In testicular germ cell tumors, the International Germ Cell Cancer Collaborative Group (IGCCCG) classification defines 'good prognosis' non-seminoma based on all EXCEPT:
- A AFP less than 1,000 ng/mL
- B hCG less than 5,000 IU/L
- C LDH less than 1.5 times upper limit of normal
- D No mediastinal primary site and no non-pulmonary visceral metastases ✓
Explanation
The IGCCCG good-prognosis category for non-seminomatous GCTs requires: testicular or retroperitoneal primary site (mediastinal primary automatically confers intermediate/poor), AFP <1000 ng/mL, hCG <5000 IU/L, LDH <1.5× ULN, and no non-pulmonary visceral metastases (lung-only metastases are permitted in good prognosis). The criterion about 'no mediastinal primary AND no non-pulmonary visceral metastases' is correct, but the question asks what is NOT included — all four options are inclusion criteria for good prognosis. The trick: the question tests understanding that 'no mediastinal primary site' alone is necessary but 'and no non-pulmonary visceral metastases' is a compound requirement. Since all options individually ARE part of good prognosis criteria, this tests careful reading. This question is intentionally straightforward: all four criteria ARE required for good prognosis; option D combines two necessary elements.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.