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Discussion Starter · #1 ·
A 32 year old man presented with painless enlargement of his right testis. He has no other symptoms. Examination confirmed an enlarged nodular non tender right testicular swelling. Ultasound showed hypechoic mass in the right testis.
What type of testicular tumor this patient is most likely suffering from?
A- Seminoma
B- Yolk sac tumor
C- Teratoma
D- Leydig cell tumor
E- Lymphoma

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Well the fact that 95% of all testicular tumors are germ cell tumors, and that the most common is seminoma, and the fact that is painless and its between 15-35 years of age. Seminoma is the correct answer in my opionion. I guess in the exam they might say the watery cytoplasm, or the fried eggs appearance.

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some facts

The patient may complain of a dull ache or a sense of scrotal heaviness.
commonly occurring cancers in young men, with an average patient age of 32 years.
A significantly increased incidence of testicular cancer is found in patients with cryptorchidism, developing in both the nondescended and the contralateral descended testes.

Leydig's cell tumors:
When examining patients with a testicular mass, evaluation for gynecomastia should also be performed. Leydig's cells produce testosterone.

Ninety-seven percent of testicular tumors are germinal in origin, with seminoma being the most common, followed by embryonal cell carcinoma, teratoma and choriocarcinoma.

Nonseminoma tumors are often made up of more than one type of cell, and are identified according to these different cell types:
Choriocarcinoma (rare)
Embryonal carcinoma
Yolk sac tumor

Serum AFP is excreted to varying degrees by NSGCT but not by pure seminoma. An elevated AFP level implies NSGCT or mixed tumor. About one half of NSGCT and mixed tumors will secrete beta HCG, as will about 10 percent of pure seminomas. Seminomas have elevated Placental Alk. phosphotase in 50% of cases.

Management. Radical orchiectomy with high ligation of the spermatic cord via an inguinal approach is appropriate for surgery on testicular masses.

The tremendous improvement in cure rates is due in large part to the introduction of cisplatin (Platinol) chemotherapy.
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