Testicular Tumor Synoptic Report — CAP elements with AJCC 9th Edition (auto stage)
Case / Specimen
Primary tumor / Testis
AJCC 9 (testis) pT summary (expanded): - pTis: Germ cell neoplasia in situ (GCNIS) / intratubular germ cell neoplasia. - pT1: Tumor limited to the testis and epididymis without vascular/lymphatic invasion; tunica albuginea may be involved but tumor not through tunica vaginalis. - pT2: Tumor limited to testis with vascular/lymphatic invasion OR tumor extends through tunica albuginea with involvement of tunica vaginalis. - pT3: Tumor invades spermatic cord. - pT4: Tumor invades scrotum (skin of scrotum) or other adjacent structures.
Notes: Report tumor size, presence/extent of tunica vaginalis involvement, spermatic cord margin status, and any scrotal wall invasion. Distinguish GCNIS from invasive components.
Regional lymph nodes / RPLND
AJCC 9 (testis) pN summary: - pN0: No regional (retroperitoneal) lymph node metastasis. - pN1: Metastasis limited to one lymph node (≤2 cm) in greatest dimension. - pN2: Metastasis in one or more nodes >2–5 cm or multiple nodes, as per site-specific size cutoffs. - pN3: Metastasis >5 cm or extranodal extension with bulky disease.
Notes: Retroperitoneal (paraaortic/interaortocaval) nodes are regional. Report number of positive nodes, size of largest deposit, extranodal extension, and RPLND template.
Distant metastasis
AJCC 9 (testis) pM summary: - pM0: No distant metastasis. - pM1: Distant metastasis present (biopsy-proven when possible).
Subclassification often used (e.g., non-regional nodal vs pulmonary vs other visceral). - Any pM1 = Stage III (in many testis staging schemas) or Stage II/III depending on histology and marker-based staging — verify AJCC 9 testis chapter.
Notes: Testis staging commonly integrates serum tumor markers (S stage) in clinical staging; document AFP/ß-hCG/LDH and method of confirmation for metastases.
Serum tumor markers & S stage
AJCC/IGCCCG use of serum markers (S) influences prognosis and clinical stage: - S0: Marker levels within normal limits. - S1–S3: Increasing marker elevations correlate with worse prognostic grouping (refer to AJCC/IGCCCG tables). - Document pre‑orchiectomy and post‑orchiectomy marker values and timing relative to surgery.
AJCC 9 Stage Group Guidance (expanded)
Simplified AJCC 9 anatomic stage grouping (testis) — site-specific tables and integration with serum markers required for clinical/prognostic staging: - Stage I: Tumor limited to testis (pT1), N0, M0. - Stage II: Regional lymph node metastasis (pN1–pN2), M0. - Stage III: Distant metastasis (pM1) or extensive nodal/visceral disease.
Note: Clinical/prognostic stage for germ cell tumors integrates serum marker (S) categories in addition to TNM. Use AJCC 9 testis chapter and IGCCCG guidelines for combined clinical/prognostic staging and treatment decisions.