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Classic Seminoma
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- Clinical: average age 40 years (slightly later than other germ cell tumors); painless testicular mass is the common presenting complaint; gynecomastia may be seen with elevated HCG; 30% have metastatic disease at the time of diagnosis
- Gross: tan or cream-colored multilobular tumor with bulging cut surface
- Histologic features:
- cells are large with abundant clear or lightly eosinophilic cytoplasm and well-defined cytoplasmic membranes
- nuclei are vesicular with prominent cherry-red nucleoli
- mitoses may be numerous (at one time, the presence of > 3 mitoses /hpf resulted in a diagnosis of “anaplastic seminoma,” but that term has been discarded as the distinction is not prognostically significant)
- cells are separated into clusters by fibrovascular septa with numerous lymphocytes
- chronic inflammation may be marked, with occasional follicle formation or granulomas
- multinucleated giant cells (syncytiotrophoblasts) may be seen, especially in patients with elevated HCG
- Treatment: orchiectomy and radiation +/- chemotherapy; 80% cure rate even in patients with advanced disease
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