Seminoma differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Overview

Seminoma must be differentiated from other diseases that cause testicular mass, such as non seminomatous germ cell tumor, sex cord tumors, focal orchitis, focal intratesticular hemorrhage, testicular torsion, tuberculosis, and polyorchidism.

Differentiating Seminoma from other Diseases

• The most common presentation of testicular seminoma is a painless testicular mass. The main differential for testicular mass in young adults is non-seminomatous germ cell tumor (NGCT) which usually appear more heterogenous, often with cysts and calcification. Lymphadenopathy of non-seminomatous germ cell tumor may enhance more heterogenously.
• Testicular lymphoma is the main differential diagnosis to consider when para-aortic lymphadenopathy is the presenting finding or in the setting of bilateral testicular lesions.

Differential diagnosis of testicular seminoma

Unilateral testicular mass

Bilateral testicular mass

Neoplastic

Non neoplastic

Neoplastic

Non neoplastic

Non seminomatous germ cell tumor ❑ Testicular teratoma ❑ Testicular epidermoid ❑ Choriocarcinoma ❑ Embryonal cell carcinoma ❑ Yolk sac tumor ❑ Mixed germ cell tumor Sex cord/stromal tumors ❑ Leydig cell tumor ❑ Sertoli cell tumor Metastasis to testis

❑ Testicular cyst ❑ Tubular ectasia of rete testes ❑ Focal orchitis ❑ Focal intratesticular hemorrhage ❑ Testicular torsion ❑ Intra testicular adrenal rest ❑ Tuberculosis ❑ Sarcoidosis ❑ Polyorchidism ❑ Intratesticular varicocele ❑ Intratesticular arteriovenous malformation

❑ Acute lymphoblastic leukemia ❑ Chronic lymphocytic leukemia ❑ Non-Hodgkin's lymphoma ❑ Metastases

❑ Intra testicular adrenal rests