Testicular cancer differential diagnosis: Difference between revisions

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* Excellent [[prognosis]]
* Excellent [[prognosis]]
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* Most common among age of 15-35 years old
* Most common among [[age]] of 15-35 years old
* Does not occur during infancy
* Does not occur during [[infancy]]
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* Late [[metastasis]]
* Late [[metastasis]]
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* [[Glycogen]]
* [[Glycogen]]
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* Large cells wit watery [[cytoplasm]]
* Large [[cells]] wit watery [[cytoplasm]]
* Fried egg appearance
* Fried egg [[appearance]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
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* [[Palpable]], nontender unilateral [[testicular]] mass
* [[Palpable]], nontender unilateral [[testicular]] [[mass]]
* Usually [[homogeneous]] enlargement
* Usually [[homogeneous]] enlargement
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* Elevated [[serum]] placental ALP (PALP)
* Elevated [[serum]] [[placental]] [[ALP]] (PALP)
| style="background: #F5F5F5; padding: 5px;" |Ultrasound:
| style="background: #F5F5F5; padding: 5px;" |[[Ultrasound]]:
* Homogeneous hypoechoic intratesticular mass
* [[Homogeneous]] hypoechoic intratesticular [[mass]]
* Cysts and calcificications are uncommon
* [[Cysts]] and [[calcification]] are uncommon
* Inhomogenous feature in larger mass
* Inhomogenous feature in larger [[mass]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Embryonal carcinoma]]<ref name="pmid19066212">{{cite journal| author=Ishida M, Hasegawa M, Kanao K, Oyama M, Nakajima Y| title=Non-palpable testicular embryonal carcinoma diagnosed by ultrasound: a case report. | journal=Jpn J Clin Oncol | year= 2009 | volume= 39 | issue= 2 | pages= 124-6 | pmid=19066212 | doi=10.1093/jjco/hyn141 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19066212  }}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Embryonal carcinoma]]<ref name="pmid19066212">{{cite journal| author=Ishida M, Hasegawa M, Kanao K, Oyama M, Nakajima Y| title=Non-palpable testicular embryonal carcinoma diagnosed by ultrasound: a case report. | journal=Jpn J Clin Oncol | year= 2009 | volume= 39 | issue= 2 | pages= 124-6 | pmid=19066212 | doi=10.1093/jjco/hyn141 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19066212  }}</ref>
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* May be nonpalpable
* May be nonpalpable
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* [[Hemorrhagic]] mass with [[necrosis]]
* [[Hemorrhagic]] [[mass]] with [[necrosis]]
* Worse [[prognosis]] than [[seminoma]]
* Worse [[prognosis]] than [[seminoma]]
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* Rare type
* [[Rare]] type
* Peak incidence at the age of 30 years old
* Peak [[incidence]] at the [[age]] of 30 years old
* Usually mixed with other types
* Usually mixed with other types
| style="background: #F5F5F5; padding: 5px;" |Early [[metastasis]] to:
| style="background: #F5F5F5; padding: 5px;" |Early [[metastasis]] to:
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* Unremarkable
* Unremarkable
* May present with abdominal/ pelvic mass
* May present with [[abdominal]]/ [[pelvic]] [[mass]]
* Abdominal pain may be present
* [[Abdominal pain]] may be present
* [[Metastatic]] findings
* [[Metastatic]] findings
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* Elevated serum hCG
* Elevated [[serum]] hCG
* Elevated serum AFP, when mixed with other tumor types
* Elevated [[serum]] [[AFP]], when mixed with other [[tumor]] types
| style="background: #F5F5F5; padding: 5px;" |Ultrasound:
| style="background: #F5F5F5; padding: 5px;" |[[Ultrasound]]:
* Usually hypoechoic mass
* Usually hypoechoic [[mass]]
* Invasion to tunica albuginea
* [[Invasion]] to [[tunica albuginea]]
* Irregular calcifications
* Irregular [[calcification]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Yolk sac tumor]]<ref name="pmid26612222">{{cite journal| author=Howitt BE, Berney DM| title=Tumors of the Testis: Morphologic Features and Molecular Alterations. | journal=Surg Pathol Clin | year= 2015 | volume= 8 | issue= 4 | pages= 687-716 | pmid=26612222 | doi=10.1016/j.path.2015.07.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26612222  }}</ref><ref name="pmid24921638">{{cite journal| author=Magers MJ, Kao CS, Cole CD, Rice KR, Foster RS, Einhorn LH et al.| title="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. | journal=Am J Surg Pathol | year= 2014 | volume= 38 | issue= 10 | pages= 1396-409 | pmid=24921638 | doi=10.1097/PAS.0000000000000262 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24921638  }}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Yolk sac tumor]]<ref name="pmid26612222">{{cite journal| author=Howitt BE, Berney DM| title=Tumors of the Testis: Morphologic Features and Molecular Alterations. | journal=Surg Pathol Clin | year= 2015 | volume= 8 | issue= 4 | pages= 687-716 | pmid=26612222 | doi=10.1016/j.path.2015.07.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26612222  }}</ref><ref name="pmid24921638">{{cite journal| author=Magers MJ, Kao CS, Cole CD, Rice KR, Foster RS, Einhorn LH et al.| title="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. | journal=Am J Surg Pathol | year= 2014 | volume= 38 | issue= 10 | pages= 1396-409 | pmid=24921638 | doi=10.1097/PAS.0000000000000262 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24921638  }}</ref>
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* History of [[undescended testes]] in youth
* History of [[undescended testes]] in youth
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* Most common prepubertal testicular cancer in children < 3 years of age
* Most common prepubertal [[testicular cancer]] in children < 3 years of [[age]]


