eMedicine Specialties > Pediatrics: General Medicine > Oncology

Seminoma

Author: Arnold C Paulino, MD, Associate Professor, Department of Radiology, Division of Radiation Oncology, Associate Professor of Pediatrics, Baylor College of Medicine; Consulting Staff, Methodist Hospital and Texas Children's Hospital
Coauthor(s): Vershalee Shukla, MD, Staff Physician, Department of Radiology, Baylor College of Medicine; Jerry L Barker, Jr, MD, Staff Physician, Clinical Associate Professor of Radiation Oncology, Department of Radiation Oncology, University of Texas Southwestern Moncrief Cancer Center
Contributor Information and Disclosures

Updated: Nov 5, 2008

Introduction

Background

Testicular tumors in children are rare, accounting for only 1-2% of all solid tumors in this age group.1 In both children and adults, the vast majority of testis tumors arise from germ cells. Seminoma is a type of testicular germ cell tumor that is believed to originate from the germinal epithelium of the seminiferous tubules. Recently, these tumors have been shown to have dramatic sensitivity to both radiotherapy and cytotoxic chemotherapy. In most patients with testicular tumors (including seminoma), the disease is readily cured with minimal long-term morbidity. The management of childhood seminoma is similar to that of adult seminoma.

Pathophysiology

Germ cell tumors account for 95% of testicular tumors and include seminomas, teratomas, choriocarcinomas, and mixed tumors. Seminomas comprise approximately 50% of all germ cell tumors. Seminomas are generally believed to arise from the germinal epithelium of the seminiferous tubules because "seminoma cells" are morphologically similar to spermatogonia and also because seminomas are frequently found within the seminiferous tubules in early stages.

Most researchers believe that seminomas can arise from any or all of the spermatocytic elements because undifferentiated seminomas can resemble primordial germ cells, spermatogonia, or spermatocytes. Unlike the nonseminomatous germ cell tumors, pure seminoma tends to remain localized or tends to involve only lymph nodes. Seminoma is confined to the testis in 85% of patients at presentation. It initially spreads to draining lymph nodes in the retroperitoneum and then spreads proximally to involve the next echelon of draining lymphatics in the mediastinum and supraclavicular fossa. Only rarely does pure seminoma spread hematogenously to involve lung parenchyma, bone, liver, or brain (ie, stage IV). Less than 5% of patients present with stage III or stage IV disease.2

Frequency

United States

Germ cell tumors are the most common solid tumor in men aged 15-35 years.3 The worldwide incidence has more than doubled over the past 40 years, and approximately 7500 cases are diagnosed annually in the United States. Seminomas account for nearly 50% of these cases.

Mortality/Morbidity

With recent advances in radiologic staging, serum tumor marker surveillance, and platinum-based chemotherapy for advanced disease, overall survival (ie, cure) rates for patients with seminoma have increased to more than 90%. Nearly 100% of patients with stage I testicular seminoma are cured. Potential adverse effects/morbidity related to therapy for this malignancy are discussed below; in general, morbidity includes infertility, second cancers, chemotherapy-related nausea and vomiting, nephrotoxicity, and cardiovascular toxicity or peptic ulcer disease from mediastinal or retroperitoneal irradiation, respectively.

Race

Geographic distribution of testicular cancer widely varies, with the highest rates among North American whites, Scandinavians, and Western Europeans. The lowest rates occur among Asians, Africans, Puerto Ricans, and North American blacks. Recent data show a white-to-black incidence ratio of approximately 5:1, and a report from the US military showed a relative white-to-black incidence ratio of 40:1.

In children and adolescents, the pattern of racial distribution for testicular cancer is different. A review of the Surveillance, Epidemiology, and End Results (SEER) data from 1973-2000 reported that Asians and Pacific Islanders had the highest incidence of testicular cancer at 7.6 per million, whereas American Indians and Alaskan Natives had an incidence of 1.4 per million children. The rates for Caucasian and African American children were the same at 5.1 per million.4

Sex

Seminomas arise from the male testicle.

Age

As noted above, germ cell tumors are the most common solid tumors in men aged 15-35 years. Seminoma (the most common germ cell tumor) occurs most commonly in the fourth decade of life. Children represent only 2-5% of all patients with testicular cancer. Seminoma is considered a postpubertal tumor, although it has been reported in a patient as young as 8 years.

