Devita, Hellman, and Rosenberg's Cancer

LWBK1006-22 LWW-Govindan-Review December 12, 2011 19:7

Chapter 22•Cancer of the Testis 301

ANSWERS

Answer 22.1. The answer is A.

Metastases from testicular cancer usually follow the lymphatic drainage,

reaching the retroperitoneal lymph nodes in a predictable way. This is

the case for seminomas and almost all subtypes of nonseminomas. The

main exception is pure choriocarcinoma, which is rare and associated

with widespread hematogenous metastases. Choriocarcinomas are, by

definition, composed of both cytotrophoblasts and syncytiotrophoblasts.

Because HCG is produced by syncytiotrophoblasts, pure choriocarcino-

mas may be associated with high levels of this serum marker.

Answer 22.2. The answer is B.

There is no established association between the use of diethylstilbestrol

and the development of germ cell tumors. Although testicular cancer has

been reported in patients with HIV, there is little evidence to support

its increased incidence in this population. Klinefelter syndrome is diag-

nosed by a 47, XXY karyotype and is characterized by testicular atrophy,

eunuchoid habitus, and gynecomastia. These patients are at increased risk

for the development of mediastinal NSGCTs, but not seminomas.

Answer 22.3. The answer is D.

Risk factors for central nervous system involvement in patients with tes-

ticular cancer include pure choriocarcinoma histology, HCG>100,000

and large volume pulmonary metastases.

Answer 22.4. The answer is D.

Virtually all seminomas express CD117 (c-kit) and PLAP.

Answer 22.5. The answer is A.

Orchiopexy does not eliminate the risk of developing germ cell tumors in

patients with cryptorchidism. HIV infection is a risk factor for developing

germ cell tumors. Contralateral primaries arise in 1% to 2% of patients.

Germ cell tumors are the most common malignancy seen in men between

the ages of 15 and 34.

Answer 22.6. The answer is C.

According to the sixth edition of the American Joint Committee on Cancer

staging handbook, invasion of the tunica albuginea and vaginalis charac-

terizes pathological stages T1 and T2, respectively. Pathological stage T3

is defined by the invasion of the spermatic cord.

Answer 22.7. The answer is B.

After resection of the primary testicular cancer, the standard treatment for

patients with stage I seminoma is radiation therapy. Because of the low