Testicular cancer differential diagnosis: Difference between revisions

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==Differentiating Testicular cancer from other Diseases==
==Differentiating Testicular cancer from other Diseases==
Testicular cancer must be differentiated from:
Abbreviations:
 
AFP: Alpha-fetoprotein, B-hCG: Beta-Human chorionic gonadotropin, P-ALP: Placental- Alkalin phosphatase,
 
{|
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
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! rowspan="3" |Benign/ Malignant
! rowspan="3" |Benign/ Malignant
! rowspan="3" |Unilateral/Bilateral
! rowspan="3" |Unilateral/Bilateral
! rowspan="3" |History
! rowspan="3" |History/demography
! rowspan="3" |Demography
! rowspan="3" |Metastasis
! rowspan="3" |Metastasis
! rowspan="3" |Genetics
! rowspan="3" |Genetics
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |p-ALP
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |p-ALP
|-
|-
! colspan="15" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Germ Cell tumors
! colspan="14" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Germ Cell tumors
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Seminoma]]<ref name="pmid26742998">{{cite journal| author=Siegel RL, Miller KD, Jemal A| title=Cancer statistics, 2016. | journal=CA Cancer J Clin | year= 2016 | volume= 66 | issue= 1 | pages= 7-30 | pmid=26742998 | doi=10.3322/caac.21332 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26742998  }}</ref><ref name="pmid9930796">{{cite journal| author=Miller FH, Whitney WS, Fitzgerald SW, Miller EI| title=Seminomas complicating undescended intraabdominal testes in patients with prior negative findings from surgical exploration. | journal=AJR Am J Roentgenol | year= 1999 | volume= 172 | issue= 2 | pages= 425-8 | pmid=9930796 | doi=10.2214/ajr.172.2.9930796 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9930796  }}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Seminoma]]<ref name="pmid26742998">{{cite journal| author=Siegel RL, Miller KD, Jemal A| title=Cancer statistics, 2016. | journal=CA Cancer J Clin | year= 2016 | volume= 66 | issue= 1 | pages= 7-30 | pmid=26742998 | doi=10.3322/caac.21332 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26742998  }}</ref><ref name="pmid9930796">{{cite journal| author=Miller FH, Whitney WS, Fitzgerald SW, Miller EI| title=Seminomas complicating undescended intraabdominal testes in patients with prior negative findings from surgical exploration. | journal=AJR Am J Roentgenol | year= 1999 | volume= 172 | issue= 2 | pages= 425-8 | pmid=9930796 | doi=10.2214/ajr.172.2.9930796 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9930796  }}</ref>
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Cryptorchidism]]
* [[Cryptorchidism]]
| style="background: #F5F5F5; padding: 5px;" |
* Most common among [[age]] of 15-35 years old
* Most common among [[age]] of 15-35 years old
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Hemorrhagic]] [[mass]] with [[necrosis]]
* [[Hemorrhagic]] [[mass]] with [[necrosis]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Rare]] type
* [[Rare]] type
* Peak [[incidence]] at the [[age]] of 30 years old
* Peak [[incidence]] at the [[age]] of 30 years old
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* [[Abdominal pain]] may be present
* [[Abdominal pain]] may be present
* [[Metastatic]] findings
* [[Metastatic]] findings
| style="background: #F5F5F5; padding: 5px;"|↑*
| style="background: #F5F5F5; padding: 5px;" |↑*
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |N/A
| style="background: #F5F5F5; padding: 5px;" |N/A
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* Known as a [[endodermal sinus tumor]]
* Known as a [[endodermal sinus tumor]]
* [[undescended testes]] in youth
* [[undescended testes]] in youth
| style="background: #F5F5F5; padding: 5px;" |
* Most common prepubertal [[testicular cancer]] in children < 3 years of [[age]]
* Most common prepubertal [[testicular cancer]] in children < 3 years of [[age]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Unilateral
* Unilateral
| style="background: #F5F5F5; padding: 5px;" |Congenital disease such as:
| style="background: #F5F5F5; padding: 5px;" |
* May present in both prepubertal and adult men
 
* [[Benign]] form in [[children]] under 4 years oldCongenital disease such as:
* [[Klinefelter's Syndrome|Klinefelter's syndrome]]
* [[Klinefelter's Syndrome|Klinefelter's syndrome]]
* [[Down syndrome]]
* [[Down syndrome]]