* Common among Asian
* Common among Asian
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* [[Palpable]] [[mass]]
* [[Palpable]] [[mass]]
* Nontender mass
* Nontender [[mass]]
* Unilateral [[mass]]
* Unilateral [[mass]]
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* Elevated serum AFP
* Elevated [[serum]] [[AFP]]
| style="background: #F5F5F5; padding: 5px;" |Ultrasound:
| style="background: #F5F5F5; padding: 5px;" |[[Ultrasound]]:
* Diffuse enlargement of the testis with a heterogeneous appearance
* [[Diffuse]] enlargement of the [[testis]] with a [[heterogeneous]] [[appearance]]
MRI:
[[MRI]]:
* Areas of hemorrhage and necrosis  
* Areas of [[hemorrhage]] and [[necrosis]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Teratoma]]<ref name="pmid8583612">{{cite journal| author=Simmonds PD, Lee AH, Theaker JM, Tung K, Smart CJ, Mead GM| title=Primary pure teratoma of the testis. | journal=J Urol | year= 1996 | volume= 155 | issue= 3 | pages= 939-42 | pmid=8583612 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8583612  }}</ref><ref name="pmid377749">{{cite journal| author=Brosman SA| title=Testicular tumors in prepubertal children. | journal=Urology | year= 1979 | volume= 13 | issue= 6 | pages= 581-8 | pmid=377749 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=377749  }}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Teratoma]]<ref name="pmid8583612">{{cite journal| author=Simmonds PD, Lee AH, Theaker JM, Tung K, Smart CJ, Mead GM| title=Primary pure teratoma of the testis. | journal=J Urol | year= 1996 | volume= 155 | issue= 3 | pages= 939-42 | pmid=8583612 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8583612  }}</ref><ref name="pmid377749">{{cite journal| author=Brosman SA| title=Testicular tumors in prepubertal children. | journal=Urology | year= 1979 | volume= 13 | issue= 6 | pages= 581-8 | pmid=377749 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=377749  }}</ref>
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* May present in both prepubertal and adult men
* May present in both prepubertal and adult men


