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Mixed Germ Cell Tumor

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  • 2nd most common GCT after seminoma.
  • Comprises 30-40% of all testicular tumors.
  • Considered "non-seminomatous" even if seminoma is present as a component.
  • Rarely seen in prepubertal children and older adults (>50 years).
  • Serum AFP or HCG elevated depending on the component.
  • Gross: variable and depends on components, but usually has necrosis and hemorrhages (image A).

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  • Histology: (image B), (image C), & (image D).
    • Embryonal carcinoma + teratoma, most common (26%).
    • Embryonal carcinoma + seminoma (16%).
    • Embryonal carcinoma + yolk sac tumor + teratoma (11%).
    • Embryonal carcinoma + teratoma + choriocarcinoma (7%).
    • Other combinations.
  • Treatment similar to NSGCT and depends on clinical stage.
  • Prognosis depends on clinical stage, proportion of embryonal carcinoma (unfavorable), and mature teratoma.
  • Excellent outcome (>95% cure rate) for stage I and II disease.