147–56. doi:10.1111/j.1365-2605.1987.tb00176.x. PMID 3583416.

UpToDate Contents

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1. 第I期セミノーマ（精上皮腫）の治療 treatment of stage i seminoma
2. ステージIIのセミノーマの治療 treatment of stage ii seminoma
3. 精巣胚細胞腫瘍の治療の概要 overview of the treatment of testicular germ cell tumors
4. 精巣胚細胞腫瘍における血清腫瘍マーカー serum tumor markers in testicular germ cell tumors
5. 進行した精巣胚細胞腫瘍のリスク別の初期治療 initial risk stratified treatment for advanced testicular germ cell tumors

English Journal

Testicular seminoma clinical stage 1: treatment outcome on a routine care level.

Dieckmann KP1, Dralle-Filiz I2, Matthies C3, Heinzelbecker J4, Bedke J5, Ellinger J6, Anheuser P2, Souchon R7, Pichlmeier U8; German Testicular Cancer Study Group.
Journal of cancer research and clinical oncology.J Cancer Res Clin Oncol.2016 Jul;142(7):1599-607. doi: 10.1007/s00432-016-2162-z. Epub 2016 Apr 26.
PURPOSE: Clinical stage 1 (CS1) testicular seminoma involves an almost 100 % disease-specific survival in controlled clinical trials. We aimed to find out whether these results can be matched in patients managed on the routine care level.PATIENTS, METHODS: In total, 725 patients with seminoma CS1 w
PMID 27116691

Intratumoral heterogeneity: Role of differentiation in a potentially lethal phenotype of testicular cancer.

Tu SM1, Bilen MA1,2, Hess KR3, Broaddus RR4, Kopetz S5, Wei C6, Pagliaro LC1, Karam JA7, Ward JF7, Wood CG7, Rao P4, Tu ZH2, General R1, Chen AH1, Nieto YL8, Yeung SC9,10, Lin SH2, Logothetis CJ1, Pisters LL7.
Cancer.Cancer.2016 Jun 15;122(12):1836-43. doi: 10.1002/cncr.29996. Epub 2016 Mar 28.
BACKGROUND: Intratumoral heterogeneity presents a major obstacle to the widespread implementation of precision medicine. The authors assessed the origin of intratumoral heterogeneity in nonseminomatous germ cell tumor of the testis (NSGCT) and identified distinct tumor subtypes and a potentially let
PMID 27018785

SOX2 is essential for in vivo reprogramming of seminoma-like TCam-2 cells to an embryonal carcinoma-like fate.

Nettersheim D1, Heimsoeth A1, Jostes S1, Schneider S1, Fellermeyer M1, Hofmann A2, Schorle H1.
Oncotarget.Oncotarget.2016 Jun 7. doi: 10.18632/oncotarget.9903. [Epub ahead of print]
Type II germ cell cancers (GCC) are divided into seminomas, which are highly similar to primordial germ cells and embryonal carcinomas (EC), often described as malignant counterparts to embryonic stem cells.Previously, we demonstrated that the development of GCCs is a highly plastic process and stro
PMID 27283990

Japanese Journal

セミノーマの診断・管理におけるトータルhCG の有用性の検討

滝沢明利,岸田健,三浦猛,石田寛明,野口和美,服部裕介,窪田吉信
泌尿器科紀要 58(3), 137-142, 2012-03
… Serum hCG is said to be more useful in the diagnosis and management of non-seminoma than serum fbhGC. … Because of the false-positive issue with serum fbhCG, however, we consider it appropriate to use serum hCG for measurement even in seminoma. … We simultaneously measured serum hCG and serum fbhCG in 25 cases of seminoma in order to evaluate the usefulness of hCG assay in the diagnosis and management of seminoma. …
NAID 120003988389

