A 32-year-old man presents with a painless left testicular swelling. Serum AFP is markedly elevated at 4500 IU/mL and beta-hCG is mildly elevated. CT shows retroperitoneal lymphadenopathy >5 cm. The correct staging and classification of this non-seminomatous germ cell tumour is:

• A Stage IIA; good prognosis per IGCCCG
• B Stage IIIA; intermediate prognosis per IGCCCG due to elevated AFP >10,000
• C Stage IIB; good prognosis per IGCCCG
• D Stage IIC/IIIA; intermediate prognosis with retroperitoneal nodes >5 cm and AFP 1000–10,000 IU/mL ✓

Explanation

By TNM staging, retroperitoneal nodes 2–5 cm = N2 (Stage IIB), >5 cm = N3 (Stage IIC). AFP 1000–10,000 is classified as S2 (intermediate IGCCCG prognostic group). With AFP 4500 IU/mL and nodes >5 cm, this is Stage IIC/IIIA intermediate prognosis NSGCT. Good prognosis requires AFP <1000, beta-hCG <5000, and LDH <1.5× ULN with no non-pulmonary visceral metastases. BEP × 4 cycles is standard for intermediate prognosis.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.