Testicular cancer differential diagnosis

Testicular cancer Microchapters
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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	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	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	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

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