May 14, 2009

Testicular Germ-cell Tumor

Figure 1 and 2: Gray-scale longitudinal (1) and Doppler flow transverse ultrasound images (2) of the testicle show an ill-defined hypoechoic, solid mass within the testicle (intratesticular mass). There are scattered microcalcifications throughout the testicle.

Histologic Classification of Primary Testicular Neoplasms
1. Germ-cell tumors (95%)
Embryonal carcinoma
Yolk-sac tumor (endodermal sinus tumor)
2. Others (5%)
Sex-cord stromal tumors: Sertoli-cell, Leydig-cell, Granulosa-cell
Both germ-cell and gonadal stromal elements: Gonadoblastoma
Adnexal and paratesticular tumors

Germ-Cell Tumor
  • Originates from primordial germ cells
  • More common in Whites
  • Predisposing factor = cryptorchidism
  • Two major types: seminoma or non-seminoma
  • Nonseminoma tumors are clinically more aggressive. Therefore, if the pathology shows mixed tumor, treatment will follow nonseminoma.
  • Seminoma is diagnosed only if histology shows "pure seminoma" and serum alfa-phetoprotein (AFP) is normal
  • Classic but uncommon = painless testicular mass
  • Common = diffuse pain, swelling, hardness or a combination of these
Tumor Markers
  1. AFP: nonseminoma, specifically embryonal cell and yolk-sac tumors
  2. hCG: both seminoma and nonseminoma
  3. LDH: both seminoma and nonseminoma

Our case = Embryonal cell carcinoma.

Bosl GJ and Motzer RJ. Testicular germ-cell cancer. New Engl J Med 1997;337:242-254.

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