Clinical

History

  • The most common presenting symptom in a patient with seminoma is a painless testicular mass. Other symptoms can include testicular pain (45%) or heaviness.5
  • A history of previous testicular trauma is common, although usually coincidental. The trauma typically draws the patient's attention to the mass.6
  • Seminoma that has spread to retroperitoneal lymph nodes can cause back pain or abdominal discomfort.
  • Widely disseminated metastatic disease to lungs, liver, bone, or brain is rare but may produce systemic symptoms.
  • A history of cryptorchidism or other genitourinary anomalies can be elicited in some patients (see Causes).

Physical

  • When a testicular mass is suspected, the physical examination should include transillumination of the scrotum, which can differentiate a solid mass from a fluid-filled hydrocele or varicocele.
  • The contralateral testis should be carefully examined because patients with seminoma have a higher risk of contralateral testis cancer than the general population of healthy males.
  • Pay careful attention to possible sites of lymph node metastases. Specifically, the abdomen should be examined to rule out the presence of large abdominal masses (suggesting bulky paraaortic/retroperitoneal lymphadenopathy), and both supraclavicular fossae should be palpated to rule out metastatic lymphadenopathy in those locations.
  • A general physical examination that includes lungs, liver, nervous system, and musculoskeletal structures can aid in ruling out widespread metastatic disease.

Causes

  • The cause of germ cell tumors is unknown. Familial clustering has been observed.
  • Prior testicular cancer is a major risk factor for a contralateral malignancy. The cumulative risk 25 years after original diagnosis is 3.6% for patients with seminoma.
  • Cryptorchidism is a predisposing factor in the development of germ cell tumors arising from the testis. In fact, 7-10% of testis tumors occur in association with cryptorchidism.3 Orchiopexy performed before puberty reduces the risk of germ cell tumors and improves the ability to observe the testis.5 However, 25% of the cancers found in association with cryptorchidism occur in the contralateral, normally descended testis, which suggests that a developmental defect is responsible for both the maldescent and the tumor. The risk of an individual with cryptorchidism developing testicular cancer is directly related to the degree of maldescent. The risk is 1 in 20 if the testis is intra-abdominal and is 1 in 80 if it is within the inguinal canal. Hypospadias and hydrocele are other genitourinary anomalies that have been associated with testicular cancers.
  • Klinefelter syndrome is associated with the development of mediastinal germ cell tumors.6
  • Human immunodeficiency virus (HIV) infection may be associated with an increased risk of germ cell tumors. Other possible associations include mumps, orchitis, history of testicular trauma, immunosuppression after organ transplant, and prior vasectomy.5
  • No clear association between seminoma or other testicular germ cell tumors and previous exposure to diethylstilbestrol has been identified.

More on Seminoma

Overview: Seminoma
Differential Diagnoses & Workup: Seminoma
Treatment & Medication: Seminoma
Follow-up: Seminoma
Multimedia: Seminoma
References
[ CLOSE WINDOW ]

References

  1. Fernandes ET, Etcubanas E, Rao BN, Kumar AP, Thompson EI, Jenkins JJ. Two decades of experience with testicular tumors in children at St Jude Children's Research Hospital. J Pediatr Surg. Jul 1989;24(7):677-81; discussion 682. [Medline].

  2. Thomas GM, Williams SD. Testis. In: Perez CA, ed. Principles and Practice of Radiation Oncology. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1997:1695-715.

  3. Hussey DH. The testicle. In: Cox JD, ed. Moss' Radiation Oncology - Rationale, Technique, Results. 7th ed. St. Louis, MO: Mosby-Year Book; 1994:559-86.

  4. Walsh TJ, Davies BJ, Croughan MS, Carroll PR, Turek PJ. Racial differences among boys with testicular germ cell tumors in the United States. J Urol. May 2008;179(5):1961-5. [Medline].

  5. Warde PR, Sturgeon JFG, Gospodarowicz MK. Testicular cancer. In: Gunderson LL, Tepper JE, eds. Clinical Radiation Oncology. 2000:844-62.

  6. Bosl GJ, Sheinfeld J, Bajorin DF. Cancer of the testis. In: Devita VT, ed. Cancer: Principles and Practice of Oncology. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1997:1397-425.

  7. Weissbach L, Bussar-Maatz R, Mann K. The value of tumor markers in testicular seminomas. Results of a prospective multicenter study. Eur Urol. 1997;32(1):16-22. [Medline].

  8. Nazeer T, Ro JY, Amato RJ, et al. Histologically pure seminoma with elevated alpha-fetoprotein: a clinicopathologic study of ten cases. Oncol Rep. Nov-Dec 1998;5(6):1425-9. [Medline].