* [[Spina Bifida|Spina bifida]]
* [[Spina Bifida|Spina bifida]]
| style="background: #F5F5F5; padding: 5px;" |
* May present in both prepubertal and adult men
* [[Benign]] form in [[children]] under 4 years old
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Uncommon in [[benign]] ones among prepubertal men
* Uncommon in [[benign]] ones among prepubertal men
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* [[cryptorchidism]]
* [[cryptorchidism]]
* Abdominal [[undescended testes]]
* Abdominal [[undescended testes]]
| style="background: #F5F5F5; padding: 5px;" |
* Most aggressive type
* Most aggressive type
| style="background: #F5F5F5; padding: 5px;" |Early [[metastasis]]:
| style="background: #F5F5F5; padding: 5px;" |Early [[metastasis]]:
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* Two or more [[germ cell tumors]] present as a single mass
* Two or more [[germ cell tumors]] present as a single mass
* Depends on underlying components
* Depends on underlying components
| style="background: #F5F5F5; padding: 5px;" |
* [[Average]] [[age]] about 30 years old
* [[Average]] [[age]] about 30 years old
* Rare in prepubertal [[age]]
* Rare in prepubertal [[age]]
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* Previous [[testicular cancer]]
* Previous [[testicular cancer]]
* [[Abnormal]] [[sexual differentiation]]
* [[Abnormal]] [[sexual differentiation]]
| style="background: #F5F5F5; padding: 5px;" |
* A [[precursor]] of most [[testicular]] [[germ cell tumors]]
* A [[precursor]] of most [[testicular]] [[germ cell tumors]]
* Adjacent to a other [[testicular]] [[germ cell tumors]] > 90% of all
* Adjacent to a other [[testicular]] [[germ cell tumors]] > 90% of all
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Benign/ Malignant
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Benign/ Malignant
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Unilateral/Bilateral
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Unilateral/Bilateral
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |History
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |History/Demography
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demography
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Metastasis
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Metastasis
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Genetics
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Genetics
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
|-
|-
! colspan="15" style="background: #4479BA; color: #FFFFFF; text-align: center;" | |Non-germ cell tumors
! colspan="14" style="background: #4479BA; color: #FFFFFF; text-align: center;" |<nowiki> |Non-germ cell tumors</nowiki>
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Leydig cell tumor]]<ref name="pmid9808128">{{cite journal| author=Cheville JC, Sebo TJ, Lager DJ, Bostwick DG, Farrow GM| title=Leydig cell tumor of the testis: a clinicopathologic, DNA content, and MIB-1 comparison of nonmetastasizing and metastasizing tumors. | journal=Am J Surg Pathol | year= 1998 | volume= 22 | issue= 11 | pages= 1361-7 | pmid=9808128 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9808128  }}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Leydig cell tumor]]<ref name="pmid9808128">{{cite journal| author=Cheville JC, Sebo TJ, Lager DJ, Bostwick DG, Farrow GM| title=Leydig cell tumor of the testis: a clinicopathologic, DNA content, and MIB-1 comparison of nonmetastasizing and metastasizing tumors. | journal=Am J Surg Pathol | year= 1998 | volume= 22 | issue= 11 | pages= 1361-7 | pmid=9808128 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9808128  }}</ref>
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Based on large size, [[vascular]] [[invasion]], and [[mitotic]] activity classify into [[benign]] / [[malignant]]
* Based on large size, [[vascular]] [[invasion]], and [[mitotic]] activity classify into [[benign]] / [[malignant]]
| style="background: #F5F5F5; padding: 5px;" |
* Bimodal [[age]] distribution in both adults and [[children]]
* Bimodal [[age]] distribution in both adults and [[children]]
*
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Uncommon [[metastasis]]
* Uncommon [[metastasis]]
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* Classified as large cell calcifying or sclerosing types
* Classified as large cell calcifying or sclerosing types
* History of [[peutz-Jeghers syndrome]] and [[Carney complex]]
* History of [[peutz-Jeghers syndrome]] and [[Carney complex]]
| style="background: #F5F5F5; padding: 5px;" |
* Occur in any ages ([[infancy]] to elderly)
* Occur in any ages ([[infancy]] to elderly)
* Average [[age]] of 45 years
* Average [[age]] of 45 years
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Aggressive extranodal [[non-Hodgkin lymphoma]]
* Aggressive extranodal [[non-Hodgkin lymphoma]]
| style="background: #F5F5F5; padding: 5px;" |
* The most common in men older than 50 years old
* The most common in men older than 50 years old
| style="background: #F5F5F5; padding: 5px;" |Common [[metastasis]] to :
| style="background: #F5F5F5; padding: 5px;" |Common [[metastasis]] to :
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* Unilateral
* Unilateral
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Juvenile type in [[children]] less than 2 years old ( the most common [[infancy]] [[tumor]])
* Adult type with [[average]] [[age]] of 44 years old ( [[rare]])
Juvenile type associated with:
Juvenile type associated with:
* [[Sex chromosome]] abnormalities
* [[Sex chromosome]] abnormalities
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* [[Ambiguous genitalia]]
* [[Ambiguous genitalia]]
* [[Cryptorchidism]]  
* [[Cryptorchidism]]  
| style="background: #F5F5F5; padding: 5px;" |
* Juvenile type in [[children]] less than 2 years old ( the most common [[infancy]] [[tumor]])
* Adult type with [[average]] [[age]] of 44 years old ( [[rare]])
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Metastasis]] occur in 10%-20% of cases
* [[Metastasis]] occur in 10%-20% of cases

