Overview
Seminoma is a germ cell tumor primarily affecting the testis, typically presenting as a solitary mass in early stages. It is classified as clinical stage I when confined to the testis without metastasis 13.Diagnosis
Clinical Presentation: Palpable testicular mass 1.
Imaging: Ultrasound and CT scans to assess tumor size and retroperitoneal lymph nodes 1.
Pathology: Histopathological examination post-orchidectomy confirms seminoma diagnosis 1.
Risk Factors: Tumor size (≤2 cm, >2-5 cm, >5 cm), rete testis invasion (RTI), and lymphovascular invasion are significant prognostic factors 1.
Serum Tumor Markers: Typically normal in clinical stage I, though monitored post-surgery 1.Management
Primary Treatment: Radical orchidectomy is the standard initial surgical intervention 1.
Surveillance: Recommended for low-risk patients (e.g., tumor ≤2 cm, no RTI) with regular follow-up imaging and marker checks 12.
Adjuvant Therapy: Chemotherapy (e.g., carboplatin) or radiotherapy considered for high-risk patients (e.g., larger tumors, RTI present) to reduce relapse risk 12.
Special Considerations: During pandemics like COVID-19, active surveillance is recommended due to potential risks associated with adjuvant treatments 2.Special Populations
Pediatrics: Seminoma is extremely rare in children; reported in an 8-year-old post-orchidectomy 8.
Comorbidities: No specific guidelines provided in abstracts regarding management adjustments for comorbidities.
Psychosocial: Psychiatric monitoring advised post-orchidectomy due to potential psychological impacts like erotomania 4.Key Recommendations
Utilize tumor size, rete testis invasion, and lymphovascular invasion to stratify risk in clinical stage I seminoma patients for surveillance versus adjuvant therapy (Evidence: Moderate) 1.
Offer active surveillance as a viable option for low-risk clinical stage I seminoma patients, especially during pandemics, without compromising overall survival (Evidence: Moderate) 2.
Regular multidisciplinary follow-up is essential for patients managed with surveillance to monitor for relapse and late effects (Evidence: Expert opinion) 3.References
1 Boormans JL, Sylvester R, Anson-Cartwright L, Glicksman RM, Hamilton RJ, Hahn E et al.. Prognostic Factor Risk Groups for Clinical Stage I Seminoma: An Individual Patient Data Analysis by the European Association of Urology Testicular Cancer Guidelines Panel and Guidelines Office. European urology oncology 2024. link
2 Kang DH, Cho KS, Jeong JY, Moon YJ, Chung DY, Jung HD et al.. Surveillance versus Adjuvant Treatment with Chemotherapy or Radiotherapy for Stage I Seminoma: A Systematic Review and Meta-Analysis According to EAU COVID-19 Recommendations. Medicina (Kaunas, Lithuania) 2022. link
3 Vossen CY, Horwich A, Daugaard G, van Poppel H, Osanto S. Patterns of care in the management of seminoma stage I: results from a European survey. BJU international 2012. link
4 Mazeh D, Merimsky O, Melamed Y, Inbar M. Erotomania following an orchiectomy: a case report. Journal of sex & marital therapy 1997. link
5 Lehmann D, Temminck B, Litmanen K, Leibundgut B, Hadziselimovic F, Müller H. Autoimmune phenomena and cytogenetic findings in a patient with carcinoma (seminoma) in situ. Cancer 1986. link58:9<2013::aid-cncr2820580910>3.0.co;2-o)
6 Blacher EJ, Maynard JF. Seminoma and sarcoidosis: an unusual association. Urology 1985. link90128-1)
7 Hosokawa S, Tomoyoshi T. Primary retroperitoneal seminoma. European urology 1983. link
8 Perry C, Servadio C. Seminoma in childhood. The Journal of urology 1980. link55740-7)