Treatment Germ Cell of Testicular Malignancies

With the exception of the classical seminoma, the treatment of choice for malignant germ cell tumors of the testis remains controversial today. Before any specific mode of therapy can be considered, it is of paramount importance to have an accurate histologic diagnosis and a complete evaluation of the extent of tumor-spread at the time of initial diagnosis. The first step in making this accurate histologic diagnosis is, of course, the orchiectomy. There is certainly unanimous agreement on inguinal orchiectomy as the initial treatment when a testicular neoplasm is suspected. This is preferably accomplished by ligation of the cord at the internal ring because of demonstrated involvement of the spermatic cord by direct tumor extension. In addition, separate ligation of the vas and spermatic vessels at the internal ring facilitates excision if subsequent retroperitoneal lymph node dissection is performed. Direct testicular biopsy or needle biopsy is to be condemned because of