Neoplasia USMLE Step 1 Practice Question
A 34-year-old man presents to urology clinic with a 3-week history of painless left testicular enlargement. He denies constitutional symptoms. Vital signs are stable. Physical examination reveals a firm, non-transilluminating 3.5-cm left testicular mass; the right testis is normal. Scrotal ultrasound demonstrates a heterogeneous echoic mass with increased Doppler flow within the left testis; no free fluid noted. Staging workup includes chest CT (no pulmonary nodules), abdominal/pelvic CT (no lymphadenopathy), and tumor markers. Results show serum AFP 4,200 ng/mL (normal <10 ng/mL), hCG 1.5 mIU/mL (normal <5 mIU/mL), and LDH 340 U/L (normal <480 U/L). Radical inguinal orchiectomy is performed; final pathology confirms mixed germ cell tumor with prominent yolk sac tumor component. According to International Germ Cell Cancer Collaborative Group (IGCCCG) classification, which of the following is the most significant independent prognostic factor in this patient?
Answer choices
- AHistologic presence of multiple germ cell subtypes within the primary tumor
- BSerum alpha-fetoprotein level at diagnosisCorrect answer
- CPatient age of 34 years (>30 years)
- DAbsence of pulmonary metastases on staging imaging
- ESerum human chorionic gonadotropin level of 1.5 mIU/mL
- FSerum lactate dehydrogenase level of 340 U/L
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