* Benign form in children under 4 years old
* [[Benign]] form in [[children]] under 4 years old
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* Uncommon in [[benign]] ones among prepubertal men
* Uncommon in [[benign]] ones among prepubertal men
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* [[AFP]]
* [[AFP]]
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* Large, [[heterogeneous]] appearance
* Large, [[heterogeneous]] [[appearance]]
* Presence of at least 2 [[germ layers]]
* Presence of at least 2 [[germ layers]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
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* Palpable [[mass]]
* [[Palpable]] [[mass]]
* Nontender mass
* Nontender [[mass]]
* Unilateral mass
* Unilateral [[mass]]
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* Elevated serum hCG
* Elevated [[serum]] [[hCG]]
* Elevated serum AFP
* Elevated [[serum]] [[AFP]]
| style="background: #F5F5F5; padding: 5px;" |Ultrasound:
| style="background: #F5F5F5; padding: 5px;" |[[Ultrasound]]:
* Heterogeneous, cystic appearance
* [[Heterogeneous]], [[cystic]] [[appearance]]
* Irregular calcifications  
* Irregular [[calcification]]  
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Choriocarcinoma]]<ref name="pmid26881635">{{cite journal| author=Puri S, Sood S, Mohindroo S, Kaushal V| title=Cytomorphology of lung metastasis of pure choriocarcinoma of testis in a 58-year-old male. | journal=J Cancer Res Ther | year= 2015 | volume= 11 | issue= 4 | pages= 1035 | pmid=26881635 | doi=10.4103/0973-1482.154010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26881635  }}</ref><ref name="pmid19084853">{{cite journal| author=Wood HM, Elder JS| title=Cryptorchidism and testicular cancer: separating fact from fiction. | journal=J Urol | year= 2009 | volume= 181 | issue= 2 | pages= 452-61 | pmid=19084853 | doi=10.1016/j.juro.2008.10.074 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19084853  }}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Choriocarcinoma]]<ref name="pmid26881635">{{cite journal| author=Puri S, Sood S, Mohindroo S, Kaushal V| title=Cytomorphology of lung metastasis of pure choriocarcinoma of testis in a 58-year-old male. | journal=J Cancer Res Ther | year= 2015 | volume= 11 | issue= 4 | pages= 1035 | pmid=26881635 | doi=10.4103/0973-1482.154010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26881635  }}</ref><ref name="pmid19084853">{{cite journal| author=Wood HM, Elder JS| title=Cryptorchidism and testicular cancer: separating fact from fiction. | journal=J Urol | year= 2009 | volume= 181 | issue= 2 | pages= 452-61 | pmid=19084853 | doi=10.1016/j.juro.2008.10.074 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19084853  }}</ref>
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| style="background: #F5F5F5; padding: 5px;" |±
| style="background: #F5F5F5; padding: 5px;" |±
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* Nonpalpable or small mass
* Nonpalpable or small [[mass]]
* Painless or radiating pain to groin/ abdomen
* Painless or radiating [[pain]] to [[groin]]/ [[abdomen]]
* Metastatic findings
* [[Metastatic]] findings
* Gynecomastia
* [[Gynecomastia]]
* Hyperthyroidism symptoms
* [[Hyperthyroidism]] [[symptoms]]
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| style="background: #F5F5F5; padding: 5px;" |
* Elevated serum hCG
* Elevated [[serum]] [[hCG]]
| style="background: #F5F5F5; padding: 5px;" |Ultrasound:
| style="background: #F5F5F5; padding: 5px;" |[[Ultrasound]]:
* Hemorrhage and necrosis
* [[Hemorrhage]] and [[necrosis]]
* May appear more cystic inhomogeneous, and calcified
* May appear more [[cystic]] inhomogeneous, and [[Calcification|calcified]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Mixed [[germ cell tumors]]<ref name="pmid20331874">{{cite journal| author=Chuang KL, Liaw CC, Ueng SH, Liao SK, Pang ST, Chang YH et al.| title=Mixed germ cell tumor metastatic to the skin: case report and literature review. | journal=World J Surg Oncol | year= 2010 | volume= 8 | issue=  | pages= 21 | pmid=20331874 | doi=10.1186/1477-7819-8-21 | pmc=2851696 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20331874  }}</ref><ref name="pmid6093440">{{cite journal| author=Krag Jacobsen G, Barlebo H, Olsen J, Schultz HP, Starklint H, Søgaard H et al.| title=Testicular germ cell tumours in Denmark 1976-1980. Pathology of 1058 consecutive cases. | journal=Acta Radiol Oncol | year= 1984 | volume= 23 | issue= 4 | pages= 239-47 | pmid=6093440 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6093440  }}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Mixed [[germ cell tumors]]<ref name="pmid20331874">{{cite journal| author=Chuang KL, Liaw CC, Ueng SH, Liao SK, Pang ST, Chang YH et al.| title=Mixed germ cell tumor metastatic to the skin: case report and literature review. | journal=World J Surg Oncol | year= 2010 | volume= 8 | issue=  | pages= 21 | pmid=20331874 | doi=10.1186/1477-7819-8-21 | pmc=2851696 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20331874  }}</ref><ref name="pmid6093440">{{cite journal| author=Krag Jacobsen G, Barlebo H, Olsen J, Schultz HP, Starklint H, Søgaard H et al.| title=Testicular germ cell tumours in Denmark 1976-1980. Pathology of 1058 consecutive cases. | journal=Acta Radiol Oncol | year= 1984 | volume= 23 | issue= 4 | pages= 239-47 | pmid=6093440 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6093440  }}</ref>
