Testicular tumor

Background
  • Most common malignancy in young men, 1% all cancers in men
  • Increased frequency in: infertile patients, whites, undescended testis, history of cryptorchidism
  • 95% germ cell tumors: half seminomas, half mixed types (teratomas, choriocarcinomas, yolk sac tumors)
  • 5% sex cord stromal tumors

Clinical Features
  • Typically present with painless scrotal mass, dull lower abdominal ache, or heaviness sensation
  • May have endocrine abnormalities from hCG elevations[1][2]
    • Gynecomastia
    • Hyperthyroid biochemical signs

Differential Diagnosis

Testicular Diagnoses

Evaluation

Work-Up
  • Testicular US
  • Urinalysis
  • CT of chest/abdomen/pelvis helpful for staging, only necessary in ED if patient has complaints related to this part of body

Evaluation
  • Testicular US
  • If pain must rule out epididymitis, torsion
  • May present with mets at time of diagnosis
    • 15% present with mets to regional lymph nodes
    • 5% present with mets to abdomen or pelvis
  • Urology may ask for LDH, AFP, hCG tumor markers[3]
    • Ensure follow up and document carefully, since EPs will not follow up on results
    • If no admission is arranged, consider deferring ordering tumor markers to consultants

Management
  • Urgent urology referral

Disposition
  • Outpatient

See Also

References
  1. Harris M et al. Testicular tumour presenting as gynaecomastia. BMJ. 2006 Apr 8; 332(7545): 837.
  2. Voigt W et al. Human chorionic gonadotropin-induced hyperthyroidism in germ cell cancer--a case presentation and review of the literature. Onkologie. 2007 Jun;30(6):330-4.
  3. Testicular Cancer: Version 1.2015. National Comprehensive Cancer Network. Available at http://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf.
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