Testicular tumors are uncommon tumors of the testicles that can be benign or malignant. These tumors occur in males of any age group. Clinical symptoms of testicular tumors include hardness, swelling, pain, and abnormalities in the shape and size of the affected testis. Other body parts may also be affected due to metastasis such as lungs, lymph nodes, liver, and the central nervous system. According to the origin of the tumors, testicular tumors can be classified into three main types: germ cell tumors, non-germ cell tumors, and extragonadal tumors. Germ cell tumors form the majority of testicular tumor cases and they are histologically subdivided to yolk sac tumor, teratoma (tumors derived from pluripotential cells), teratocarcinoma, and seminoma. Alpha-fetoprotein is usually detected in the blood of two-thirds of children with malignant teratoma.
The overall incidence of testicular tumors ranges from 0.2 to 10.3 cases per 100,000 individuals and the highest rates have been found in Norway, Denmark, Germany, and Switzerland. Testicular tumors account 1-2% of all pediatric solid tumors. Diagnosis of testicular tumors is confirmed by radiological and histopathological findings. Orchiectomy (removing the testicles) is the usual choice with malignant testicular tumors.
Al-Hindi et al. (2001) documented a 6-month-old infant produced by in-vitro fertilization (IVF) who had a right testicular swelling since birth and the suggested diagnosis was teratoma of the right testis. Family history was negative for any cancer type. Alpha fetoprotein (AFP) was 271 microgram/liter and the other tumor markers (such as Ca 25, Ca 15-3, Ca 19-9, and CEA) were within normal range. Ultrasonography and MRI showed gross right testicular enlargement, which was four times as compared to the left, and no lymph node enlargement was evident there. The patient underwent right testicular frozen section followed by orchidectomy as section proved malignancy. The right testis weighted 16 grams and its microscopic examination revealed aggregates of immune neuroepithelial tubular structures interspersed with primitive embryonal stroma, rosettes, frequent mitotic figures, and admixtures of mature and immature tissues of endo- and mesoderms mainly. Consequently, a diagnosis of Grade III immature teratoma involving the testis was established. Two weeks after the surgery, AFP dropped to 52 microgram/liter. Right groin swelling was noted four months after surgery, which was excised suspecting recurrence or involvement of lymph node. Microscopically, it showed tell-tale features of mature cystic/solid teratoma. One week later, AFP level was within normal limits.
[Al-Hindi S, Al-Khuzaie J, Al-Awadhi M, Malik AK. Malignant testicular tumor in an infant. Bahrain Med Bull. 2001; 23(4):185-6.]
Bani-Hani et al. (2003) conducted a retrospective study to investigate the correlation between testicular tumors and undescended testis. Medical records of all patients with testicular germ cell cancer were seen and examined at the Princess Basma Teaching Hospital, Jordan University of Science and Technology, Irbid, Jordan, between 1990 and 2000 (group 1) for any evidence of undescended testis. All males with undescended testis attending the infertility clinic during the period 1999-2001 (group 2) were re-evaluated for any evidence of testicular tumors. Forty-four patients with testicular germinal cell tumors; mean age at diagnosis were 32.6 years (range 20-50) were identified. All patients had unilateral involvement and none of them were found to have tumors in undescended testis. The tumor was in the scrotum in all patients. None of the 117 infertile patients with undescended testis had clinical or ultrasonic evidence of testicular tumors. Of nearly 2071 traceable patients who had an operation for undescended testicle in the past 30 years none developed testicular tumor.
Motawy et al. (1992) serially measured serum levels of AFP, hCG and CEA in 59 patients with testicular germ cell tumors, and serially in 37 with ovarian and 3 with extragonadal germ cell tumors. Patients with seminoma/dysgerminoma or mature teratoma had normal serum AFP and sporadically slightly elevated hCG. Some patients with embryonal carcinoma, pure or with admixture of seminoma, had serum AFP elevated to maximum 100 U/ml, yet its use for monitoring therapy was limited. High AFP and/or hCG levels indicated the presence of the relevant tumor cells both in the primary and in residual tumor and/or metastases, also those missed in histological material, and thus were useful in restaging.