Abstract
Testicular cancer is the most common solid-non hematological cancer diagnosed in young adult men. Personal history of testicular cancer is a major risk factor for developing testicular cancer. Testicular germ cell tumors are the most common tumors, these are further divided into seminomas and non seminomatous germ cell tumors. Tumors generally present as painless testicular mass, the first investigation is testicular ultrasound followed by serum biomarkers. MRI can be used as a problem solver only in equivocal cases. Radical orchiectomy provides therapy as well as pathological T staging. CT scan is the primary investigation for assessing lymph node status and for evaluation of distant metastasis. [18F]FDG PET/CT is not recommended for diagnosis of primary testicular cancer with reported unsatisfactory negative predictive value, nevertheless PET/CT offers several advantages over CT particularly for patients with equivocal CT findings and in patients who exhibit elevated tumor markers and negative CT scan. In addition, [18F]FDG PET/CT is especially useful for evaluation of post chemotherapy residual masses in metastatic seminoma. [18F]FDG PET/CT is, however; not routinely indicated for post chemotherapy evaluation of non seminomatous germ cell tumors because of high false negative rate in Teratomas.
Similar content being viewed by others
Abbreviations
- [18F]FDG:
-
2-Deoxy-2-[18F]fluoro-d-glucose
- AFP:
-
α-Fetoprotein
- AJCC:
-
American Joint Committee on Cancer
- Beta-hCG:
-
Beta-human chorionic gonadotropin
- BRAF:
-
Gene encoding for the B-Raf protein, a serine/threonine-protein kinase (also known as the proto-oncogene B-Raf and v-Raf murine sarcoma viral oncogene homolog B)
- C-KIT:
-
Proto-oncogene encoding for tyrosine-protein kinase Kit (or CD117), also known as mast/stem cell growth factor receptor (SCFR)
- CT:
-
X-ray computed tomography
- CXCR4:
-
Gene encoding for C-X-C chemokine receptor type 4 (CXCR-4), also known as fusin or CD184 (cluster of differentiation 184)
- EGFR:
-
Epidermal growth factor receptor; the mutated form EGFRvIII plays a prominent role in tumorigenesis and proangiogenic signaling
- GCT:
-
Germ cell tumor
- IGD:
-
In greatest dimension
- IGF:
-
Insulin-like factor
- LDH:
-
Lactate dehydrogenase
- M:
-
Metastasis status according to the AJCC/UICC TNM staging system
- MRI:
-
Magnetic resonance imaging
- N:
-
Lymph node status according to the AJCC/UICC TNM staging system
- NCCN:
-
National Comprehensive Cancer Network
- NSGCT:
-
Nonseminomatous germ cell tumor
- p53:
-
Tumor protein p53, also known as cellular tumor antigen p53, phosphoprotein p53, tumor suppressor p53, antigen NY-CO-13, or transformation-related protein 53 (TRP53)
- PET:
-
Positron emission tomography
- PET/CT:
-
Positron emission tomography/Computed tomography
- RAS:
-
Oncogene regulating signaling cascades
- SDF-1:
-
Gene encoding for the stromal cell-derived factor 1, also known as C-X-C motif chemokine 12 (CXCL12)
- SNP:
-
Single nucleotide polymorphism
- SPECT:
-
Single-photon emission tomography
- SPECT/CT:
-
Single-photon emission tomography/Computed tomography
- T:
-
Tumor status according to the AJCC/UICC TNM staging system
- TGCT:
-
Testicular germ cell tumor
- TNM:
-
AJCC/UICC staging system based on parameters “T” (tumor status), “N” (lymph node status), and “M” (distant metastasis status)
- UICC:
-
Union Internationale Contre le Cancer (International Union Against Cancer)
- ULN:
-
Upper limit of normal range
- US:
-
Ultrasonography
- WHO:
-
World Health Organization
References
Gonzalez-Exposito R, Merino M, Aguayo C. Molecular biology of testicular germ cell tumors. Clin Transl Oncol. 2016;18:550–6.
