Testicular tumors: Pathology review

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Testicular tumors: Pathology review



Testicular tumors: Pathology review

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A 68-year-old man comes to his primary care provider for evaluation of “fullness in the groin,” which started 3 weeks ago. The discomfort is present in both testicles and has not improved with over-the-counter ibuprofen. On review of systems, the patient endorses a decreased appetite, 7-kg (15-lb) weight loss over the past 2 months, and occasionally wakes up at night drenched in sweat. Past medical history is notable for hypertension, peripheral vascular disease, and chronic venous insufficiency. Temperature is 37.2°C (99.0°F), pulse is 71/min and blood pressure is 147/82 mmHg. Physical examination reveals a thin man with diffuse muscle wasting. Bilateral testicular enlargement is present. The masses do not decrease in size when the patient lies flat. The testes are nontender to palpation. No erythema or rashes are noted over the scrotum. Which of the following best describes the pathophysiology of this patient’s testicular findings?


25-year-old Kyle comes to the office after palpating a lump on his left testicle while showering this morning. On physical examination, there is a nontender, round, firm, rubbery mass in the left testicle that does not transilluminate with light. Scrotal ultrasound shows a 1.4-cm solid mass with no cystic components. Laboratory tests reveal normal serum human chorionic gonadotropin or hCG level, and normal α-fetoprotein or AFP level. Later that day, 32-year-old William comes to the physician's office complaining of heat intolerance, excessive sweating, palpitations, frequent bowel movements and recent weight loss despite increased appetite. His past medical history is insignificant. On examination, the thyroid gland is normal with no signs of goiter or nodules. However, a hard nodule is palpated in the right testicle which does not transilluminate with light and appears solid on scrotal ultrasound. Laboratory studies show increased serum T4 and T3 levels as well as extremely elevated hCG levels.

Based on the initial presentation, Kyle and William both have some form of testicular mass. In fact, testicular tumors are the most common solid malignancy in males between 20 and 35 years old.

Okay, now, for your exams, it’s important to know that the main risk factors for developing testicular cancer, especially the germ cell variety, include cryptorchidism, which is when the testicles fail to descend to the scrotum or get stuck in the inguinal canal, as well as Klinefelter syndrome, where biological male individuals inherit more than one X chromosome leading to small, undeveloped testicles.

For symptoms, a testicular tumor most often comes up as a small, firm lump that is typically painless, but can sometimes cause a sharp or dull pain in the testicles and lower abdomen. In more severe cases, symptoms may arise from a malignant tumor metastasizing to other organs. This is most commonly hematogenous to the lungs, leading to dyspnea or hemoptysis, which is the coughing of blood, or to the brain, leading to headache, nausea, vomiting or seizures. Another way for the cancer cells to metastasize is by the testicular lymphatic system that drains into retroperitoneal lymph nodes. Metastasis to these lymph nodes leads to symptoms like lower back pain.


Testicular tumors are abnormal growths that can develop in one or both testicles. Most testicular tumors are germ cell tumors and can be classified into seminomas, which are the common ones and have a better prognosis; and non-seminomas, which have a worse prognosis.

Non-seminomas include yolk sac tumors, which are the most common type in children; choriocarcinomas, which are associated with hyperthyroidism and gynecomastia; teratomas, which are usually benign in children and malignant in adults; and embryonal carcinomas, which are rare as pure carcinomas but a common element of mixed germ cell tumors. Non-germ cell testicular tumors come from the Sertoli cells, which don't produce hormones, or the Leydig cells which can secrete excess male and female sex hormones. Diagnosis is made primarily with physical examination, ultrasound findings, and determination of serologic tumor markers, including PLAP, AFP, hCG, and LDH. Treatment is radical orchiectomy, chemotherapy, or radiotherapy.


  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Sternberg's Diagnostic Surgical Pathology" LWW (2009)
  4. "Medical Treatment of Advanced Testicular Cancer" JAMA (2008)
  5. "Testicular Cancer: A Prototypic Tumor of Young Adults" Seminars in Oncology (2009)
  6. "Testicular Choriocarcinoma Presenting as Hyperthyroidism" The American Journal of Medicine (2013)

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