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* Depends on underlying components
* Depends on underlying components
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* Average age about 30 years old
* [[Average]] [[age]] about 30 years old
* Rare in prepubertal age
* Rare in prepubertal [[age]]
* Include one-third of all [[testicular]] [[germ cell tumors]]
* Include one-third of all [[testicular]] [[germ cell tumors]]
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* Variable components depends on [[tumor]]
* Variable components depends on [[tumor]]
* Accompanied with necrosis and hemorrhages  
* Accompanied with [[necrosis]] and [[hemorrhages]]
| style="background: #F5F5F5; padding: 5px;" |±
| style="background: #F5F5F5; padding: 5px;" |±
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
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* Physical exam findings based on underlying components
* [[Physical exam]] findings based on underlying components
| style="background: #F5F5F5; padding: 5px;" |
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Elevations in:
Elevations in:
* AFP
* [[AFP]]
* Beta-hCG
* [[Beta-hCG]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Imaging findings based on underlying components
* [[Imaging]] findings based on underlying components
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Carcinoma in situ]] (intratubular germ cell neoplasia )<ref name="pmid7517917">{{cite journal| author=Rajpert-De Meyts E, Skakkebaek NE| title=Expression of the c-kit protein product in carcinoma-in-situ and invasive testicular germ cell tumours. | journal=Int J Androl | year= 1994 | volume= 17 | issue= 2 | pages= 85-92 | pmid=7517917 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7517917  }}</ref><ref name="pmid6209917">{{cite journal| author=Jacobsen GK, Nørgaard-Pedersen B| title=Placental alkaline phosphatase in testicular germ cell tumours and in carcinoma-in-situ of the testis. An immunohistochemical study. | journal=Acta Pathol Microbiol Immunol Scand A | year= 1984 | volume= 92 | issue= 5 | pages= 323-9 | pmid=6209917 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6209917  }}</ref><ref name="pmid7260858">{{cite journal| author=Jacobsen GK, Henriksen OB, von der Maase H| title=Carcinoma in situ of testicular tissue adjacent to malignant germ-cell tumors: a study of 105 cases. | journal=Cancer | year= 1981 | volume= 47 | issue= 11 | pages= 2660-2 | pmid=7260858 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7260858  }}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Carcinoma in situ]] (intratubular germ cell neoplasia )<ref name="pmid7517917">{{cite journal| author=Rajpert-De Meyts E, Skakkebaek NE| title=Expression of the c-kit protein product in carcinoma-in-situ and invasive testicular germ cell tumours. | journal=Int J Androl | year= 1994 | volume= 17 | issue= 2 | pages= 85-92 | pmid=7517917 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7517917  }}</ref><ref name="pmid6209917">{{cite journal| author=Jacobsen GK, Nørgaard-Pedersen B| title=Placental alkaline phosphatase in testicular germ cell tumours and in carcinoma-in-situ of the testis. An immunohistochemical study. | journal=Acta Pathol Microbiol Immunol Scand A | year= 1984 | volume= 92 | issue= 5 | pages= 323-9 | pmid=6209917 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6209917  }}</ref><ref name="pmid7260858">{{cite journal| author=Jacobsen GK, Henriksen OB, von der Maase H| title=Carcinoma in situ of testicular tissue adjacent to malignant germ-cell tumors: a study of 105 cases. | journal=Cancer | year= 1981 | volume= 47 | issue= 11 | pages= 2660-2 | pmid=7260858 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7260858  }}</ref>
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* Cryptorchid [[testes]]  
* Cryptorchid [[testes]]  
* Previous [[testicular cancer]]
* Previous [[testicular cancer]]
* Abnormal sexual differentiation
* [[Abnormal]] [[sexual differentiation]]
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| style="background: #F5F5F5; padding: 5px;" |
* A precursor of most [[testicular]] [[germ cell tumors]]
* A [[precursor]] of most [[testicular]] [[germ cell tumors]]
* Adjacent to a other [[testicular]] [[germ cell tumors]] > 90% of all
* Adjacent to a other [[testicular]] [[germ cell tumors]] > 90% of all
| style="background: #F5F5F5; padding: 5px;" |Common:
| style="background: #F5F5F5; padding: 5px;" |Common:
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Stain positively for:
Stain positively for:
* PALP
* [[Placental]] ALP


