DeCure for Spermatocytic seminoma

Spermatocytic seminoma is a rare testicular tumour, accounting for between 1.3% and 2.3% of all seminomas. It occurs in elderly men, with an average age at diagnosis of 53 years in one series of five cases, and is not associated with a history of cryptorchidism or germ cell tumour. The tumour is grossly gelatinous, has distinctive microscopic features, and is never associated with teratomatous elements. Its degree of differentiation is far greater than that of classical seminoma. In a review of six cases and the literature, the large majority of patients were cured by orchiectomy alone, whether or not postoperative radiotherapy was given. The claim that spermatocytic seminoma has a less favourable prognosis than classical seminoma is refuted; the reverse is probably true.

A retrospective analysis of 66 cases of classical seminoma and 5 cases of spermatocytic seminoma found that all five spermatocytic tumours were stage pT1, and all five patients were well after operation. In contrast, 11% of the classical seminoma patients were stage pT2 or above, 2 developed metastasis, and 3 died of disease. Immunohistochemically, spermatocytic seminoma is negative for CK, vimentin, OCT3/4, PLAP, LCA, and PAS, while classical seminoma is positive for OCT3/4, PLAP, and CD117. The authors conclude that spermatocytic seminoma follows a benign clinical course and that further treatment after orchidectomy is not necessary.

An anaplastic variant of spermatocytic seminoma exists, characterised by earlier onset than typical spermatocytic seminoma but a benign behaviour despite histological patterns similar to classical seminoma. The first reported case of bilateral, synchronous anaplastic spermatocytic seminoma was treated with radical orchifunicolectomy alone and had a long-term follow-up. No distant metastases from anaplastic spermatocytic seminoma have been reported. A single case report describes a spermatocytic seminoma with a 15-year history, drawing attention to its slow growth and excellent prognosis; chromosomal analysis of that case revealed moderate aneuploidy.

What remains missing is prospective data from larger, multi-centre registries given the extreme rarity of the tumour, and any evidence base for managing the anaplastic variant beyond case reports. No randomised trials exist, and no systemic therapy has been tested because the disease is almost always cured by surgery alone. Patient stratification beyond stage and histology is not required by current evidence.