NonSeminomatous

Nonseminomatous germ cell tumors (NSGCTs) are a group of malignant testicular germ cell tumors that do not exhibit seminoma histology. They arise from the germ cell lineage and include pure forms such as embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma, as well as mixed tumors containing nonseminomatous elements.

Most NSGCTs occur in young men, typically in the second and third decades of life. They often present as a painless testicular mass; risk factors include cryptorchidism, infertility, and a family history. Serum tumor markers aid in diagnosis and monitoring: AFP is elevated with yolk sac and some embryonal components; beta-hCG is elevated with choriocarcinoma and some embryonal tumors; LDH correlates with tumor burden but is nonspecific.

Diagnosis involves scrotal ultrasound and orchiectomy for definitive histology. Staging includes CT of the chest, abdomen, and pelvis; PET scans may be used in selected cases. NSGCTs can metastasize to retroperitoneal lymph nodes and lungs. Residual masses after therapy may require further evaluation or surgical removal.

Management begins with orchiectomy. For localized disease, options include surveillance, adjuvant chemotherapy, or retroperitoneal lymph node dissection depending on stage and histology. Advanced NSGCT typically requires platinum-based chemotherapy, most commonly BEP (bleomycin, etoposide, cisplatin) or VIP when bleomycin is contraindicated. Teratoma components may be resistant to chemotherapy and may need surgical resection, especially in post-therapy residual masses. Fertility preservation, including sperm banking, is an important consideration.

Prognosis is generally favorable with modern multimodal therapy, with cure rates high for most stages. Prognostic factors include stage at diagnosis, tumor marker levels, and the extent of metastatic spread.