Testicular cancer differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shadan Mehraban, M.D.[2]

Overview

Testicular cancer must be differentiated from epididymitis, hematocele, hydrocele, spermatocele, granulomatous orchitis, and varicocele.

Differentiating Testicular cancer from other Diseases

Abbreviations:

AFP: Alpha-fetoprotein, B-hCG: Beta-human chorionic gonadotropin, P-ALP: Placental- Alkaline phosphatase

Diseases Benign/ Malignant Unilateral/Bilateral History/demography Metastasis Genetics Clinical manifestations Para-clinical findings
Symptoms Physical examination Lab findings Imaging Histopathology
Pain Mass AFP Beta hCG p-ALP
Germ Cell tumors
Seminoma[1][2] Stains positively for: - + N/A N/A Ultrasound
Embryonal carcinoma[3] Early metastasis to: Stains positively for:

May stain positively for :

+ ± ↑* N/A Ultrasound
Yolk sac tumor[4][5]
  • Unilateral
  • Uncommon
Stains positively for: + + N/A N/A Ultrasound

MRI

  • Schiller-Duval bodies (perivascular structures)
  • Hyaline-type globules
Teratoma[6][7]
  • Unilateral
  • May present in both prepubertal and adult men
  • Uncommon in benign ones among prepubertal men

Stains positively for:

- + N/A Ultrasound
Choriocarcinoma[8][9] Early metastasis: Stains positively for: + ± N/A N/A Ultrasound
Mixed germ cell tumors[10][11]
  • Unilateral
  • May stain positive based on underlying components
± + N/A
  • Imaging findings based on underlying components
Carcinoma in situ (intratubular germ cell neoplasia )[12][13][14]
  • Unilateral
  • Bilateral
Common:

Stain positively for:

- -
  • N/A
N/A N/A
  • N/A
Diseases Benign/ Malignant Unilateral/Bilateral History/Demography Metastasis Genetics Pain Mass Physical exam AFP Beta hCG p-ALP Imaging Histopathology
Non-germ cell tumors
Leydig cell tumor[15]
  • Unilateral

Stains positively for:

- + N/A N/A N/A Ultrasound
Sertoli cell tumor ( Androblastoma)[16][17][18]
  • Unilateral
  • Bilateral
Stain positively for: - + N/A N/A N/A Ultrasound
  • Large cell calcifying variant
  • Hypoechoic
Testicular lymphoma[19][20][21]
  • Unilateral
  • Bilateral ( mostly up to 35% of cases)
Common metastasis to : Stains positively for: - + ↑ or ↓ ↑ or ↓ N/A Ultrasound
Granulosa cell tumors[22][23]
  • Unilateral

Juvenile type associated with:

Stains positively for: - + N/A N/A N/A Ultrasound

* May stain positively when mixed.