* [[Genetic]] changes in [[chromosome 12]]  
* [[Genetic]] changes in [[chromosome 12]]  
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* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |Elevated for:
| style="background: #F5F5F5; padding: 5px;" |Elevated for:
* PALP
* [[Placental]] [[ALP]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
Line 301: Line 301:
* Unilateral
* Unilateral
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Slowly enlarging painless unilateral mass
* Slowly enlarging painless unilateral [[mass]]


* Based on large size, vascular invasion, and mitotic activity classify into benign / [[malignant]]
* Based on large size, [[vascular]] [[invasion]], and [[mitotic]] activity classify into [[benign]] / [[malignant]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Bimodal age distribution in both adults and children
* Bimodal [[age]] distribution in both adults and [[children]]
* Considered as stromal tumors
* Considered as [[stromal]] [[tumors]]
*
*
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Uncommon metastasis
* Uncommon [[metastasis]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Mutation in fumarate hydratase
* [[Mutation]] in [[fumarate]] hydratase
Stains positively for:  
Stains positively for:  
* inhibin-A  
* [[Inhibin A]]
* Calretinin
* [[Calretinin]]
* WT-1
* WT-1
* SALL-4
* SALL-4
Line 324: Line 324:
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Palpable mass
* [[Palpable]] [[mass]]
* Unilateral mass
* Unilateral [[mass]]
* Nontender
* Nontender
* Gynecomastia
* [[Gynecomastia]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |Ultrasound:
| style="background: #F5F5F5; padding: 5px;" |[[Ultrasound]]:
* Well-defined, hypoechoic solid mass
* Well-defined, hypoechoic [[solid]] mass
* Cystic component
* [[Cystic]] component
* Irregular calcifications
* Irregular [[calcification]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Sertoli cell tumor<ref name="pmid27036305">{{cite journal| author=Banerji JS, Odem-Davis K, Wolff EM, Nichols CR, Porter CR| title=Patterns of Care and Survival Outcomes for Malignant Sex Cord Stromal Testicular Cancer: Results from the National Cancer Data Base. | journal=J Urol | year= 2016 | volume= 196 | issue= 4 | pages= 1117-22 | pmid=27036305 | doi=10.1016/j.juro.2016.03.143 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27036305  }}</ref><ref name="pmid15502809">{{cite journal| author=Young RH| title=Sex cord-stromal tumors of the ovary and testis: their similarities and differences with consideration of selected problems. | journal=Mod Pathol | year= 2005 | volume= 18 Suppl 2 | issue=  | pages= S81-98 | pmid=15502809 | doi=10.1038/modpathol.3800311 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15502809  }}</ref><ref name="pmid7003168">{{cite journal| author=Gabrilove JL, Freiberg EK, Leiter E, Nicolis GL| title=Feminizing and non-feminizing Sertoli cell tumors. | journal=J Urol | year= 1980 | volume= 124 | issue= 6 | pages= 757-67 | pmid=7003168 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7003168  }}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Sertoli cell tumor<ref name="pmid27036305">{{cite journal| author=Banerji JS, Odem-Davis K, Wolff EM, Nichols CR, Porter CR| title=Patterns of Care and Survival Outcomes for Malignant Sex Cord Stromal Testicular Cancer: Results from the National Cancer Data Base. | journal=J Urol | year= 2016 | volume= 196 | issue= 4 | pages= 1117-22 | pmid=27036305 | doi=10.1016/j.juro.2016.03.143 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27036305  }}</ref><ref name="pmid15502809">{{cite journal| author=Young RH| title=Sex cord-stromal tumors of the ovary and testis: their similarities and differences with consideration of selected problems. | journal=Mod Pathol | year= 2005 | volume= 18 Suppl 2 | issue=  | pages= S81-98 | pmid=15502809 | doi=10.1038/modpathol.3800311 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15502809  }}</ref><ref name="pmid7003168">{{cite journal| author=Gabrilove JL, Freiberg EK, Leiter E, Nicolis GL| title=Feminizing and non-feminizing Sertoli cell tumors. | journal=J Urol | year= 1980 | volume= 124 | issue= 6 | pages= 757-67 | pmid=7003168 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7003168  }}</ref>
Line 344: Line 344:
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Classified as large cell calcifying or sclerosing types
* Classified as large cell calcifying or sclerosing types
* [[Androblastoma]] from sex cord stroma
