A 28-year-old man presents with a painless right testicular mass. AFP is 450 IU/mL, β-hCG is 5 IU/L, and LDH is mildly elevated. Radical orchidectomy histology confirms pure embryonal carcinoma. CT reveals retroperitoneal lymph nodes of 2.5 cm maximum diameter. According to IGCCCG classification, what is the prognostic group and what tumour marker pattern best characterises pure embryonal carcinoma?

• A Poor prognosis; AFP normal, β-hCG markedly elevated
• B Intermediate prognosis; AFP normal, LDH elevated only
• C Good prognosis; AFP markedly elevated, β-hCG normal or mildly elevated ✓
• D Good prognosis; AFP and β-hCG both markedly elevated (>10,000 IU/L each)

Explanation

Pure embryonal carcinoma is a non-seminomatous germ cell tumour characterised by AFP elevation (since embryonal cells differentiate toward yolk sac elements) and variable β-hCG. With retroperitoneal nodes <5 cm, no visceral metastases, and the primary in the testis, this falls within IGCCCG good prognosis for NSGCT (AFP <1000 IU/mL, β-hCG <5000 IU/L, LDH <1.5× upper limit). Pure seminoma does NOT produce AFP; elevated AFP in a 'seminoma' reclassifies it as NSGCT. Chemotherapy regimen: BEP (bleomycin, etoposide, cisplatin) × 3 cycles for good prognosis.

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

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Written and medically reviewed by the StethoPrep medical team.