A 35-year-old man presents with a painless left testicular swelling. Ultrasound shows a heterogeneous intratesticular mass. Tumor markers: AFP 850 ng/mL, beta-hCG 12 IU/L, LDH elevated. After radical orchiectomy, histology shows mixed germ cell tumor (teratoma + embryonal carcinoma). CT shows para-aortic nodes measuring 2.5 cm. What is the IGCCCG risk classification?
- A Good prognosis — AFP <1000 ng/mL with non-seminoma
- B Good prognosis — AFP <1000 ng/mL and gonadal primary ✓
- C Intermediate prognosis — AFP 1000–10,000 ng/mL or hCG 5000-50,000 IU/L
- D Intermediate prognosis — AFP <1000 ng/mL but non-pulmonary visceral metastases
Explanation
The IGCCCG (International Germ Cell Cancer Collaborative Group) classifies non-seminomatous germ cell tumors: Good prognosis requires gonadal or retroperitoneal primary AND no non-pulmonary visceral metastases AND AFP <1000 ng/mL AND hCG <5000 IU/L AND LDH <1.5x ULN. This patient has AFP 850 ng/mL (<1000), hCG 12 IU/L (<5000), gonadal primary, and only para-aortic lymph nodes (not non-pulmonary visceral metastases), placing him in the good prognosis group with ~92% 5-year survival. Intermediate prognosis requires AFP 1000-10,000 or hCG 5000-50,000 or non-pulmonary visceral mets.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.