seminoma

Seminoma is a malignant germ cell tumor of the testis, accounting for about 40% of testicular germ cell tumors. It most often affects men in their 30s and 40s. Two main forms are recognized: classical seminoma, which is common, and spermatocytic seminoma, a rarer variant occurring in older men with a different histology and behavior.

Pathology and presentation: classical seminoma shows sheets of uniform cells with clear cytoplasm, central nuclei, and prominent nucleoli, arranged in lobules separated by fibrous septa containing lymphocytes. Spermatocytic seminoma has three cell types and lacks the lymphocytic infiltration seen in classical tumors. Clinically, seminomas usually present as a painless testicular mass; metastatic spread is typically to retroperitoneal lymph nodes. Serum tumor markers are usually normal for AFP; beta-hCG may be elevated in a minority of cases, and LDH may be elevated nonspecifically.

Diagnosis and initial management: diagnosis relies on scrotal ultrasound and measurement of tumor markers, with radical inguinal orchiectomy providing tissue for histology and serving as the initial therapeutic step. Staging uses imaging of the chest, abdomen, and pelvis to assess lymph node involvement and metastasis.

Treatment and prognosis: after orchiectomy, stage I disease may be managed with surveillance, adjuvant radiotherapy to the para-aortic region, or single-dose carboplatin. Stage II–III disease is typically treated with combination chemotherapy, most often BEP (bleomycin, etoposide, cisplatin) or EP regimens. Spermatocytic seminoma is treated with orchiectomy; adjuvant therapy is rarely required, and prognosis is excellent.

Follow-up focuses on physical exams, tumor markers, and imaging to detect relapse, with considerations for fertility and contralateral testicular cancer risk. Seminomas generally have a high cure rate across stages.