Revision as of 20:37, 28 January 2019

Testicular cancer Microchapters

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

Overview

Testicular cancer must be differentiated from epididymitis, hematocele, hydrocele, spermatocele, granulomatous orchitis, and varicocele.

Differentiating Testicular cancer from other Diseases

Abbreviations:

AFP: Alpha-fetoprotein, B-hCG: Beta-Human chorionic gonadotropin, P-ALP: Placental- Alkalin phosphatase,

Diseases Benign/ Malignant Unilateral/Bilateral History/demography Metastasis Genetics Clinical manifestations Para-clinical findings
Symptoms Physical examination Lab findings Imaging Histopathology
Pain Mass AFP Beta hCG p-ALP
Germ Cell tumors
Seminoma[1][2] Stains positively for: - + N/A N/A ↑ Ultrasound:
Embryonal carcinoma[3] Early metastasis to: Stains positively for:

May stain positively for :

+ ± ↑* ↑ N/A Ultrasound:
Yolk sac tumor[4][5]
  • Unilateral
  • Uncommon
 Stains positively for: + + ↑ N/A N/A Ultrasound:

MRI:

  • Schiller-Duval bodies (perivascular structures)
  • Hyaline-type globules
Teratoma[6][7]
  • Unilateral
  • May present in both prepubertal and adult men
  • Uncommon in benign ones among prepubertal men

Stains positively for:

- + ↑ ↑ N/A Ultrasound:
Choriocarcinoma[8][9] Early metastasis: Stains positively for: + ± N/A ↑ N/A Ultrasound:
Mixed germ cell tumors[10][11]
  • Unilateral
  • May stain positive based on underlying components
 ± + ↑ ↑ N/A
  • Imaging findings based on underlying components
Carcinoma in situ (intratubular germ cell neoplasia )[12][13][14]
  • Unilateral
  • Bilateral
 Common:

Stain positively for:

- -
  • N/A
 N/A N/A ↑
  • N/A
Diseases Benign/ Malignant Unilateral/Bilateral History/Demography Metastasis Genetics Pain Mass Physical exam AFP Beta hCG p-ALP Imaging Histopathology
|Non-germ cell tumors
Leydig cell tumor[15]
  • Unilateral

Stains positively for:

- + N/A N/A N/A Ultrasound:
Sertoli cell tumor ( Androblastoma)[16][17][18]
  • Unilateral
  • Bilateral
 Stain positively for: - + N/A N/A N/A Ultrasound:
  • Large cell calcifying variant
  • Hypoechoic
Testicular lymphoma[19][20][21]
  • Unilateral
  • Bilateral ( mostly up to 35% of cases)
 Common metastasis to : Stains positively for: - + ↑ or ↓ ↑ or ↓ N/A Ultrasound:
Granulosa cell tumors[22][23]
  • Unilateral

Juvenile type associated with:

Stains positively for: - + N/A N/A N/A Ultrasound:

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.
  5. ↑ Magers MJ, Kao CS, Cole CD, Rice KR, Foster RS, Einhorn LH; et al. (2014). ""Somatic-type" malignancies arising from testicular germ cell tumors: a clinicopathologic study of 124 cases with emphasis on glandular tumors supporting frequent yolk sac tumor origin". Am J Surg Pathol. 38 (10): 1396–409. doi:10.1097/PAS.0000000000000262. PMID 24921638.
  6. ↑ Simmonds PD, Lee AH, Theaker JM, Tung K, Smart CJ, Mead GM (1996). "Primary pure teratoma of the testis". J Urol. 155 (3): 939–42. PMID 8583612.
  7. ↑ Brosman SA (1979). "Testicular tumors in prepubertal children". Urology. 13 (6): 581–8. PMID 377749.
  8. ↑ Puri S, Sood S, Mohindroo S, Kaushal V (2015). "Cytomorphology of lung metastasis of pure choriocarcinoma of testis in a 58-year-old male". J Cancer Res Ther. 11 (4): 1035. doi:10.4103/0973-1482.154010. PMID 26881635.
  9. ↑ Wood HM, Elder JS (2009). "Cryptorchidism and testicular cancer: separating fact from fiction". J Urol. 181 (2): 452–61. doi:10.1016/j.juro.2008.10.074. PMID 19084853.
  10. ↑ Chuang KL, Liaw CC, Ueng SH, Liao SK, Pang ST, Chang YH; et al. (2010). "Mixed germ cell tumor metastatic to the skin: case report and literature review". World J Surg Oncol. 8: 21. doi:10.1186/1477-7819-8-21. PMC 2851696. PMID 20331874.
  11. ↑ Krag Jacobsen G, Barlebo H, Olsen J, Schultz HP, Starklint H, Søgaard H; et al. (1984). "Testicular germ cell tumours in Denmark 1976-1980. Pathology of 1058 consecutive cases". Acta Radiol Oncol. 23 (4): 239–47. PMID 6093440.
  12. ↑ Rajpert-De Meyts E, Skakkebaek NE (1994). "Expression of the c-kit protein product in carcinoma-in-situ and invasive testicular germ cell tumours". Int J Androl. 17 (2): 85–92. PMID 7517917.
  13. ↑ Jacobsen GK, Nørgaard-Pedersen B (1984). "Placental alkaline phosphatase in testicular germ cell tumours and in carcinoma-in-situ of the testis. An immunohistochemical study". Acta Pathol Microbiol Immunol Scand A. 92 (5): 323–9. PMID 6209917.
  14. ↑ Jacobsen GK, Henriksen OB, von der Maase H (1981). "Carcinoma in situ of testicular tissue adjacent to malignant germ-cell tumors: a study of 105 cases". Cancer. 47 (11): 2660–2. PMID 7260858.
  15. ↑ Cheville JC, Sebo TJ, Lager DJ, Bostwick DG, Farrow GM (1998). "Leydig cell tumor of the testis: a clinicopathologic, DNA content, and MIB-1 comparison of nonmetastasizing and metastasizing tumors". Am J Surg Pathol. 22 (11): 1361–7. PMID 9808128.
  16. ↑ Banerji JS, Odem-Davis K, Wolff EM, Nichols CR, Porter CR (2016). "Patterns of Care and Survival Outcomes for Malignant Sex Cord Stromal Testicular Cancer: Results from the National Cancer Data Base". J Urol. 196 (4): 1117–22. doi:10.1016/j.juro.2016.03.143. PMID 27036305.
  17. ↑ Young RH (2005). "Sex cord-stromal tumors of the ovary and testis: their similarities and differences with consideration of selected problems". Mod Pathol. 18 Suppl 2: S81–98. doi:10.1038/modpathol.3800311. PMID 15502809.
  18. ↑ Gabrilove JL, Freiberg EK, Leiter E, Nicolis GL (1980). "Feminizing and non-feminizing Sertoli cell tumors". J Urol. 124 (6): 757–67. PMID 7003168.
  19. ↑ Shahab N, Doll DC (1999). "Testicular lymphoma". Semin Oncol. 26 (3): 259–69. PMID 10375083.
  20. ↑ Kim J, Abu-Yousef M (2013). "Testicular lymphoma". Ultrasound Q. 29 (3): 247–8. doi:10.1097/RUQ.0b013e3182a0ac0e. PMID 23945480.
  21. ↑ Vega F, Medeiros LJ, Abruzzo LV (2001). "Primary paratesticular lymphoma: a report of 2 cases and review of literature". Arch Pathol Lab Med. 125 (3): 428–32. doi:10.1043/0003-9985(2001)125<0428:PPL>2.0.CO;2. PMID 11231498.
  22. ↑ Garrett JE, Cartwright PC, Snow BW, Coffin CM (2000). "Cystic testicular lesions in the pediatric population". J Urol. 163 (3): 928–36. PMID 10688023.
  23. ↑ Ditonno P, Lucarelli G, Battaglia M, Mancini V, Palazzo S, Trabucco S; et al. (2007). "Testicular granulosa cell tumor of adult type: a new case and a review of the literature". Urol Oncol. 25 (4): 322–5. doi:10.1016/j.urolonc.2006.08.019. PMID 17628299.


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