Just diagnosed with Seminoma

[Pinstryped]

Hi everyone,

First of all, thanks for being here. The information and knowledge contained on this website has been invaluable to me staying sane during the last month.

Around the beginning of the month I saw my primary doctor for a lump on my right testicle. She was concerned so sent me for an ultrasound and gave me a referral for a urologist. I went that day for the ultrasound, and a week later to the urologist who said it needed to come out because he was worried it could be malignant. I agreed, and had the orchiectomy on 1/25/2023.

Today, 1/30/2023, my doctor called with the results (posted at the end of this post) and it sounds like it’s pure seminoma. I’m scheduled for a CT scan on 2/8/2023 and guess I’ll find out more then.

Not sure why I’m making this post, I guess I mainly just wanted to come here to introduce myself and my situation and thank you all for being here as well.


PT Category: pT2
PN Category: pN not assigned (no nodes submitted or found)
Additional Findings: Germ cell neoplasia in situ (GCNIS)

Gross Description:
Specimen is received in formalin, consists of a 54.2 g and 5.7 x 4.6 x 3.5 cm orchiectomy specimen with 5.0 x 1.9 cm of attached spermatic cord. The tunica albuginea is tan-pink, soft and shaggy; the tunica albuginea is tan-white and smooth. The testicle is 4.6 x 3.8 x 3.4 cm and displays a 3.6 x 3.5 x 2.4 cm tan-pink, soft and fleshy mass located at the rete testis. A touch preparation is performed. The mass grossly abuts the tunica albuginea but appears confined. The mass is 5.8 cm from the spermatic cord margin. Remaining cut surfaces display tan-brown, stringy parenchyma. The epididymis is 5.3 x 0.8 x 0.4 cm tan-pink and unremarkable, grossly uninvolved. Representative sections are submitted as follows: A1: Spermatic cord margin, en face; A2: Mid spermatic cord; A3: Spermatic cord adjacent to testicle; A4: Epididymis and adjacent testicular parenchyma; A5: Mass to tunica albuginea and tunica vaginalis; A6: Mass at rete testis; A7-A 15: Additional mass.

Microscopic Description
Touch preparation demonstrates loosely cohesive ovoid to plasmacytoid cells with round nuclei and prominent nucleoli in a tigroid background of proteinaceous material. Scattered admixed lymphocytes are noted. Histologic sections contain a rounded lesion comprised of loosely cohesive, ovoid to plasmacytoid cells with round nuclei, vesicular chromatin and prominent nucleoli with admixed lymphocytes, compatible with seminoma. Focal intratubular germ cell neoplasia as well as focal intratubular seminoma are identified. Focal lymphovascular invasion is identified.

[Mike]

I hope you are recovering from surgery well.

The CT really will be the biggest piece of information at this point to determine if there is any spread or not. If there is spread then the extent of the spread will dictate your further treatments options. If there is no spread and your tumor markers (AFP, beta-hCG) return to normal, if elevated preoperatively, then there could be some intricacies in the pathology report to help determine risk of relapse. Although, with pure seminoma, those prognostic factors are not very good, whereas for nonseminoma, they seem to be more validated.

How are you doing mentally/physically?

Where about are you located, if you don't mind sharing.

Mike

[Pinstryped]

Mentally I’m fine. I know it’s curable and I might have to go through some sort of treatment. I think the waiting is The worst part for me. I have my wife, daughter, and friends as a support group so I’m as good as I can be. My wife is a lot more emotional and scared than I am, I think.

Physically, I’m still a little sore from the surgery but getting better every day.

I’m from the US, in Maryland.

[Mike]

Often times right now is the hardest part because of the waiting and the unknown. Once a plan is in place, I think it gets a bit easier.

Great to hear that you have an awesome support crew as well.

If needed, you are not too far from NYC or Philly and they both have excellent testicular cancer programs. Johns Hopkins may be an option too, if needed, I am just not sure who is the main RPLND surgeon now, but other wise they are there as well.

Keep us posted and keep on the good road to recovery.

Mike

[Pinstryped]

Oncology called today and scheduled me for an appointment Friday morning 2/3/23 to get started as a new patient and go over some things. I’m surprised they’re seeing me before the CT scan but glad at the same time so at least I’ll be able to ask questions and get the ball rolling.

it’s good to know I have options like NYC and Philly. Thanks for the tip!