Fosså SD, Chen J, Schonfeld SJ, et al. Risk of contralateral testicular cancer: a population-based study of 29,515 U.S. men. J Natl Cancer Inst. 2005;97:1056–66.
Heller HT, Oliff MC, Doubilet PM, O’Leary MP, Benson CB. Testicular microlithiasis: prevalence and association with primary testicular neoplasm. J Clin Ultrasound. 2014;42:423–6.
Crockford GP, Linger R, Hockley S, et al. Genome-wide linkage screen for testicular germ cell tumour susceptibility loci. Hum Mol Genet. 2006;15:443–5.
Gonzalez-Exposito R, Merino M, Aguayo C. Molecular biology of testicular germ cell tumors. Clin Transl Oncol. 2016;18:550–6.
Madani A, Kemmer K, Sweeney C, et al. Expression of kit and epidermal growth factor receptor in chemotherapy refractory non-seminomatous germ cell tumors. Ann Oncol. 2003;14:873–80.
Howitt BE, Berney DM. Tumors of the testis: morphologic features and molecular alterations. Surg Pathol Clin. 2015;8:687–716.
Skakkebaek NE, Rajpert-De Meyts E, et al. Germ cell cancer and disorders of spermatogenesis: an environmental connection? APMIS. 1998;106:3–11.
Chaganti RS, Houldsworth J. The cytogenetic theory of the pathogenesis of human adult male germ cell tumors. APMIS. 1998;106:80–3.
Ulbright TM, Tickoo SK, Berney DM, Srigley JR. Members of the IIiDUPG. Best practices recommendations in the application of immunohistochemistry in testicular tumors: report from the International Society of Urological Pathology consensus conference. Am J Surg Pathol. 2014;38:e50–9.
Leite KR, Garicochea B, Srougi M, et al. Monoclonality of asynchronous bilateral lymphoma of the testis. Eur Urol. 2000;38:774–7.
Nazeer T, Ro JY, Amato RJ, Park YW, Ordonez NG, Ayala AG. Histologically pure seminoma with elevated alpha-fetoprotein: a clinicopathologic study of ten cases. Oncol Rep. 1998;5:1425–9.
Weissbach L1, Bussar-Maatz R, Mann K. The value of tumor markers in testicular seminomas. Results of a prospective multicenter study. Eur Urol. 1997;32:16–22.
Motzer RJ, Jonasch E, Agarwal N, et al. Testicular cancer, version 2.2015. J Natl Compr Canc Netw. 2015;13:772–99.
Albers P, Albrecht W, Algaba F, et al. Guidelines on testicular cancer: 2015 update. Eur Urol. 2015;68:1054–68.
Sobin LH, Gospodarowicz MK, Wittekind C, editors. TNM classification of malignant tumors. 7th ed. Oxford: Wiley-Blackwell; 2009. p. 249–54.
Ray B, Hajdu SI, Whitmore Jr WF. Proceedings: distribution of retroperitoneal lymph node metastases in testicular germinal tumors. Cancer. 1974;33:340–8.
Donohue JP, Zachary JM, Maynard BR. Distribution of nodal metastases in nonseminomatous testis cancer. J Urol. 1982;128:315–20.
Weissbach L, Boedefeld EA. Localization of solitary and multiple metastases in stage II nonseminomatous testis tumor as basis for a modified staging lymph node dissection in stage I. J Urol. 1987;138:77–82.
Brouwer OR, Valdés Olmos RA, Vermeeren L, Hoefnagel CA, Nieweg OE, Horenblas S. SPECT/CT and a portable gamma-camera for image-guided laparoscopic sentinel node biopsy in testicular cancer. J Nucl Med. 2011;52:551–4.
Mead GM, Stenning SP. The International Germ Cell Consensus Classification: a new prognostic factor-based staging classification for metastatic germ cell tumours. Clin Oncol. 1997;9:207–9.
Guthrie JA, Fowler RC. Ultrasound diagnosis of testicular tumours presenting as epididymal disease. Clin Radiol. 1992;46:397–400.
