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

Step 1: Recall what germ cell tumours are.
Germ cell tumours of the testis arise from the sperm-forming cells and are split into two broad groups: seminomas and non-seminomatous germ cell tumours, which include yolk sac tumour, embryonal carcinoma, choriocarcinoma and teratoma.

Step 2: Check statement 1.
Germ cell tumours make up about 90 to 95 percent of all primary testicular tumours, with the remaining small share being sex cord stromal tumours, such as Leydig or Sertoli cell tumours, and other rare types. This statement is true.

Step 3: Check statement 2.
In an undescended, cryptorchid testis, the risk of testicular cancer rises, and among the germ cell tumours that develop there, seminoma is the most common histological type. This statement is also true.

Step 4: Check statement 3, the key one.
Alpha-fetoprotein (AFP) is a marker made by yolk sac elements. It is raised in yolk sac tumours, embryonal carcinoma and mixed germ cell tumours that carry yolk sac elements, but a pure seminoma does not produce AFP, so its level stays normal in pure seminoma. Since seminoma is itself a germ cell tumour, saying AFP is markedly raised in all germ cell tumours is not correct. This statement is false.

Step 5: Check statement 4.
Once a solid testicular mass is suspected to be cancer, the first surgical step is high inguinal orchidectomy: the testis is removed through a groin incision with early ligation of the spermatic cord at the internal ring, before the tumour is handled, to avoid seeding cancer cells into the scrotum. This statement is true and is the standard first step in management.

Step 6: Final Answer.
The one statement that is not true is that AFP is markedly raised in all germ cell tumours, since pure seminoma does not raise AFP.
\[ \boxed{\text{Alpha-fetoprotein is markedly raised in all germ cell tumours}} \]