Germ Cell Tumours

Germ Cell Tumours


  • Below the age of 20 years, 60% of the tumors are of germ cell origin.
  • < 10 yrs: 85% belong to this group & are malignant.


Malignant epithelial tumors


Benign cystic teratoma




Endodermal sinus tumour


Granulosa cell tumour

Post menopausal

Sertoli Leydig cell

20-30 yrs


Post menopausal

 Classification of Germ Cell Tumors:
  • Benign: Mature teratomas, Dermoid cysts
  •  Malignant:Seminomas
  • Seminomas are radiosensitive
  • Non-seminomatous germ cell tumors: Immature teratoma
  • Teratoma with malignant components
  1. Choriocarcinoma
  2. Endodermal cell (yolk sac) tumors
  3. Mixed germ cell tumors
  • Germ cell tumors have the following subtypes and frequencies:
  1. Seminoma (40%)
  2. Embryonal tumors (25%)
  3. Teratocarcinoma (25%), teratomata (5%)
  4. Choriocarcinoma (1%)
  5. Other (5%)
  • Primary germ cell tumors (GCTs) of the testis, constitute 95% of all testicular neoplasms.
  • Infreguently, GCTs arise from an extragonadal site, including the mediastinum, retroperitoneum and, very rarely, the pineal gland.
  • Bilateral in 10% cases:Embryonal cell carcinoma
  • Cryptorchidism is associated with a several fold higher risk of GCT. 
  • Abdominal cryptorchid testes are at a higher risk than inguinal cryptorchid testes.
  • Orchiopexy should be performed before puberty, if possible. 
  • Alpha feto protein, LDH & p HCG are the markers for malignant germ cell tumors of ovary 
  • Testicular feminization syndromes increase the risk of testicular GCT, and 
  • Klinefelter’s syndrome is associated with mediastinal GCT.       
  • Intratubular germ cell tumor found adjacent to Dysgerminoma
  • An isochromosome of the short arm of chromosome 12 is pathognomonic for GCT
  • A painless testicular mass is pathognomonic for a testicular malignancy.
  1. Mc tumor of testis in younger age group: seminoma or Dysgerminomas 
  2. Mc histological subtype: mixed
  3. Mc tumor in infants: yolk sac tumor 
  4. Mc tumor in
  5. aged elderly: lymphoma
  6. Commonest testicular malignancy is: Seminoma
  • Most malignant testicular cancer is: Choriocarcinoma
  • Serum alpha feto proetin level is elevated in non seminomatous testicular tumors.
  • Non seminomatous testicular tumors include
  • Yolk sac or endodermal sinus tumor
  • Embryonal carcinoma
  • Teratomas

Germ Cell Tumor Staging and Treatment


Extent of Disease





Testis only, no vascular/lymphatic

invasion (T1)

Radiation therapy

RPLND or observation


Testis only, with vascular/lymphatic

invasion (T2), or extension through

tunica albuginea (T2), or involvement of spermatic cord (T3) or scrotum (T4)

Radiation therapy



Nodes < 2 cm

Radiation therapy

RPLND or chemotherapy followed by RPLND


Nodes 2-5 cm

Radiation therapy

RPLND +/– adjuvant chemotherapy or

chemotherapy followed by RPLND


Nodes > 5 cm


Chemotherapy, often followed by RPLND


Distant metastases


Chemotherapy, often followed by surgery

(biopsy or resection)

Exam Question
  • The most common pure germ cell tumour of the ovary is Dysgerminoma
  • Most common ovarian tumor in less than 20 years is Germ cell tumour
  • Bilateral germ cell tumour is Embryonal cell carcinoma
  • Choriocarcinoma is Malignant germ cell tumours of ovary
  • Alpha feto protein, LDH & p HCG are the markers for malignant germ cell tumors of ovary 
  • Dysgerminoma, Polyembryoma & Endodermal sinus tumor are germ cell tumours of ovary
  • Most common germ cell tumor of ovary is Dermoid
  • The most common pure germ cell tumor of the ovary is Dysgerminoma
  • Serum alpha feto protein level is raised in Teratoma, Endodermal sinus tumor
  • Cryptochidism, Testicular feminising syndrome & Klinefelter’s syndrome are Predisposing features for germ cell tumour
  • Extragonadal germ cell tumors occur in Sacrococcygeal region, Mediastinum & Brain
  • The commonest site for extragonadal germ cell tumour is Mediastinum 
  • Germ cell tumours of testis are Seminoma, Teratoma
  • Intratubular germ cell tumor found adjacent to Dysgerminoma
  • Treatment of extragonadal germ cell tumour is Chemotherapy
  • Seminomas are radiosensitive
Don’t Forget to Solve all the previous Year Question asked on Germ Cell Tumours


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