* [[Androblastoma]] from [[sex cord]] [[stroma]]
* History of [[peutz-Jeghers syndrome]] and [[Carney complex]]
* History of [[peutz-Jeghers syndrome]] and [[Carney complex]]
* Gradually enlarging testicular mass
* Gradually enlarging [[testicular]] [[mass]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Occur in any ages (infancy to elderly)
* Occur in any ages ([[infancy]] to elderly)
* Average age of 45 years
* Average [[age]] of 45 years
* Mean age for large cell calcifying variant is 21 years old
* [[Mean]] [[age]] for large [[cell]] calcifying variant is 21 years old
* 0.1% of testicular tumors
* 0.1% of [[testicular]] [[tumors]]
* Considered as stromal tumors
* Considered as [[stromal]] [[tumors]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Uncommon [[metastasis]]
* Uncommon [[metastasis]]
| style="background: #F5F5F5; padding: 5px;" |Stain positively for:
| style="background: #F5F5F5; padding: 5px;" |Stain positively for:
* Inhibin
* [[Inhibin]]
* Cytokeratin
* [[Cytokeratin]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Solid or hollow tubules divided by [[basement membrane]]
* Solid or hollow tubules divided by [[basement membrane]]
Line 365: Line 365:
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Palpable and painless mass
* [[Palpable]] and painless [[mass]]
* Hyperestrinism is noted in syndromic cases
* Hyperestrinism is noted in syndromic cases
* Gynecomastia
* [[Gynecomastia]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |Ultrasound:
| style="background: #F5F5F5; padding: 5px;" |[[Ultrasound]]:
* Large cell calcifying variant
* Large [[cell]] calcifying variant
* Hypoechoic
* Hypoechoic
|-
|-
Line 383: Line 383:
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Aggressive extranodal [[non-Hodgkin lymphoma]]
* Aggressive extranodal [[non-Hodgkin lymphoma]]
* Large cell diffuse [[B-cell lymphoma]] is responsible for most cases
* Large [[cell]] [[diffuse]] [[B-cell lymphoma]] is responsible for most cases
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* The most common in men older than 50 years old
* The most common in men older than 50 years old
Line 404: Line 404:
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Palpable]] mass
* [[Palpable]] [[mass]]
* Nontender mass
* Nontender [[mass]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Depends on [[lymphoma]] subtype
* Depends on [[lymphoma]] subtype
| style="background: #F5F5F5; padding: 5px;" |Ultrasound:
| style="background: #F5F5F5; padding: 5px;" |[[Ultrasound]]:
* Diffuse testicular infiltration and enlargement
* [[Diffuse]] [[testicular]] [[Infiltration (medical)|infiltration]] and enlargement
* Hypervascularity  
* Hypervascularity  
* Hypoechoic and solid lesion
* Hypoechoic and [[solid]] lesion
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Granulosa cell tumors]]<ref name="pmid10688023">{{cite journal| author=Garrett JE, Cartwright PC, Snow BW, Coffin CM| title=Cystic testicular lesions in the pediatric population. | journal=J Urol | year= 2000 | volume= 163 | issue= 3 | pages= 928-36 | pmid=10688023 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10688023  }}</ref><ref name="pmid17628299">{{cite journal| author=Ditonno P, Lucarelli G, Battaglia M, Mancini V, Palazzo S, Trabucco S et al.| title=Testicular granulosa cell tumor of adult type: a new case and a review of the literature. | journal=Urol Oncol | year= 2007 | volume= 25 | issue= 4 | pages= 322-5 | pmid=17628299 | doi=10.1016/j.urolonc.2006.08.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17628299  }}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Granulosa cell tumors]]<ref name="pmid10688023">{{cite journal| author=Garrett JE, Cartwright PC, Snow BW, Coffin CM| title=Cystic testicular lesions in the pediatric population. | journal=J Urol | year= 2000 | volume= 163 | issue= 3 | pages= 928-36 | pmid=10688023 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10688023  }}</ref><ref name="pmid17628299">{{cite journal| author=Ditonno P, Lucarelli G, Battaglia M, Mancini V, Palazzo S, Trabucco S et al.| title=Testicular granulosa cell tumor of adult type: a new case and a review of the literature. | journal=Urol Oncol | year= 2007 | volume= 25 | issue= 4 | pages= 322-5 | pmid=17628299 | doi=10.1016/j.urolonc.2006.08.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17628299  }}</ref>
Line 425: Line 425:
* [[Cryptorchidism]]  
* [[Cryptorchidism]]  
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Similar to ovarian counterparts
* Similar to [[ovarian]] counterparts


