Extragonadal Germ Cell Tumours (EGGCTs)

Abstract

One question should always be borne in mind while dealing with an EGGCT: Is it truly a primary extragonadal or a secondary of an occult testicular tumour? Hence, every effort must be made to confirm a possible testicular primary since this differentiation has direct clinical, therapeutic and prognostic consequences. Therefore, the testes are carefully examined by palpation, high-definition ultrasound and even random biopsy. It is generally accepted now that “primary” retroperitoneal EGGCTs arise from occult or burnt-out testicular GCTs because they behave clinically in a manner very similar to that of the primary testicular cancers [1]. However, this is not true for mediastinal, pineal or sacrococcygeal EGGCTs which show major differences in clinical behaviour compared to testicular tumours. Hypothetically ruling out a testicular primary with absolute certainty can only be achieved by performing bilateral orchidectomy and a careful histopathological examination of the testes. Clearly, this extreme approach is neither ethical nor clinically acceptable. However, it does illustrate the point that when a clinician is talking about a primary testicular tumour, he should only state “not confirmed” rather than “ruled out”.