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%)

Seminoma

Embryonal carcinoma

Teratoma

Choriocarcinoma

Yolk-sac tumor (endodermal sinus tumor)

Mixed

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

Miscellaneous

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

Clinical

• 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.

Reference:

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