Presentation of Germ Cell Tumors

TIMOTHY J. CHRISTMAS, MD, FRCS ALAN HORWICH, PhD, FRCR, FRCP

In the male, the classic presenting symptom of a germ cell tumor (GCT) is a painless hard swelling within the body of the testis in a young man. In the United States, the lifetime risk for developing a testicular tumor is about 1 in 300, and the incidence has been increasing.1

The swelling within the testis may be noticed by the patient or his sexual partner. The presence of tes-ticular atrophy, which is a predisposing factor for GCT, may make the swelling more readily apparent. Atrophy of the testis can occur as a result of cryp-torchidism (especially when it has not been corrected until late childhood), infection (particularly mumps orchitis), or torsion or local trauma. Some men with testicular tumors and atrophic testes may present to an infertility clinic and be diagnosed on examination in that setting.2

The age pattern of testicular cancer is unusual. The incidence of germ cell tumors rises sharply from late teens to a peak just under 30 years of age for nonseminoma and between 30 and 35 years of age for seminoma. There is a fall in the incidence of germ cell tumors at older ages, and they are distinctly uncommon in those aged over 65 years. Sper-matocytic seminoma occurs typically in older men, but the most common testicular tumor in the older age group is lymphoma.

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