* Occur in both adult and juvenile
* Occur in both adult and juvenile
* Juvenile type in children less than 2 years old ( the most common infancy tumor)
* Juvenile type in [[children]] less than 2 years old ( the most common [[infancy]] [[tumor]])
* Adult type with average age of 44 years old ( rare)
* Adult type with [[average]] [[age]] of 44 years old ( [[rare]])
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Metastasis]] occur in 10%-20% of cases
* [[Metastasis]] occur in 10%-20% of cases
Line 445: Line 445:
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Palpable]] mass
* [[Palpable]] [[mass]]
* Nontender mass
* Nontender [[mass]]
| style="background: #F5F5F5; padding: 5px;" |Elevated [[serum]]:
| style="background: #F5F5F5; padding: 5px;" |Elevated [[serum]]:
* [[Inhibin]]
* [[Inhibin]]
* [[Müllerian inhibiting factor]]
* [[Müllerian inhibiting factor]]
| style="background: #F5F5F5; padding: 5px;" |Ultrasound:
| style="background: #F5F5F5; padding: 5px;" |[[Ultrasound]]:
* Hypoechoic mass
* Hypoechoic [[mass]]
* Solid and cystic appearance
* [[Solid]] and [[cystic]] [[appearance]]
|}
|}


Revision as of 15:45, 28 January 2019

Testicular cancer Microchapters

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Overview

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Differentiating Testicular cancer from other Diseases

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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

Testicular cancer must be differentiated from:

Diseases Benign/ Malignant Unilateral/Bilateral History Demography Metastasis Genetics Histopathology Clinical manifestations Para-clinical findings
Pain Mass Physical examination
Lab findings Imaging
Germ Cell tumors Seminoma[1][2]
  • Most common among age of 15-35 years old
  • Does not occur during infancy
 Stains positively for: - + Ultrasound:
Embryonal carcinoma[3]
  • Rare type
  • Peak incidence at the age of 30 years old
  • Usually mixed with other types
 Early metastasis to: Stains positively for:

May stain positively for :

+ ± Ultrasound:
Yolk sac tumor[4][5]
  • Unilateral
  • Common among Asian
  • Uncommon
 Stains positively for:
  • Schiller-Duval bodies (perivascular structures)
  • Hyaline-type globules
 + + Ultrasound:

MRI:

Teratoma[6][7]
  • Unilateral
 History of congenital disease such as:
  • May present in both prepubertal and adult men
  • Uncommon in benign ones among prepubertal men

Stains positively for:

- + Ultrasound:
Choriocarcinoma[8][9]
  • Most aggressive type
 Early metastasis: Stains positively for: + ± Ultrasound:
Mixed germ cell tumors[10][11]
  • Unilateral
  • Two or more germ cell tumors present as a single mass
  • Depends on underlying components
  • May stain positive based on underlying components
 ± +

Elevations in:

  • Imaging findings based on underlying components
Carcinoma in situ (intratubular germ cell neoplasia )[12][13][14]
  • Unilateral
  • Bilateral
 Common:

Stain positively for:

- -
  • N/A
 Elevated for:
  • N/A
Diseases Benign/ Malignant Unilateral/Bilateral History Demography Metastasis Genetics Histopathology Pain Mass Physical exam Lab Findings Imaging
Non- germ cell tumors Leydig cell tumor[15]
  • Unilateral
  • Slowly enlarging painless unilateral mass

Stains positively for:

- +
  • N/A
 Ultrasound:
Sertoli cell tumor[16][17][18]
  • Unilateral
  • Bilateral
 Stain positively for: - +
  • N/A
 Ultrasound:
  • Large cell calcifying variant
  • Hypoechoic
Testicular lymphoma[19][20][21]
  • Unilateral
  • Bilateral ( mostly up to 35% of cases)
  • The most common in men older than 50 years old
 Common metastasis to : Stains positively for: - + Ultrasound:
Granulosa cell tumors[22][23]
  • Unilateral

Juvenile type associated with:

Stains positively for: - + Elevated serum: Ultrasound:

References

  1. ↑ Siegel RL, Miller KD, Jemal A (2016). "Cancer statistics, 2016". CA Cancer J Clin. 66 (1): 7–30. doi:10.3322/caac.21332. PMID 26742998.
  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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