Pediatric Seminoma Clinical Presentation

Updated: Sep 16, 2022
  • Author: Arnold C Paulino, MD; Chief Editor: Cameron K Tebbi, MD  more...
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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. [5]

A history of previous testicular trauma is common, although usually coincidental. The trauma typically draws the patient's attention to the mass. [6]

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.


Physical Examination

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.