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Seminoma

Testicular cancer is a type of cancer that develops in the testicles, a part of the male reproductive system. In the United States, about 8,000 to 9,000 diagnoses of testicular cancer are made each year. Over his lifetime, a man's chance of getting testicular cancer is roughly 1 in 250 (four tenths of one percent). It is most common among males aged 15–40 years. Testicular cancer has one of the highest cure rates of all cancers: in excess of ninety percent; essentially one hundred percent if it has not spread. more...

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Medicines

Even for the relatively few cases in which the cancer has spread widely, chemotherapy offers a cure rate of at least fifty percent.

Symptoms and early detection

Because testicular cancer is curable when detected early, experts recommend regular monthly testicular self-examination after a hot shower, when the scrotum is looser. Men should examine each testicle, first feeling for lumps and then compare the testicles to each other together to see whether one is larger than the other.

Symptoms may include one or more of the following:

  • a lump in one testicle
  • pain and tenderness in the testicles
  • blood in semen during ejaculation
  • build-up of fluid in the scrotum
  • enlargement or tenderness of breasts
  • a dull ache in the lower abdomen or groin
  • an increase, or significant decrease, in the size of one testicle.

Men should report any of these to a doctor as soon as possible.

The extent of testicular cancer and whether the cancer is present are ascertained by ultrasound (of the testicles), X-rays, and/or CT-scans, which are used to locate tumors. For nonseminomas (see below), a blood test is used to identify and measure tumor indicators that are specific to that type of testicular cancer.

Pathology

Testicular cancer can be caused by any type of cell found in the testes, but more than 95% of all cancers are from germ cells. (Germ cells produce sperm. They are not pathogenic; i.e., they are not to be confused with the "germs" (viruses, bacteria) that cause illness.) In general, the remainder of this article discusses germ-cell testicular cancer.

Germ-cell tumors are classified as either seminomas or nonseminomas. Seminomas are slow-growing, immature germ cells. Seminomas, when found, tend to be localized (i.e., only in the testicles), simply because they spread relatively slowly. Nonseminomas, on the other hand, are more-mature germ cells and spread more quickly. (Nonseminomas are classified as one of three or four subtypes; their rate of spread varies somewhat, but they are treated similarly.) When seminomas and nonseminomas are both present (which is not unusual), the cancer is classified as nonseminoma.

A case of testicular cancer is categorized as being in one of three stages (which have subclassifications). Stage one is that in which the cancer remains localized to the testicle. In stage two, the cancer has spread to the nearest lymph nodes, which are small, bean-shaped structures that produce and store infection-fighting cells, in the abdomen. In stage three, the cancer has spread farther, to locations that may include the kidneys, liver, bones, lungs, or brain. The majority of cases are stage 1 when first identified; stage 3 is relatively rare.

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The effect of immunostaining with anti-OCT4 antibodies on the expression of OCT4 in mediastinal germ cell tumors
From CHEST, 10/1/05 by Pao-Hsien Chu

PURPOSE: The Primary germ cell tumor (GCT) is a relatively rare tumor usually located in the anterior mediastinum. A previous study has postulated that OCT4 is a nuclear transcription factor that is expressed in pluripotent embryonic germ cells. This study attempted to identify and characterize OCT4 expression in the GCTs originating in the mediastinum.

METHODS: A retrospective study conducted between 1983 and 2005 included 46 consecutive patients with GCTs in the mediastinum whose tumors had been surgically excised. We examined histological sections from 46 primary GCTs in the mediastinum, including teratoma (n=27; 58.7%), seminoma (n=10; 21.7%), yolk sac tumor (n=6; 13%), embryonal carcinoma (n=1; 2.1%), and mixed GCTs (n=2; 4%; one consisted of teratoma and yolk sac tumor, and the other teratoma, yolk sac tumor and seminoma). Each tumor was examined with hematoxylin and eosin staining and with anti-OCT4 antibodies. An overexpression of OCT4 was studied using immunohistochemistry.

RESULTS: The patient population was comprised of 16 (34.8%) women and 30 (65.2%) men. The mean age of patient participants was 25.1 years, with an age range of 9 to 56 years. The presentations included: asymptomatic tumor (28.5%), dyspnea (17.1%), coughing (22.8%), superior vena syndrome (5.7%), chest pain (20%), and fever (5.7%). The therapies administered were surgical-excision (75%), followed by chemotherapy (48.6%) and/or radiotherapy (31.4%). Serum tumor markers were measured for twenty (47%) of the 46patients whose, including 68% elevated alpha-fetoprotein, 30% elevated beta subunits of human chorionic gonadotropin, and 17% elevated carcinoembryonic antigen. There was greater than 90% nuclear staining of the embryonal carcinoma and seminoma tumor cells with little to no background staining. The other GCT components (yolk sac tumor and teratoma) showed no staining.

CONCLUSION: We conclude that immunostaining with anti-OCT4 antibodies is a useful diagnostic tool in the identification of primary embryonal carcinomas and seminomas in the GCT originating in the mediastinum.

CLINICAL IMPLICATIONS: anti-OCT4 antibodies is a useful diagnostic tool in the identification of mediastinal primary embryonal carcinomas and seminomas.

DISCLOSURE: Pao-Hsien Chu, None.

Pao-Hsien Chu MD * Shih-Ming Jung MD Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan ROC

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group

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