Question 12. 
 
A 30-year-old man presented with a swelling in the testis and an ultrasound scan confirmed 
the presence of a malignant mass. Following orchidectomy, he was found to have a 40-mm 
seminomatous germ cell tumour without non-seminomatous components. There was 
evidence of vascular invasion within the testis. 
 
Investigations: 
 
 

serum lactate dehydrogenase (LDH) 

1250 U/L (10–250) 

 serum 

α

-fetoprotein  

normal 

 serum 

β

-human chorionic gonadotrophin (HCG)  700 U/L (<5) 

 
A CT scan of body showed retroperitoneal lymphadenopathy of up to 7 cm in size, a 3-cm 
mediastinal lymph node and over 30 pulmonary metastases. There were no signs of liver, 
brain or bone metastases. 
 
What is the most appropriate International Germ Cell Cancer Collaborative Group 
classification? 
 
A  good prognosis because of the absence of liver, bone and brain metastases 
B  good prognosis because of the raised HCG and LDH 
C  intermediate prognosis because of the presence of lung metastases 
D  intermediate prognosis because of the raised serum HCG and LDH 
E  poor prognosis because of the raised serum HCG and LDH