  9. Foster RS, Nichols CR. Testicular cancer: what's new in staging, prognosis, and therapy. Oncology (Williston Park). Dec 1999;13(12):1689-94; discussion 1697-700, 1703. [Medline].

  10. American Joint Committee on Cancer. AJCC Cancer Staging Manual. 6th ed. Philadelphia, PA: Lippincott-Raven Publishers; 2002:347-60.

  11. Capelouto CC, Clark PE, Ransil BJ, Loughlin KR. A review of scrotal violation in testicular cancer: is adjuvant local therapy necessary?. J Urol. Mar 1995;153(3 Pt 2):981-5. [Medline].

  12. Gordon W Jr, Siegmund K, Stanisic TH, et al. A study of reproductive function in patients with seminoma treated with radiotherapy and orchidectomy: (SWOG-8711). Southwest Oncology Group. Int J Radiat Oncol Biol Phys. Apr 1 1997;38(1):83-94. [Medline].

  13. DeSantis M, Albrecht W, Holtl W, Pont J. Impact of cytotoxic treatment on long-term fertility in patients with germ-cell cancer. Int J Cancer. Dec 10 1999;83(6):864-5. [Medline].

  14. Hallak J, Kolettis PN, Sekhon VS, Thomas AJ Jr, Agarwal A. Sperm cryopreservation in patients with testicular cancer. Urology. Nov 1999;54(5):894-9. [Medline].

  15. Kliesch S, Bergmann M, Hertle L, et al. Semen parameters and testicular pathology in men with testicular cancer and contralateral carcinoma in situ or bilateral testicular malignancies. Hum Reprod. Dec 1997;12(12):2830-5. [Medline].

  16. Zapzalka DM, Redmon JB, Pryor JL. A survey of oncologists regarding sperm cryopreservation and assisted reproductive techniques for male cancer patients. Cancer. Nov 1 1999;86(9):1812-7. [Medline].

  17. Warde P, Gospodarowicz MK, Panzarella T, et al. Stage I testicular seminoma: results of adjuvant irradiation and surveillance. J Clin Oncol. Sep 1995;13(9):2255-62. [Medline].

  18. Zagars GK, Babaian RJ. Stage I testicular seminoma: rationale for postorchiectomy radiation therapy. Int J Radiat Oncol Biol Phys. Feb 1987;13(2):155-62. [Medline].

  19. Zagars GK, Babaian RJ. The role of radiation in stage II testicular seminoma. Int J Radiat Oncol Biol Phys. Feb 1987;13(2):163-70. [Medline].

  20. Schmidberger H, Bamberg M, Meisner C, et al. Radiotherapy in stage IIA and IIB testicular seminoma with reduced portals: a prospective multicenter study. Int J Radiat Oncol Biol Phys. Sep 1 1997;39(2):321-6. [Medline].

  21. Kiricuta IC, Sauer J, Bohndorf W. Omission of the pelvic irradiation in stage I testicular seminoma: a study of postorchiectomy paraaortic radiotherapy. Int J Radiat Oncol Biol Phys. May 1 1996;35(2):293-8. [Medline].

  22. Fossa SD, Horwich A, Russell JM, et al. Optimal planning target volume for stage I testicular seminoma: A Medical Research Council randomized trial. Medical Research Council Testicular Tumor Working Group. J Clin Oncol. Apr 1999;17(4):1146. [Medline].

  23. Niazi TM, Souhami L, Sultanem K, et al. Long-term results of para-aortic irradiation for patients with stage I seminoma of the testis. Int J Radiat Oncol Biol Phys. Mar 1 2005;61(3):741-4. [Medline].

  24. Sultanem K, Souhami L, Benk V, et al. Para-aortic irradiation only appears to be adequate treatment for patients with Stage I seminoma of the testis. Int J Radiat Oncol Biol Phys. Jan 15 1998;40(2):455-9. [Medline].

  25. Martin JM, Panzarella T, Zwahlen DR, Chung P, Warde P. Evidence-based guidelines for following stage 1 seminoma. Cancer. Jun 1 2007;109(11):2248-56. [Medline].

  26. Fiveash J, Sandler HM. Controversies in the management of stage I seminoma. Oncology (Huntingt). Aug 1998;12(8):1203-12; discussion 1212-21. [Medline].

  27. Buchholz TA, Walden TL, Prestidge BR. Cost-effectiveness of posttreatment surveillance after radiation therapy for early stage seminoma. Cancer. Mar 15 1998;82(6):1126-33. [Medline].

