A 55-year-old man presents with a non-tender, hard testicular mass. Serum AFP is 850 ng/mL, beta-hCG is 10 IU/L, and LDH is elevated. CT abdomen/pelvis shows retroperitoneal lymph nodes 3 cm. Which is the MOST likely histology and appropriate staging?
- A Pure seminoma, Stage IIA — elevated AFP rules out pure seminoma
- B Teratoma Stage I — nodes are reactive
- C Non-seminomatous germ cell tumour (NSGCT), Stage IIA — retroperitoneal nodes 2-5 cm ✓
- D Lymphoma of the testis — treated with rituximab
Correct answer: C. Non-seminomatous germ cell tumour (NSGCT), Stage IIA — retroperitoneal nodes 2-5 cm
Explanation
Elevated AFP is NEVER seen in pure seminoma — its presence indicates a non-seminomatous germ cell tumour (NSGCT) or mixed GCT, even if the histology appears to be seminoma. Retroperitoneal lymph nodes 2-5 cm on CT constitute Stage IIA disease (nodes <2 cm = IIA per some classifications; 2-5 cm = IIB). After orchidectomy, management of NSGCT Stage IIA/IIB is BEP chemotherapy (bleomycin, etoposide, cisplatin) or retroperitoneal lymph node dissection.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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