[Mike]

I suppose it is better to get your foot in the door, when you can, vs. waiting until the CT is back to schedule an appointment. Although, they could have scheduled something for the next day I suppose.

Have they done tumor marker blood tests yet (AFP and beta-hCG)?

Mike

[Pinstryped]

Oh yeah, I have my pre-op blood work that was done about two weeks before surgery.

hCG Tumor Marker: 3mIU/mL
Alpha-Fetoprotein: 1.8ng/mL
LD: 169IU/L

The urologist said they all seemed to be within good levels. I have not gotten any post op blood work done yet.

[Mike]

Excellent that the markers are all negative and it makes sense to check them again, just to be sure, but they are likely not going to play a role in the decision making since they are normal.

The CT is the next big information piece so keep us posted and on how your appt goes.

Mike

[Pinstryped]

Just checking in after the oncologist appointment. She said we really need to wait for the CT results to make a plan but as long as it comes back clear we can either do surveillance or one dost of Carboplatin chemotherapy.

currently just trying to weigh the pros and cons of each.

[Mike]

Yeah, the CT will be key. Keep us posted and glad to days appointment went well.

If a negative CT then both options are available for stage I seminoma. It is a bit of a long conversation so we can wait on the CT, but no matter the choice the outcomes would be the same so it very much depends on what is right for you, to a major extent. I tend to look at the real-life data from SWENOTECA, https://www.sciencedirect.com/scienc...23753419356923 so if your bored, you might want to take a look at it as well. Unfortunately, there are not really good prognostic factors for relapse with stage I seminoma. Tumor size is probably the most validated and then perhaps some added value of if the rete testis area was involved, but even that is weaker evidence. Basically, if I had a smaller tumor and no rete testis involvement then I would feel that perhaps I was at the lowest risk for relapse.

Mike

[ralphsong]

Yeah, the CT will be key. Keep us posted and glad to days appointment went well.

If a negative CT then both options are available for stage I seminoma. It is a bit of a long conversation so we can wait on the CT, but no matter the choice the outcomes would be the same so it very much depends on what is right for you, to a major extent. I tend to look at the real-life data from SWENOTECA, https://www.sciencedirect.com/scienc...23753419356923 so if your bored, you might want to take a look at it as well. Unfortunately, there are not really good prognostic factors for relapse with stage I seminoma. Tumor size is probably the most validated and then perhaps some added value of if the rete testis area was involved, but even that is weaker evidence. Basically, if I had a smaller tumor and no rete testis involvement then I would feel that perhaps I was at the lowest risk for relapse.

Mike

Thank you Mike for the information. It seems that surveillance for stage I seminoma is the preferred option based on the study. BTW, the relapse rate was relatively low compared to what I thought 15%-20%. Is 15-20% relapse rate for overall seminoma rathe than Stage I?

[Pinstryped]

Here’s the results from the chest portion of the CT scan. The pelvic CT scan hasn’t come back yet.

1. In the right paraspinal location, adjacent to T9 and T10 is a lobular mass measuring 4.3 x 4.4 x 1.6 cm. This could well represent metastatic lymphadenopathy, the differential also would include a neurogenic tumor.

2. No evidence for pulmonary parenchymal metastatic disease. No hilar or mediastinal lymphadenopathy.

[Pinstryped]

As I posted that, the results for the pelvic scan came in lol.

1. Postoperative changes in the right inguinal region with a 3.2 x 3.6 x 5.9 cm fusiform fluid collection likely representing a postoperative seroma.

2. No evidence of residual, recurrent or metastatic disease in the abdomen.

[Pinstryped]

Also, I don’t know if it’s a subconscious thing because of the scan finding a mass near my spine or not but last night into this morning I seem to be having pain while taking a deep breath near where the mass.

I have an appointment with the urologist and the oncologist tomorrow so hopefully we can figure out where to go from here. It’s finally sinking in and I really don’t like the direction it’s going in.

[Pinstryped]

Oncologist wants to biopsy the mass found next to my spine. She also ordered more blood tests just to make sure nothing has changed.

Just waiting on the call for the biopsy referral ?