Schwerk WB, Schwerk WN, Rodeck G. Testicular tumors: prospective analysis of real-time US patterns and abdominal staging. Radiology. 1987;164:369–74.
Meyts ER, McGlynn KA, Okamoto K, Jewett MA, Bokemeyer C. Testicular germ cell tumours. Lancet. 2016;387(10029):1762–74.
Coursey Moreno C, Small WC, Camacho JC, et al. Testicular tumors: what radiologists need to know – differential diagnosis, staging, and management. Radiographics. 2015;35:400–15.
Höbarth K, Szabo N, Klingler HC, Kratzik C. Sonographic appearance of testicular microlithiasis. Eur Urol. 1993;24:251–5.
Richenberg J, Belfield J, Ramchandani P, et al. Testicular microlithiasis imaging and follow-up: guidelines of the ESUR scrotal imaging subcommittee. Eur Radiol. 2015;25:323–30.
Secil M, Altay C, Basara I. State of the art in germ cell tumor imaging. Urol Oncol. 2016;34:156–64.
Kreydin EI, Barrisford GW, Feldman AS, Preston MA. Testicular cancer: what the radiologist needs to know. AJR Am J Roentgenol. 2013;200:1215–25.
Correas JM, Drakonakis E, Isidori AM, et al. Update on ultrasound elastography: miscellanea. Prostate, testicle, musculo-skeletal. Eur J Radiol. 2013;82:1904–12.
Tsili AC, Argyropoulou MI, Giannakis D, Sofikitis N, Tsampoulas K. MRI in the characterization and local staging of testicular neoplasms. AJR Am J Roentgenol. 2010;194:682–9.
Algebally AM, Tantawy HI, Yousef RR, Szmigielski W, Darweesh A. Advantage of adding diffusion weighted imaging to routine MRI examinations in the diagnostics of scrotal lesions. Pol J Radiol. 2015;80:442–9.
Hilton S, Herr HW, Teitcher JB, Begg CB, Castéllino RA. CT detection of retroperitoneal lymph node metastases in patients with clinical stage I testicular nonseminomatous germ cell cancer: assessment of size and distribution criteria. AJR Am J Roentgenol. 1997;169:521–5.
Rajpert-De Meyts E, McGlynn KA, Okamoto K, Jewett MA, Bokemeyer C. Testicular germ cell tumours. Lancet. 2016;387(10029):1762–74.
Sohaib SA, Koh DM, Barbachano Y, et al. Prospective assessment of MRI for imaging retroperitoneal metastases from testicular germ cell tumours. Clin Radiol. 2009;64:362–7.
Zhao JY, Ma XL, Li YY, et al. Diagnostic accuracy of 18F-FDG-PET in patients with testicular cancer: a meta-analysis. Asian Pac J Cancer Prev. 2014;15:3525–31.
Mansberg R, Ho B, Bui C. Positive FDG PET/CT of recurrent testicular tumour due to orchitis. Mol Imaging Radionucl Ther. 2014;23:28–30.
Lassen U, Daugaard G, Eigtved A, Højgaard L, Damgaard K, Rørth M. Whole-body FDG-PET in patients with stage I non-seminomatous germ cell tumours. Eur J Nucl Med Mol Imaging. 2003;30:396–402.
Tsatalpas P, Beuthien-Baumann B, Kropp J, et al. Diagnostic value of 18F-FDG positron emission tomography for detection and treatment control of malignant germ cell tumors. Urol Int. 2002;68:157–63.
De Wit M, Brenner W, Hartmann M, et al. [18F]-FDG-PET in clinical stage I/II non-seminomatous germ cell tumours: results of the German multicentre trial. Ann Oncol. 2008;19:1619–23.
Cook GJ, Sohaib A, Huddart RA, Dearnaley DP, Horwich A, Chua S. The role of 18F-FDG PET/CT in the management of testicular cancers. Nucl Med Commun. 2015;36:702–8.
