Testicular cancer differential diagnosis: Difference between revisions

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* Irregular calcifications
* Irregular calcifications
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Yolk sac tumor
| 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>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |Malignant
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| style="background: #F5F5F5; padding: 5px;" |Unilateral
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* Known as a endodermal sinus tumor
* History of undescended testes in youth
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* Most common prepubertal testicular cancer in children < 3 years of age
* Common among Asian
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* Uncommon
| style="background: #F5F5F5; padding: 5px;" |Stains positively for:
* AFP
* Alpha-1-antitrypsin
* PAS diastase
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* Yellow, mucinous, encapsulated mass
* Schiller-Duval bodies (perivascular structures)
* Hyaline-type globules
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" |+
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* Palpable mass
* Nontender mass
* Unilateral testicular mass
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* Elevated serum AFP
| style="background: #F5F5F5; padding: 5px;" |Ultrasound:
* Diffuse enlargement of the testis with a heterogeneous appearance
MRI:
* Areas of hemorrhage and necrosis
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Teratoma
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Teratoma

Revision as of 18:35, 23 January 2019

Testicular cancer Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Testicular cancer from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Staging

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Biopsy

Treatment

Medical Therapy

Surgery

Primary Prevention

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Future or Investigational Therapies

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Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shanshan Cen, 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 Seminoma[1][2] Malignant Unilateral
  • History of cryptorchidism
  • Excellent prognosis
  • Most common among age of 15-35 years old
  • Does not occur during infancy
  • Late metastasis
 Stains positively for:
  • ALP
  • C-KIT
  • CD30
  • EMA
  • Glycogen
  • Large cells wit watery cytoplasm
  • Fried egg appearance
 - +
  • Palpable, nontender unilateral testicular mass
  • Usually homogeneous enlargement
  • Elevated serum placental ALP (PALP)
 Ultrasound:
  • Homogeneous hypoechoic intratesticular mass
  • Cysts and calcificications are uncommon
  • Inhomogenous feature in larger mass
Embryonal carcinoma[3] Malignant
  • Usually located in parenchyma of testis
  • May be nonpalpable
  • Hemorrhagic mass with necrosis
  • Worse prognosis than seminoma
  • Rare type
  • Peak incidence at the age of 30 years old
  • Usually mixed with other types
 Early metastasis to:
  • retroperitoneum
  • Lung
  • Liver
 Stains positively for:
  • CD30
  • HCG

May stain positively for :

  • AFP, when mixed with other tumors
  • Primitive epithelial cells with marked pleomorphism
  • Often mixed histopathological features (solid, papillary, tubular, pseudoglandular)
 + ±
  • Unremarkable
  • May present with abdominal/ pelvic mass
  • Abdominal pain may be present
  • Elevated serum hCG
  • Elevated serum AFP, when mixed with other tumor types
 Ultrasound:
  • Usually hypoechoic mass
  • Invasion to tunica albuginea
  • Irregular calcifications
Yolk sac tumor[4] Malignant Unilateral
  • Known as a endodermal sinus tumor
  • History of undescended testes in youth
  • Most common prepubertal testicular cancer in children < 3 years of age
  • Common among Asian
  • Uncommon
 Stains positively for:
  • AFP
  • Alpha-1-antitrypsin
  • PAS diastase
  • Yellow, mucinous, encapsulated mass
  • Schiller-Duval bodies (perivascular structures)
  • Hyaline-type globules
 + +
  • Palpable mass
  • Nontender mass
  • Unilateral testicular mass
  • Elevated serum AFP
 Ultrasound:
  • Diffuse enlargement of the testis with a heterogeneous appearance

MRI:

  • Areas of hemorrhage and necrosis
Teratoma
Choriocarcinoma
Diseases Benign/ Malignant Unilateral/Bilateral History Demography Metastasis Genetics Histopathology Pain Mass Physical exam Lab Findings Imaging
Non germ cell Leydig cell tumor
Sertoli cell tumor
Testicular lymphoma
Carcinoma in situ of the testicle

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.


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