Testicular tumours
Key points
1 in 50,000
Bimodal - <3 y, adolescence
Yolk sac tumour most common in infants <2 years
Pre-pubertal - mostly benign - teratoma, epidermoid cyst, and stromal tumors
Post pubertal - mostly malignant - mixed germ-cell tumours (embryonal carcinoma, yolk sac tumour, choriocarcinoma, teratoma) or non-seminomatous germ-cell tumours
Pure seminoma is quite rare
Testicular microlithiasis is not associated with increased risk of testicular cancer during childhood, but if there are other risk factors such as undescended testis and microlithiasis persists into adulthood, they should be followed up and advised regular self examination - JPU 2021 Systematic review
Splenogonadal fusion - can be testicular mass
Associations
Undescended testis
Trisomy 21
Testicular dysgenesis syndrome (TDS): cryptorchidism, hypospadias, impaired spermatogenesis and testicular germ cell cancer - gonadoblastoma
CCLG staging of testicular GCT
1 - Complete removal, no capsule rupture, R0
2 - Capsule rupture, R1 in scrotum or spermatic cord, LN negative
3 - Retroperitoneal node involvement
4 - Metastases
If stage 1 - surveillance only
Stages 2-4 - Adjuvant chemotherapy is carboplatin/cisplatin + etoposide + bleomycin
Outcome
100% survival
90% if mets
Standard scenario
Testicular mass
Concerns:
1. Malignancy
2. Hormone secretion
3. Confusion with torsion
History
Mass, pain
Virilisation, precocious puberty
Family history of tumour syndromes
Examination
Mass
Secondary sexual characteristics
Investigations
aFP - for Yolk sac + mixed + Sertoli-Leydig
BHCG - for dysgerminoma, yolk sac, choriocarcinoma
LDH - for dysgerminoma
Inhibin A + B - for granulosa cell tumours only
USS
Looking for cystic, solid features
MDT
Staging CT chest abdo pelvis
Management
CCLG guidelines for extracranial GCT
European Association of Urology guidelines
Testis sparing surgery if:
• Pre-pubertal
• USS shows well circumscribed, resectable mass
• Tumour markers normal
Do inguinal approach - frozen section
No evidence that clamping vessels prevents tumour spread
If R0 resection or non-malignant - place back in tunica vaginalis and put into scrotum
Follow up with USS every 3 months for 1 year
If probably malignant or confirmed malignant on frozen section - Radical orchidectomy + high ligation of cord via inguinal approach
Platinum based chemotherapy
Retroperitoneal LN dissection if residual mass after chemo
If incidental tumour found at scrotal exploration:
J Urol 1995 meta analysis - higher local recurrence but no increased distant recurrence or survival impact for scrotal approach
Special Scenario - Cystic dysplastic testes
Congenital, benign
Origin: Rete/mediastinal testis
Mean age at diagnosis at ~5–6 years
Association: ipsilateral renal agenesis, MCDK (≈55%)
Likely a mesonephric duct abnormality
Markers: Normal AFP, β‑hCG, LDH
Key Imaging: US: anechoic cysts, no solid component, no vascularity; MRI confirmatory
Management
Wait and watch, monitoring, 44% regress with time
Biopsy if uncertain, grows, or compressive testicular parenchyma
Orchiectomy when malignancy cannot be excluded
Follow-up
US 6 monthly then annually
Differential Diagnosis:
o Testicular Teratoma: Solid and cystic
o Testicular lymphangioma: often inguinoscrotal
o Intratesticular Simple Cyst: Solitary, well-circumscribed anechoic lesion.
o Epididymal Cyst/Spermatocele: mobile and non-tender.
o Multicystic Dysplastic Testis: Extremely rare; cluster of cysts without normal parenchyma.
o Testicular Abscess: Complex cystic, internal echoes, painful.
Page edited by Mr Mahmoud Abdelbary MSc, MRCS August 2025
Page edited by Mrs Charnjit Seehra BSc August 2025
References
CCLG Interim Guidelines for the Treatment of Extracranial Germ Cell Tumours in Children and Adolescents
June 2018
't Hoen LA, Bhatt NR, Radmayr C, Dogan HS, Nijman RJM, Quaedackers J, Rawashdeh YF, Silay MS, Tekgul S, Stein R, Bogaert G. The prognostic value of testicular microlithiasis as an incidental finding for the risk of testicular malignancy in children and the adult population: A systematic review. On behalf of the EAU pediatric urology guidelines panel. J Pediatr Urol. 2021 Dec;17(6):815-831. doi: 10.1016/j.jpurol.2021.06.013. Epub 2021 Jun 13. PMID: 34217588.
Capelouto CC, Clark PE, Ransil BJ, Loughlin KR. A review of scrotal violation in testicular cancer: is adjuvant local therapy necessary? J Urol. 1995 Mar;153(3 Pt 2):981-5. PMID: 7853587.
Manning MA, Woodward PJ. Testicular epidermoid cysts: sonographic features with clinicopathologic correlation. Journal of Ultrasound in Medicine. 2010 May;29(5):831-7.
Camassei FD, Francalanci P, Ferro F, Capozza N, Boldrini R. Cystic dysplasia of the rete testis: report of two cases and review of the literature. Pediatric and Developmental Pathology. 2002 Mar;5(2):206-10.
Contini G, Frediani S, Pardi V, Diomedi-Camassei F, Inserra A. Cystic dysplasia of the rete testis: case report and systematic review of the literature. Frontiers in Pediatrics. 2022 May 18;10:898038.
Liniger B, Fleischmann A, Zachariou Z. Benign cystic lesions in the testis of children. Journal of pediatric urology. 2012 Jun 1;8(3):226-33.
Boutaleb J, Lina B, Hafsa R, Sarah L, Chaimae B, Lamiae R, Nazik A, Latifa C, Siham EH. Cystic dysplasia of the rete testis: A rare mimicker of malignancy in pediatric patients. Urology Case Reports. 2025 Mar 1;59:102974.
Franin I, Grubišić I, Postružin Gršić L, Stephany Kirigin M, Vodopić T, Krušlin B. Cystic dysplasia of the rete testis accompanying ipsilateral renal agenesis in a young adult: a case report. Croatian medical journal. 2023 Jun 30;64(3):198-200.