  28. Reiter WJ, Brodowicz T, Alavi S, et al. Twelve-year experience with two courses of adjuvant single-agent carboplatin therapy for clinical stage I seminoma. J Clin Oncol. Jan 1 2001;19(1):101-4. [Medline].

  29. [Best Evidence] Oliver RT, Mason MD, Mead GM, von der Maase H, Rustin GJ, Joffe JK, et al. Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial. Lancet. Jul 23-29 2005;366(9482):293-300. [Medline].

  30. [Best Evidence] Oliver RT, Mason MD, Mead GM, et al. Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial. Lancet. Jul 23-29 2005;366(9482):293-300. [Medline].

  31. Warde P, Gospodarowicz M, Panzarella T. Management of stage II seminoma. J Clin Oncol. Jan 1998;16(1):290-4. [Medline].

  32. Steele GS, Richie JP, Stewart AK, Menck HR. The National Cancer Data Base report on patterns of care for testicular carcinoma, 1985-1996. Cancer. Nov 15 1999;86(10):2171-83. [Medline].

  33. Jacobsen KD, Olsen DR, Fossa K, Fossa SD. External beam abdominal radiotherapy in patients with seminoma stage I: field type, testicular dose, and spermatogenesis. Int J Radiat Oncol Biol Phys. Apr 1 1997;38(1):95-102. [Medline].

  34. Bauman GS, Venkatesan VM, Ago CT, et al. Postoperative radiotherapy for Stage I/II seminoma: results for 212 patients. Int J Radiat Oncol Biol Phys. Sep 1 1998;42(2):313-7. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

seminoma, testicular germ cell tumor, classic seminoma, pure seminoma, typical seminoma, anaplastic seminoma, spermatocytic seminoma, testicular cancer, testicular tumor, teratomas, choriocarcinomas, chemotherapy-related nausea and vomiting, peptic ulcer disease, testicular trauma, back pain, cryptorchidism, hydrocele, varicocele, hypospadias, Klinefelter syndrome, HIV, mumps, orchitis, vasectomy

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Arnold C Paulino, MD, Associate Professor, Department of Radiology, Division of Radiation Oncology, Associate Professor of Pediatrics, Baylor College of Medicine; Consulting Staff, Methodist Hospital and Texas Children's Hospital
Arnold C Paulino, MD is a member of the following medical societies: American College of Radiology, American Medical Association, American Radium Society, American Society for Therapeutic Radiology and Oncology, Children's Oncology Group, Connective Tissue Oncology Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Coauthor(s)

Vershalee Shukla, MD, Staff Physician, Department of Radiology, Baylor College of Medicine
Disclosure: Nothing to disclose.

Jerry L Barker, Jr, MD, Staff Physician, Clinical Associate Professor of Radiation Oncology, Department of Radiation Oncology, University of Texas Southwestern Moncrief Cancer Center
Jerry L Barker, Jr, MD is a member of the following medical societies: American Society for Therapeutic Radiology and Oncology
Disclosure: Nothing to disclose.

Medical Editor

Kathleen M Sakamoto, MD, PhD, Professor and Chief, Division of Hematology-Oncology, Vice-Chair of Research, Mattel Children's Hospital at UCLA; Department of Pathology and Laboratory Medicine, Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA and California Nanosystems Institute and Molecular Biology, UCLA
Kathleen M Sakamoto, MD, PhD is a member of the following medical societies: American Society of Hematology, American Society of Pediatric Hematology/Oncology, New York Academy of Sciences, Society for Pediatric Research, and Western Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Steven K Bergstrom, MD, Assistant to the Chairman, Department of Pediatrics, Division of Hematology-Oncology, Kaiser Permanente Medical Center of Oakland
Steven K Bergstrom, MD is a member of the following medical societies: Alpha Omega Alpha, American Society of Clinical Oncology, American Society of Hematology, American Society of Pediatric Hematology/Oncology, Children's Oncology Group, and International Society for Experimental Hematology
Disclosure: Nothing to disclose.

CME Editor

Helen SL Chan, MBBS, FRCP(C), FAAP, Senior Scientist, Research Institute; Professor, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Canada
Helen SL Chan, MBBS, FRCP(C), FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association for Cancer Research, American Society of Hematology, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Chief Editor

Robert J Arceci, MD, PhD, King Fahd Professor of Pediatric Oncology, Department of Oncology, Division of Pediatric Oncology, Johns Hopkins University School of Medicine
Robert J Arceci, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Pediatric Society, American Society of Hematology, and American Society of Pediatric Hematology/Oncology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.