Testis and epididymis
Miscellaneous
Staging

Author: Debra Zynger, M.D.

Revised: 7 February 2018, last major update January 2018

Copyright: (c) 2002-2018, PathologyOutlines.com, Inc.

PubMed Search: Staging[title] testis

Cite this page: Zynger, D. Staging. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/testisstaging.html. Accessed February 21st, 2018.

Pathologic TNM staging of Testis Germ Cell Tumor and Malignant Sex Cord Stromal Tumor, AJCC 8th edition
Definition / general
Pathologic staging (pTNM) definitions (Amin: AJCC Cancer Staging Manual, 8th Edition, 2017)
Primary tumor (pT)
  • pTX: cannot be assessed
  • pT0: no evidence of primary tumor
  • pTis: germ cell neoplasia in situ
  • pT1: nonpure seminoma confined to testis / tunica albuginea / rete and no LVI
  • pT1a: seminoma < 3 cm confined to testis / tunica albuginea / rete and no LVI
  • pT1b: seminoma ≥ 3 cm confined to testis / tunica albuginea / rete and no LVI
  • pT2: lymphovascular, hilar fat, epididymal or tunica vaginalis invasion
  • pT3: direct spermatic cord soft tissue invasion
  • pT4: direct scrotum invasion
  • (LVI = lymphovascular invasion, LVI of the spermatic cord without soft tissue invasion is not pT3)
Regional lymph nodes (pN)
  • pNX: cannot be assessed
  • pN0: no regional lymph node metastasis
  • pN1: 1 - 5 involved nodes with node size ≤ 2 cm
  • pN2: > 5 involved nodes OR extranodal extension OR involved nodes > 2 cm and ≤ 5 cm
  • pN3: lymph node mass > 5 cm
  • (Regional lymph nodes = interaortocaval, para / periaortic, paracaval, preaortic, precaval, retroaortic and retrocaval nodes)
Distant metastasis (pM)
  • pM1a: nonregional lymph node (ex: iliac, inguinal, pelvic NOS) or lung metastasis
  • pM1b: distant metastasis (includes discontinuous spermatic cord, not lymph node / lungs)
  • (NOS = not otherwise specified)
Serum markers (S)
  • SX: serum tumor markers not available or not performed
  • S0: markers within normal limits
  • S1: LDH < 1.5 x upper limit of normal, hCG < 5,000 mIU/mL and AFP < 1000 ng/mL
  • S2: LDH 1.5 - 10 x upper limit of normal OR hCG 5,000 - 50,000 mIU/mL OR AFP 1,000 - 10,000 ng/mL
  • S3: LDH > 10 x upper limit of normal OR hCG > 50,000 mIU/mL OR AFP > 10,000 ng/mL
AJCC Prognostic Stage Groups
  • Stage group 0:pTis N0 M0 S0
  • Stage group I:pT1 - 4 N0 M0 SX
  • Stage group IA:pT1 N0 M0 S0
  • Stage group IB:pT2 - 4 N0 M0 S0
  • Stage group IS:pT1 - 4,X N0 M0 S1 - 3
  • Stage group II:pT1 - 4,X N1 - 3 M0 SX
  • Stage group IIA:pT1 - 4,X N1 M0 S0 - 1
  • Stage group IIB:pT1 - 4,X N2 M0 S0 - 1
  • Stage group IIC:pT1 - 4,X N3 M0 S0 - 1
  • Stage group III:pT1 - 4,X N0 - 3 M1 SX
  • Stage group IIIA:pT1 - 4,X N0 - 3 M1a S0 - 1
  • Stage group IIIB:pT1 - 4,X N1 - 3M0 S2;pT1 - 4,XN0 - 3M1aS2
  • Stage group IIIC:pT1 - 4,X N1 - 3M0S3; pT1 - 4,XN0 - 3 M1aS3; pT1 - 4,X N0 - 3M1bS0 - 3
Microscopic (histologic) images

Images hosted on PathOut server:

Images contributed by Debra Zynger M.D.

Hilar soft tissue invasion (pT2)