Huddart RA, O’Doherty MJ, Padhani A, NCRI Testis Tumour Clinical Study Group, et al. 18Fluorodeoxyglucose positron emission tomography in the prediction of relapse in patients with high-risk, clinical stage I nonseminomatous germ cell tumors: preliminary report of MRC Trial TE22 – the NCRI Testis Tumour Clinical Study Group. J Clin Oncol. 2007;25:3090–5.
Tandstad T, Smaaland R, Solberg A, et al. Management of seminomatous testicular cancer: a binational prospective population-based study from the Swedish Norwegian Testicular Cancer Study Group. J Clin Oncol. 2011;29:719–25.
De Santis M, Becherer A, Bokemeyer C, et al. 2-18fluoro-deoxy-D-glucose positron emission tomography is a reliable predictor for viable tumor in postchemotherapy seminoma: an update of the prospective multicentric SEMPET trial. J Clin Oncol. 2004;22:1034–9.
Becherer A, De Santis M, Karanikas G, et al. FDG PET is superior to CT in the prediction of viable tumour in post-chemotherapy seminoma residuals. Eur J Radiol. 2005;54:284–8.
Stattaus J, Bockisch A, Forsting M, Müller SP. Value of imaging for lymph node metastases from renal cell, bladder, prostate, penile, and testicular cancers. Urologe A. 2005;44:614–24.
Bachner M, Loriot Y, Gross-Goupil M, et al. 2-18Fluoro-deoxy-D-glucose positron emission tomography (FDG-PET) for postchemotherapy seminoma residual lesions: a retrospective validation of the SEMPET trial. Ann Oncol. 2012;23:59–64.
Hinz S, Schrader M, Kempkensteffen C, et al. The role of positron emission tomography in the evaluation of residual masses after chemotherapy for advanced stage seminoma. J Urol. 2008;179:936–40.
Gerl A, Clemm C, Schmeller N, et al. Sequential resection of residual abdominal and thoracic masses after chemotherapy for metastatic nonseminomatous germ cell tumours. Br J Cancer. 1994;70:960–5.
Hartmann JT, Schmoll HJ, Kuczyk MA, et al. Postchemotherapy resections of residual masses from metastatic non-seminomatous testicular germ cell tumors. Ann Oncol. 1997;8:531–8.
Oechsle K, Hartmann M, Brenner W, et al. [18F]Fluorodeoxyglucose positron emission tomography in nonseminomatous germ cell tumors after chemotherapy: the German multicenter positron emission tomography study group. J Clin Oncol. 2008;26:5930–5.
Quak E, Kovacs I, Oyen WJ, van der Graaf WT. FDG-PET/CT in a patient with poor-risk non-seminoma testis with mature teratoma and secondary gliosarcoma: multimodality imaging for guiding multimodality treatment. Nucl Med Mol Imaging. 2015;49:237–40.
Brouwer OR, Meinhart W, Horenblas S, Valdés Olmos RA. Preoperative and intraoperative lymphatic mapping for radioguided sentinel node biopsy in cancers of the male reproductive system. In: Mariani G, Manca G, Orsini F, Vidal-Sicart S, Valdés Olmos RA, editors. Atlas of lymphoscintigraphy and sentinel node mapping – a pictorial case-based approach. Milan: Springer-Verlag Italia; 2013. p. 269–83.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this entry
Cite this entry
AlSharif, A., Chiacchio, S., Giovacchini, G. (2016). Diagnostic Applications of Nuclear Medicine: Testicular Cancer. In: Strauss, H., Mariani, G., Volterrani, D., Larson, S. (eds) Nuclear Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-26067-9_21-1
Download citation
DOI: https://doi.org/10.1007/978-3-319-26067-9_21-1
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Online ISBN: 978-3-319-26067-9
eBook Packages: Springer Reference MedicineReference Module Medicine
Publish with us
Chapter history
-
Latest
Diagnostic Applications of Nuclear Medicine: Testicular Cancer- Published:
- 22 April 2022
DOI: https://doi.org/10.1007/978-3-319-26067-9_21-2
-
Original
Diagnostic Applications of Nuclear Medicine: Testicular Cancer- Published:
- 27 September 2016
DOI: https://doi.org/10.1007/978-3-319-26067-9_21-1