Case submitted / contributed via our radiology website partner, RiT.
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.