References

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  2. Miller FH, Whitney WS, Fitzgerald SW, Miller EI (1999). "Seminomas complicating undescended intraabdominal testes in patients with prior negative findings from surgical exploration". AJR Am J Roentgenol. 172 (2): 425–8. doi:10.2214/ajr.172.2.9930796. PMID 9930796.
  3. Ishida M, Hasegawa M, Kanao K, Oyama M, Nakajima Y (2009). "Non-palpable testicular embryonal carcinoma diagnosed by ultrasound: a case report". Jpn J Clin Oncol. 39 (2): 124–6. doi:10.1093/jjco/hyn141. PMID 19066212.
  4. Howitt BE, Berney DM (2015). "Tumors of the Testis: Morphologic Features and Molecular Alterations". Surg Pathol Clin. 8 (4): 687–716. doi:10.1016/j.path.2015.07.007. PMID 26612222.
  5. Magers MJ, Kao CS, Cole CD, Rice KR, Foster RS, Einhorn LH; et al. (2014). ""Somatic-type" malignancies arising from testicular germ cell tumors: a clinicopathologic study of 124 cases with emphasis on glandular tumors supporting frequent yolk sac tumor origin". Am J Surg Pathol. 38 (10): 1396–409. doi:10.1097/PAS.0000000000000262. PMID 24921638.
  6. Simmonds PD, Lee AH, Theaker JM, Tung K, Smart CJ, Mead GM (1996). "Primary pure teratoma of the testis". J Urol. 155 (3): 939–42. PMID 8583612.
  7. Brosman SA (1979). "Testicular tumors in prepubertal children". Urology. 13 (6): 581–8. PMID 377749.
  8. Puri S, Sood S, Mohindroo S, Kaushal V (2015). "Cytomorphology of lung metastasis of pure choriocarcinoma of testis in a 58-year-old male". J Cancer Res Ther. 11 (4): 1035. doi:10.4103/0973-1482.154010. PMID 26881635.
  9. Wood HM, Elder JS (2009). "Cryptorchidism and testicular cancer: separating fact from fiction". J Urol. 181 (2): 452–61. doi:10.1016/j.juro.2008.10.074. PMID 19084853.
  10. Chuang KL, Liaw CC, Ueng SH, Liao SK, Pang ST, Chang YH; et al. (2010). "Mixed germ cell tumor metastatic to the skin: case report and literature review". World J Surg Oncol. 8: 21. doi:10.1186/1477-7819-8-21. PMC 2851696. PMID 20331874.
  11. Krag Jacobsen G, Barlebo H, Olsen J, Schultz HP, Starklint H, Søgaard H; et al. (1984). "Testicular germ cell tumours in Denmark 1976-1980. Pathology of 1058 consecutive cases". Acta Radiol Oncol. 23 (4): 239–47. PMID 6093440.
  12. Rajpert-De Meyts E, Skakkebaek NE (1994). "Expression of the c-kit protein product in carcinoma-in-situ and invasive testicular germ cell tumours". Int J Androl. 17 (2): 85–92. PMID 7517917.
  13. Jacobsen GK, Nørgaard-Pedersen B (1984). "Placental alkaline phosphatase in testicular germ cell tumours and in carcinoma-in-situ of the testis. An immunohistochemical study". Acta Pathol Microbiol Immunol Scand A. 92 (5): 323–9. PMID 6209917.
  14. Jacobsen GK, Henriksen OB, von der Maase H (1981). "Carcinoma in situ of testicular tissue adjacent to malignant germ-cell tumors: a study of 105 cases". Cancer. 47 (11): 2660–2. PMID 7260858.
  15. Cheville JC, Sebo TJ, Lager DJ, Bostwick DG, Farrow GM (1998). "Leydig cell tumor of the testis: a clinicopathologic, DNA content, and MIB-1 comparison of nonmetastasizing and metastasizing tumors". Am J Surg Pathol. 22 (11): 1361–7. PMID 9808128.
  16. Banerji JS, Odem-Davis K, Wolff EM, Nichols CR, Porter CR (2016). "Patterns of Care and Survival Outcomes for Malignant Sex Cord Stromal Testicular Cancer: Results from the National Cancer Data Base". J Urol. 196 (4): 1117–22. doi:10.1016/j.juro.2016.03.143. PMID 27036305.
  17. Young RH (2005). "Sex cord-stromal tumors of the ovary and testis: their similarities and differences with consideration of selected problems". Mod Pathol. 18 Suppl 2: S81–98. doi:10.1038/modpathol.3800311. PMID 15502809.
  18. Gabrilove JL, Freiberg EK, Leiter E, Nicolis GL (1980). "Feminizing and non-feminizing Sertoli cell tumors". J Urol. 124 (6): 757–67. PMID 7003168.
  19. Shahab N, Doll DC (1999). "Testicular lymphoma". Semin Oncol. 26 (3): 259–69. PMID 10375083.
  20. Kim J, Abu-Yousef M (2013). "Testicular lymphoma". Ultrasound Q. 29 (3): 247–8. doi:10.1097/RUQ.0b013e3182a0ac0e. PMID 23945480.
  21. Vega F, Medeiros LJ, Abruzzo LV (2001). "Primary paratesticular lymphoma: a report of 2 cases and review of literature". Arch Pathol Lab Med. 125 (3): 428–32. doi:10.1043/0003-9985(2001)125<0428:PPL>2.0.CO;2. PMID 11231498.
  22. Garrett JE, Cartwright PC, Snow BW, Coffin CM (2000). "Cystic testicular lesions in the pediatric population". J Urol. 163 (3): 928–36. PMID 10688023.
  23. Ditonno P, Lucarelli G, Battaglia M, Mancini V, Palazzo S, Trabucco S; et al. (2007). "Testicular granulosa cell tumor of adult type: a new case and a review of the literature". Urol Oncol. 25 (4): 322–5. doi:10.1016/j.urolonc.2006.08.019. PMID 17628299.

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