Despite the fact that testicular tumors comprise about 1% of all malignancies seen in males, it is the most common solid tumor encountered in males between 15-35 years of age [1]. Cryptorchidism is the most important risk factor for the development of testicular cancers [2], whereas genetic factors, a positive family history, and unexplained infertility have been associated with an increased incidence of this tumor [2] [3]. The clinical presentation in virtually all patients starts with the appearance of a painless lump or swelling within the testes that is incidentally discovered by the patient himself [1] [4]. Swelling is usually unilateral, and only a small number of males report bilateral symptoms [1]. The presence of pain is noted in approximately a third of patients, most commonly in the form of a dull ache, whereas acute pain is seen in only 10% of cases [1]. Fortunately, the majority of individuals are diagnosed in early stages of the disease, but abdominal or back pain, headaches, hemoptysis and other signs of distant tumor spread are seen in 25-35% of cases [4].

• Back Pain

  Fortunately, the majority of individuals are diagnosed in early stages of the disease, but abdominal or back pain, headaches, hemoptysis and other signs of distant tumor spread are seen in 25-35% of cases. [symptoma.com]

  Patients with retroperitoneal adenopathy may present with abdominal or back pain or systemic symptoms ( Fig 6 ) ( 11 ). CT may be the first imaging modality in the case of these nonspecific symptoms. [pubs.rsna.org]

  Back pain, abdominal discomfort or abdominal mass may be a presenting feature in the 25% of patients who have retroperitoneal nodal metastases 3. Presentation with distant or extranodal metastases is rare (~5%). [radiopaedia.org]

  Low back pain may occur after metastasis to the retroperitoneum. [4] Some cases of seminoma can present as a primary tumour outside the testis, most commonly in the mediastinum. [4] In the ovary, the tumor is called a dysgerminoma, and in non- gonadal [en.wikipedia.org]

• Confusion

  However, without a medical background or experience reading scientific papers this can lead to conflicting information and websites / literature that cause more confusion. [starthrowers.org.uk]

• Testicular Mass

  Computed tomography in the emergency department showed haemoperitoneum and a torted large left testicular mass, likely malignant. The patient underwent laparotomy and excision of the mass. [ncbi.nlm.nih.gov]

  […] with a hypoechoic testicular mass Germ cell tumors: Seminomas: Large vascularized intratesticular mass that proved to be a pure seminoma Germ cell tumors: Seminomas: Multifocal seminoma testis Germ cell tumors: Seminomas: Testis tumor that proved to [ultrasoundcases.info]

• Testicular Pain

  In summary, in patients presenting with manifestations of extragonadal germ cell tumor or lymphoma, it is important to rule out a primary tumor in the testes, even when they do not present with symptoms such as testicular pain or mass. [ispub.com]

  Testicular pain is reported in up to one fifth of cases. [en.wikipedia.org]

  History and Physical Patients usually present with an asymptomatic testicular mass which may be associated with infertility. Testicular pain from malignancy is relatively rare but still should be included in the differential diagnosis. [ncbi.nlm.nih.gov]

  Testicular pain and/or abdominal pain. Dragging sensation. Recent history of trauma; it is probably the trauma that leads the man to examine himself and find the tumour rather than being the cause of malignant change. Hydrocele. [patient.info]

• Scrotal Mass

  Genitourinary Radiology > Male Pelvis > Testis > Seminoma Seminoma Seminomas are the most common malignancy of males age 15-30, usually presenting as a painless scrotal mass. [med-ed.virginia.edu]

  Leydig cell neoplasm in a 24-year-old man with a palpable right scrotal mass and new-onset gynecomastia. [pubs.rsna.org]

  Testicular tumors often clinically appear with a painless scrotal mass. At the time of diagnosis retroperitoneal metastases can be detected in some patients. Abdominal, flank and back pain depending on retroperitoneal metastases can be seen. [turkiyeklinikleri.com]

  A painless testicular mass is the classic presentation for testicular cancer, although a number of patients present with diffuse pain or swelling. Ultrasonography may be helpful in confirming the presence of a scrotal mass within the testicle. [aafp.org]

• Scrotal Pain

  Testicular hematoma in a 29-year-old man with scrotal pain after trauma. [pubs.rsna.org]

  […] ultrasonography Consider this study in any male with a palpable testicular mass that is suspicious or questionable Other indications may include acute scrotal pain (especially when associated with a hydrocele), nonspecific scrotal pain, or swelling If [emedicine.medscape.com]

  A painless testicular mass is the classic presentation for testicular cancer, although a number of patients present with diffuse pain or swelling. Ultrasonography may be helpful in confirming the presence of a scrotal mass within the testicle. [aafp.org]

• Painless Testicular Mass

  The most common presentation is with a painless testicular mass although some 45% will report a degree of testicular discomfort. Bilateral tumors are rare (~2%) and are almost always asynchronous 1. [radiopaedia.org]

  A painless testicular mass is the classic presentation for testicular cancer, although a number of patients present with diffuse pain or swelling. Ultrasonography may be helpful in confirming the presence of a scrotal mass within the testicle. [aafp.org]

An extensive diagnostic workup is necessary if signs and symptoms are suggestive of a testicular tumor. A thorough patient history that will confirm the onset of swelling and accompanying symptoms (if present) should be performed, followed by a detailed physical examination of the scrotum. Testicular ultrasonography must be conducted immediately if swelling or a lump is observed, which may be sufficient to make an initial diagnosis [1]. In order to classify the tumor into its appropriate stage, the following criteria should be used [1] [3] [4] [5]:

• Invasiveness of the tumor (T) - Seminomas can be limited to the testis and/or epididymis with or without infiltration of the tunica albuginea and vaginalis (T1 and T2, respectively), they can invade the spermatic cord (T3) or the scrotal wall (T4).
• Nodal spread (N) - In early stages of the disease (stage I), tumor spread to the lymph nodes does not occur (N0), but stages II and III are distinguished by a varying degree of lymph node enlargement (≤ 2 cm, between 2-5 cm, and > 5 cm).
• Metastatic spread (M) - Dissemination of the tumor into the non-regional lymph nodes and the lungs (M1a) or distant spread (M1b) may occur in later stages of the disease (III).
• Laboratory values (S) - Lactate dehydrogenase (LDH), beta human chorionic gonadotropin (βhCG) and alpha-fetoprotein (AFP) are well-established tumor markers of testicular cancer, and their values should be obtained in a prompt fashion, as they are vital constituents of seminoma staging.

Such criteria can only be obtained after a detailed imaging and histopathological workup, indicating that computed tomography (CT) and magnetic resonance imaging (MRI) of the pelvis, abdomen, and thorax, as well as microscopic examination of the tumor (most frequently performed after a sample is obtained during radical orchiectomy), are essential in order to make a definite diagnosis [5]. For patients in whom metastatic spread is suspected, positron emission tomography (PET) scanning can be useful as well [5].

More reliable predictive factors are needed to make treatment decisions. [ncbi.nlm.nih.gov]

Men's outlook is defined as having good prognosis, intermediate prognosis or poor prognosis. [cancerresearchuk.org]

AFP < 1000 ng/mL hCG < 5000 IU/L (1000 ng/mL) LDH < 1.5x ULN Seminoma (90% of cases) All of the following criteria: 5-year PFS 82% 5-year survival 86% Any primary site No non-pulmonary visceral metastases Normal AFP Any hCG Any LDH Intermediate prognosis [esmo.org]

Accurate staging is crucial in planning the treatment and follow up of seminoma and determines the prognosis. [ncbi.nlm.nih.gov]

[…] group Good prognosis 34 17.7 39 36.4 Stage II 25 73.5 † 29 74.4 † Stage III 9 26.5 † 10 25.6 † Intermediate prognosis 4 2.1 6 5.6 Stage II 1 25 † Stage III 3 75 † 6 100 † Poor prognosis – – 5 4.7 Stage II – – Stage III – – 5 100 † Elevated preoperative [smw.ch]

Tumor induction by therapeutic irradiation remains the most likely etiology. Other possibilities include a natural association between seminoma and angiosarcoma, and perhaps the use of chemotherapy. [ncbi.nlm.nih.gov]

Etiology Etiology is unknown but tumors are thought to arise from an embryonic germ cell leading to testicular intraepithelial neoplasia (the precursor to classical seminoma). [orpha.net]

Etiology Based on the presumed origin of spermatocytic seminoma from mature (postpubertal) germ cells, it has been hypothesised that the increased proliferation of these cells causes the growth of the tumours, but the etiology has long been unknown. [atlasgeneticsoncology.org]

MATERIALS AND METHODS: Two hundred and forty-one patients with stage IIA and IIB testicular seminoma were identified between 1988 and 2003 using the Surveillance, Epidemiology, and End Results (SEER) database. RESULTS: Median follow-up was 10 years. [ncbi.nlm.nih.gov]

Pathophysiology Testicular seminoma originates in the germinal epithelium of the seminiferous tubules. The disease is thought to result from the proliferation of immature spermatogonia. [ncbi.nlm.nih.gov]

Pathophysiology Testicular seminoma is a pathologic diagnosis in which only seminomatous elements are observed upon histopathologic review after a radical orchiectomy and in which serum alpha-fetoprotein (AFP) is within the reference range. [emedicine.medscape.com]

Prevention Preventing most cases testicular cancer is not possible, as the causes are largely unknown. Many men who develop testicular cancer do not have any known risk factors. [medicalnewstoday.com]

Thus, precautions for preventing further complications could be initiated. [ncbi.nlm.nih.gov]

Sometimes, seminomas may require radiotherapy after surgery to help prevent the cancer returning. [nhs.uk]

Side effects not only cause patients discomfort, but also may prevent the optimal delivery of therapy at its planned dose and schedule. [texasoncology.com]

1. Boujelbene N, Cosinschi A, Boujelbene N, et al. Pure seminoma: A review and update. Radiat Oncol. 2011;6:90.
2. Ferguson L, Agoulnik AI. Testicular Cancer and Cryptorchidism. Front Endocrinol (Lausanne). 2013;4:32.
3. Coursey Moreno C, Small WC, Camacho JC, et al. Testicular tumors: what radiologists need to know--differential diagnosis, staging, and management. Radiographics. 2015;35(2):400-415.
4. Hayes-Lattin B, Nichols CR. Testicular Cancer: A Prototypic Tumor of Young Adults. Semin Oncol. 2009;36(5):432-438.
5. Schmoll HJ, Jordan K, Huddart R, et al. Testicular seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21(5):v140-146.