Testis and epididymis
Miscellaneous
Staging

Author: Debra Zynger, M.D.

Revised: 24 September 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 September 25th, 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
Gross images

Images hosted on PathOut server:

Contributed by Debra Zynger, M.D.

Teratoma (pT1)

Seminoma (pT1a)

Seminoma (pT1b)

Mixed germ cell tumor (pT2)

Seminoma (pT2)

Lymph node with residual tumor (ypN3)

Microscopic (histologic) images

Images hosted on PathOut server:

Contributed by Debra Zynger M.D.

Epididymal invasion (pT2)

Lymphovascular invasion (pT2)

Tunica vaginalis invasion (pT2)


Hilar soft tissue invasion (pT2)

Discontinuous spermatic cord invasion (pM1b)

Lymph node metastasis (pN1)