שאלה משלב א׳ בכירורגיה אורולוגית · מועד 2022, שאלה 65

Correct: C — primary retroperitoneal lymph node dissection. This is a non-seminomatous germ cell tumour, since teratoma is present, with a 3 cm interaortocaval node and normal post-orchidectomy markers — clinical stage IIA with negative markers. In that specific situation the differential includes a benign node, and primary RPLND is the preferred option: it is both diagnostic and therapeutic, it avoids chemotherapy in those whose nodes prove benign or who are cured by surgery alone, and in those with pathological nodes it allows adjuvant treatment to be tailored. Three cycles of BEP (option A) is the alternative strategy and is preferred for marker-positive or bulkier disease; radiotherapy (options B and D) has no role in non-seminoma.

מקור: Campbell-Walsh p. p.1696 1722, ניתוחים בסרטן אשכים ch.77