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Surgery

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Urology

Question
70 out of 129
 

Alpha feto protein is not raised in which of the following tumors



A Endodermal sinus tumor

B Pure seminoma

C Choriocarcinoma

D Embryonal carcinoma

Ans. B Pure seminoma (REF. SABISTON SURGERY 18TH EDN CHP 77 PG 2198)

a. In men suspected of having testicular tumor, serum markers of α-fetoprotein, the sb subunit of human chorionic gonadotropin (β-HCG), and lactate dehydrogenase (LDH) are obtained.

b. Serum levels of AFP or β-HCG are elevated in 80% to 85% of men with nonseminomatous GCTs , even when nonmetastatic.

c. In contrast, serum β-HCG is elevated in fewer than 20% of testicular seminomas, and AFP is not elevated in pure seminomas.

d. Neither serum β-HCG nor AFP alone or in combination is sufficiently sensitive or specific to establish the diagnosis of testicular cancer in the absence of histologic confirmation.

e. Serum LDH concentrations are elevated in pure seminoma and in nonseminomatous tumors. LDH is a less sensitive and less specific tumor marker than β-HCG or AFP nonseminomatous GCTs, but it may be the only marker that is elevated in seminomas.

f. In addition, a significantly elevated serum LDH has independent prognostic value in men with advanced seminoma.

g. A radical inguinal orchiectomy with high ligation of the spermatic cord near the internal inguinal ring is performed to permit histologic evaluation of the primary tumor and to provide local tumor control.

h. Scrotal violation through a scrotal incision or an attempt to biopsy the testicle must be avoided because of concern for changing the lymphatic channels available to the testis tumor and potential for a poorer outcome.

i. The serum half-lives of HCG and AFP are 18 to 36 hours and 5 to 7 days, respectively.

j. Rapid normalization of serum tumor markers after orchiectomy for stage I disease suggests elimination of the tumor, whereas persistence of tumor markers after the period during which normalization is expected to occur may be the only evidence of persistent occult disease.

k. After determination of the histologic subtype of the testis cancer, several parameters may identify patients at high risk for metastasis to the retroperitoneum despite absence of lymphadenopathy on the staging CT scan. For nonseminomatous germ cell tumors, those factors include the following:

1.

Vascular or lymphatic invasion

2.

Primary tumor (T) stage T2-T3

3.

Embryonal carcinoma component greater than 40% of total tumor volume .

Urology Flashcard List

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