Testicular Seminoma Clinical Presentation

Updated: Sep 05, 2019
  • Author: Michael B Williams, MD, MS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Presentation

History

Testicular seminoma is most often diagnosed when a male aged 15-35 years presents with a painless testicular lump that has been noticeable for several days to months. Delay in diagnosis is common because of patients' failure to perform self-examinations or to seek medical attention after noticing a testicular mass, or a physician's delay while treating the patient for presumed epididymo-orchitis or testicular trauma.

Patients commonly have abnormal findings on semen analysis at presentation, and they may be subfertile. [3]

Overall, in approximately 75% of patients, the seminomas are localized (stage I) at diagnosis. However, 15% have metastatic disease to the regional lymph nodes, and 5-10% have involvement of juxtaregional nodes or visceral metastases.

Uncommon presentations include the following:

  • Testicular pain, possibly with an acute onset, especially when an associated hydrocele prevents adequate physical examination.

  • A testis tumor may become metastatic and may manifest as large retroperitoneal and/or chest lesions, while the primary tumor is nonpalpable. Scrotal ultrasonography may locate the primary tumor. Histopathology of the primary testis often shows a focus of tumor surrounded by fibrous scar, termed burned-out testis cancer.

  • In 1996, Miller and associates reported on a series of patients with previously nonpalpable testes that were explored and incorrectly diagnosed as vanished testes. A subsequent seminoma was diagnosed intra-abdominally. [2]