Pediatric Seminoma Clinical Presentation

Updated: Apr 18, 2017
  • Author: Arnold C Paulino, MD; Chief Editor: Cameron K Tebbi, MD  more...
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Presentation

History

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  • The most common presenting symptom in a patient with seminoma is a painless testicular mass. Other symptoms can include testicular pain (45%) or heaviness. [6]

  • A history of previous testicular trauma is common, although usually coincidental. The trauma typically draws the patient's attention to the mass. [7]

  • Seminoma that has spread to retroperitoneal lymph nodes can cause back pain or abdominal discomfort.

  • Widely disseminated metastatic disease to lungs, liver, bone, or brain is rare but may produce systemic symptoms.

  • A history of cryptorchidism or other genitourinary anomalies can be elicited in some patients (see Causes).

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Physical

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  • When a testicular mass is suspected, the physical examination should include transillumination of the scrotum, which can differentiate a solid mass from a fluid-filled hydrocele or varicocele.

  • The contralateral testis should be carefully examined because patients with seminoma have a higher risk of contralateral testis cancer than the general population of healthy males.

  • Pay careful attention to possible sites of lymph node metastases. Specifically, the abdomen should be examined to rule out the presence of large abdominal masses (suggesting bulky paraaortic/retroperitoneal lymphadenopathy), and both supraclavicular fossae should be palpated to rule out metastatic lymphadenopathy in those locations.

  • A general physical examination that includes lungs, liver, nervous system, and musculoskeletal structures can aid in ruling out widespread metastatic disease.

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Causes

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  • The cause of germ cell tumors is unknown. Familial clustering has been observed.

  • Prior testicular cancer is a major risk factor for a contralateral malignancy. The cumulative risk 25 years after original diagnosis is 3.6% for patients with seminoma.

  • Cryptorchidism especially when bilateral, is a predisposing factor in the development of germ cell tumors arising from the testis. In fact, 7-10% of testis tumors occur in association with cryptorchidism. [4] Orchiopexy performed before puberty reduces the risk of germ cell tumors and improves the ability to observe the testis. [6] However, 25% of the cancers found in association with cryptorchidism occur in the contralateral, normally descended testis, which suggests that a developmental defect is responsible for both the maldescent and the tumor. The risk of an individual with cryptorchidism developing testicular cancer is directly related to the degree of maldescent. The risk is 1 in 20 if the testis is intra-abdominal and is 1 in 80 if it is within the inguinal canal. Hypospadias and hydrocele are other genitourinary anomalies that have been associated with testicular cancers.

  • Presence of chromosomal abnormalities including del(1p36), i(12p), loss of chromosomes 11,13 and 18; gain in chromosomes 7, 8 or X.  In germ cell tumors, deletions of chromosomes 1p, 4q, and 6q and gains of chromosomes 1q, 3, and 20q have been reported.

  • Klinefelter syndrome is associated with the development of mediastinal germ cell tumors. [7]

  • Human immunodeficiency virus (HIV) infection may be associated with an increased risk of germ cell tumors. Other possible associations include mumps, orchitis, history of testicular trauma, immunosuppression after organ transplant, and prior vasectomy. [6]

  • A Children's Oncology Group study suggests that maternal vitamin supplementation may reduce the risk of pediatric germ cell tumors in their offspring. [8]

  • No clear association between seminoma or other testicular germ cell tumors and previous exposure to diethylstilbestrol has been identified.

  • Testicular teratomas and malignant testicular germ cell tumors (GCTs) are seen in early childhood. These are often composed of pure yolk sac tumor which are also called endodermal sinus.
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