Question

All the following statements are true about germ cell tumours of the testis except:

• A. They constitute 90 to 95 percent of all primary testicular tumours
• B. Seminoma is the most common tumour developing in patients with cryptorchid testes
• C. Alpha-fetoprotein is markedly raised in all germ cell tumours
• D. High inguinal orchidectomy is the initial surgical procedure

Hint:

AFP comes from yolk sac elements, so pure seminoma does not raise it.

Answer 1

The Correct Option is C

The question asks us to find the one FALSE statement about germ cell tumours of the testis among four choices.

1. They constitute 90 to 95 percent of all primary testicular tumours: True. Germ cell tumours are by far the largest group of testicular cancers, with sex cord stromal and other rare tumours making up the small remainder.
2. Seminoma is the most common tumour developing in patients with cryptorchid testes: True. An undescended testis carries a higher cancer risk, and seminoma is the type most often seen when cancer develops in such a testis.
3. Alpha-fetoprotein is markedly raised in all germ cell tumours: False. AFP comes from yolk sac tissue, so it rises in yolk sac tumour, embryonal carcinoma and mixed tumours with yolk sac elements. A pure seminoma has no yolk sac component and does not raise AFP, so this marker is not raised in every germ cell tumour.
4. High inguinal orchidectomy is the initial surgical procedure: True. Removing the testis through the groin with early cord ligation is the standard first surgical step for a suspicious testicular mass, done to avoid spreading tumour cells into the scrotal tissue.

Three statements hold up against what is known about testicular germ cell tumours. The claim about AFP being raised in every germ cell tumour breaks down because pure seminoma does not secrete it.

Let's summarize:

• AFP is a marker for yolk sac elements, not for germ cell tumours as a whole.
• Pure seminoma stays AFP negative, which actually helps tell it apart from non-seminomatous tumours.
• The other three statements about incidence, cryptorchidism and initial surgery are all standard and correct.

So the false statement is that alpha-fetoprotein is markedly raised in all germ cell tumours.