前立腺・精嚢転移を来たしたpure seminomaの症例

栗原聰太,大木一成,鈴木光一,久保田裕,松尾康滋
The Kitakanto medical journal 62(1), 80-80, 2012-02-01
NAID 120003911569

Related Pictures

★リンクテーブル★

リンク元	「IGCCC Prognosis」「セミノーマ」「未分化胚細胞腫」「ディスジャーミノーマ」「セミノーム」
拡張検索	「nonseminoma」「spermatocytic seminoma」

「IGCCC Prognosis」

Seminoma
Classification and external resources
ICD-10	C62 (ILDS C62.920)
ICD-9	186
ICD-O	M9061/3
OMIM	273300
DiseasesDB	12966
eMedicine	med/2250
MeSH	D018239

　　[★]

関: 精巣腫瘍

	nonseminoma	seminoma
GOOD PROGNOSIS	Testis/retroperitoneal primary and	Any primary site and
	No nonpulmonary visceral metastases and	No nonpulmonary
	Good markers ? all of:	Normal AFP, any hCG, any LDH
	AFP < 1000 ng/ml and
	hCG < 5000 iu/l
	LDH < 1.5 × upper limit of normal
	56% of nonseminomas	90% of seminomas
	5-year PFS 89%	5-year PFS 82%
	5-year survival 92%	5-year survival 86%
INTERMEDIATE PROGNOSIS	Testis/retroperitoneal primary and	Any primary site and
	No nonpulmonary visceral metastases and	Nonpulmonary visceral metastases and
	Intermediate markers ? any of:	Normal AFP, any hCG, any LDH
	AFP ? 1000 and ? 50,000 iu/l or
	hCG ? 5000 iu/l and ? 50 000 iu/l
	LDH ? 1.5 × N and ? 10 × N
	28% of nonseminomas	10% of seminomas
	5-year PFS 75%	5-year PFS 67%
	5-year survival 80%	5-year survival 72%
POOR PROGNOSIS	Mediastinal primary or	No patients classified and poor prognosis
	Nonpulmonary visceral metastases or
	Poor markers ? any of:
	AFP > 10,000 ng/mL or
	hCG > 50,000 IU/L (10000ng/mL) or
	LDH > 10 × upper limit of normal
	16% of nonseminomas
	5-year PFS 41%
	5-year survival 48%

「セミノーマ」

　　[★]

英: seminoma, seminomas
同: 精上皮腫 disgerminoma dysgerminoma
関: 精巣腫瘍

概念

精母細胞から生じる腫瘍。
似た組織像を示す卵巣腫瘍に未分化胚細胞腫 dysgerminomaがある。

疫学

精巣腫瘍の約50%を占める
40歳以上

症状

診断

免疫組織化学

syncytial cellはhCGが陽性かも

検査

治療

高位精巣摘除術　→　化学療法・放射線療法

予後

化学療法によく反応し放射線感受性が高い。
良好
IGCCC Prognosis

参考

1. 精巣腫瘍診療ガイドライン - 香川県立中央病院 (2010年)

http://www.chp-kagawa.jp/docs/seisou.pdf

「未分化胚細胞腫」

　　[★]

英: dysgerminoma
同: ジスジャーミノーマ、卵巣精上皮腫 ovarian seminoma
関: セミノーマ

後発部位

卵巣
睾丸
縦隔
まれに延髄

悪性腫瘍で最も高頻度なのは未分化胚細胞腫

精巣のセミノーマ seminomaに相当する
両側性(5-10%, 10-20%(APT.323))　←　悪性肺細胞腫瘍の中で唯一両側発生傾向があるらしい
放射線感受性あり

疫学

若い女性に多い。妊娠に合併しうる
20-30歳代80%。10歳未満5% (also see APT.323

病理

This neoplasm is composed of sheets and cords of large polyhedral cells with large nuclei and pale pink to watery cytoplasm. (APT.323)
hCGを産生する栄養膜合胞体細胞(syncytiotrophoblastic cell)が存在することがある。