Testicular Tumors (Testicular Malignancies): Classification

Histopathologic classification of germ cell tumors (KZT) of the testis according to WHO 2004.

Seminoma

Non-seminomatous germ cell tumors (NSGCT).

Other histopathological classification

Tumors with only one histological type

Tumors with multiple histological types

TNM classification of testicular carcinoma.

T	Infiltration depth of the tumor
TIS	Intratubular tumor (carcinoma in situ)
T1	Tumor confined to testis and epididymis
T2	With vascular or lymphatic infiltration or penetration of the tunica albuginea
T3	Infiltration of the spermatic cord
T4	Infiltration of the scrotum
N	Lymph node involvement
N0	No lymph node metastases
N1	Lymph nodes ≤ 2 cm; also multiple
N2	Lymph nodes < 5 cm; also multiple
N3	Lymph node > 5 cm
M	Metastases
M0	No distant metastases
M1a	Metastases pulmonary or non-regional lymph nodes
M1b	Other distant metastases

Lugano classification

Stage	Description
I	Tumor confined to the testis
II	Retroperitoneal lymph node metastasis
IIA	Lymph node <2 cm
IIB	Lymph nodes 2-5 cm
IIC	Lymph nodes > 5 cm
III	Organ metastasis/lymph node metastasis above the diaphragm

Prognosis-dependent classification of metastatic germ cell tumor according to IGCCCG* .

	Non-seminoma	Seminoma
Good prognosis	Testicular/retroperitoneal primary tumor. No visceral metastases AFP < 1,000 ng/ml HCG < 5,000 IU/l LDH < 1.5 x upper normal value	Any primary tumor No visceral metastases AFP normal Any HCH serum level Any LDH serum level
Intermediate prognosis	Testicular/retroperitoneal primary tumor No visceral metastases AFP <10,000 ng/ml HCG < 50,000 IU/l LDH < 10 x upper normal value	Any primary tumor Visceral metastases AFP normal Any HCH serum level Any LDH serum level
Poor prognosis	Mediastinal primary tumor Visceral metastases AFP > 10,000 ng/ml HCG > 50,000 IU/l LDH > 10 x upper normal value	Not defined

* International Germ Cell Cancer Collaboration Group.