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Testicular Tumors
Hank Baskin, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Synonyms

            • Yolk sac tumor (YST): Endodermal sinus tumor, orchioblastoma
            • Teratoma: Differentiated or mature teratoma, undifferentiated or immature teratoma
            • Mixed germ cell tumor (MGCT): Polyembryoma
            • Leydig cell tumor: Interstitial cell tumor
            • Sertoli cell tumor: Androblastoma
          • Definitions

            • Primary testicular tumors: Germ cell tumors (GCTs) vs. non-GCTs
            • GCTs: ~ 2/3 of pediatric testicular tumors
              • YST: Histologically recapitulates yolk sac, allantois, & extraembryonic mesenchyme
              • Teratoma: Contains elements of all 3 germinal layers (endoderm, mesoderm, & ectoderm)
                • Mature contains only well-differentiated tissues; immature adds fetal elements
                • Epidermoids: Monodermal cysts (not neoplasms) filled with keratinizing stratified squamous epithelium
              • Embryonal carcinoma: Malignant tumor of anaplastic undifferentiated cells similar to those seen in very early embryo
              • Choriocarcinoma: Rare, highly malignant tumor composed of placenta-like tissues
              • Mixed GCTs: Malignant tumor of 2 or more germ cell types
              • Seminoma: Malignant tumor of germ cell origin lacking any embryonic elements
            • Non-GCTs: ~ 1/3 of pediatric testicular tumors
              • Leydig cell tumors: Recapitulate normal development of Leydig cells (stromal cells that produce androgens)
              • Sertoli cell tumors: Recapitulate normal development of Sertoli cells (sex cord cells that support spermatogonial stem cells)
              • Juvenile granulosa cell tumors: Extremely rare stromal tumor that resembles ovarian graafian follicles
            • Lymphoma & leukemia can also involve testes

          IMAGING

          • General Features

            • Ultrasonographic Findings

              • MR Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • Staging, Grading, & Classification

                      CLINICAL ISSUES

                      • Presentation

                        • Demographics

                          • Natural History & Prognosis

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Image Interpretation Pearls

                                Selected References

                                1. Davis JT et al: Imaging of childhood urologic cancers: current approaches and new advances. Transl Androl Urol. 9(5):2348-57, 2020
                                2. Yu CJ et al: Incidence characteristics of testicular microlithiasis and its association with risk of primary testicular tumors in children: a systematic review and meta-analysis. World J Pediatr. 16(6):585-97, 2020
                                3. Wu D et al: Prepubertal testicular tumors in China: a 10-year experience with 67 cases. Pediatr Surg Int. 34(12):1339-43, 2018
                                4. Alkhori NA et al: Pediatric scrotal ultrasound: review and update. Pediatr Radiol. 47(9):1125-33, 2017
                                5. Marte A et al: Long-term follow-up of testicular microlithiasis in children and adolescents: multicenter prospective cohort study of the Italian Society of Pediatric Urology. Eur J Pediatr Surg. 27(2):155-60, 2017
                                6. Trout AT et al: Association between testicular microlithiasis and testicular neoplasia: large multicenter study in a pediatric population. Radiology. 285(2):576-83, 2017
                                7. Yılmaz R et al: Sonography and magnetic resonance imaging characteristics of testicular adrenal rest tumors. Pol J Radiol. 82:583-8, 2017
                                8. Murcia-Pascual FJ et al: Testicular and paratesticular tumors in children. Arch Esp Urol. 69(10):691-7, 2016
                                9. Woo LL et al: The role of testis-sparing surgery in children and adolescents with testicular tumors. Urol Oncol. 34(2):76-83, 2016
                                10. Cornejo KM et al: Yolk sac tumor of the testis in infants and children: a clinicopathologic analysis of 33 cases. Am J Surg Pathol. 39(8):1121-31, 2015
                                11. Kao CS et al: Juvenile granulosa cell tumors of the testis: a clinicopathologic study of 70 cases with emphasis on its wide morphologic spectrum. Am J Surg Pathol. 39(9):1159-69, 2015
                                12. Chung JM et al: Overview of pediatric testicular tumors in Korea. Korean J Urol. 55(12):789-96, 2014
                                13. Leonhartsberger N et al: Organ-sparing surgery is the treatment of choice in benign testicular tumors. World J Urol. 32(4):1087-91, 2014
                                14. Lock G et al: Contrast-enhanced ultrasound and real-time elastography for the diagnosis of benign Leydig cell tumors of the testis - a single center report on 13 cases. Ultraschall Med. 35(6):534-9, 2014
                                15. Wang X et al: Prepubertal testicular and paratesticular tumors in China: a single-center experience over a 10-year period. J Pediatr Surg. 47(8):1576-80, 2012
                                16. Hisamatsu E et al: Prepubertal testicular tumors: a 20-year experience with 40 cases. Int J Urol. 17(11):956-9, 2010
                                17. Nerli RB et al: Prepubertal testicular tumors: our 10 years experience. Indian J Cancer. 47(3):292-5, 2010
                                18. Parenti GC et al: Imaging of the scrotum: role of MRI. Radiol Med. 114(3):414-24, 2009
                                19. Chen YS et al: Prepubertal testicular germ cell tumors: 25-year experience in Taipei Veterans General Hospital. J Chin Med Assoc. 71(7):357-61, 2008
                                20. Taskinen S et al: Testicular tumors in children and adolescents. J Pediatr Urol. 4(2):134-7, 2008
                                21. Kim W et al: US MR imaging correlation in pathologic conditions of the scrotum. Radiographics. 27(5):1239-53, 2007
                                22. Ebele JN et al: World Health Organization Classification of Tumours. Pathology & Genetics of Tumours of the Urinary System & Male Genital Organs. Lyon: IARC Press, 2004
                                23. Woodward PJ et al: From the archives of the AFIP: tumors and tumorlike lesions of the testis: radiologic-pathologic correlation. Radiographics. 22(1):189-216, 2002
                                Related Anatomy
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                                Related Differential Diagnoses
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                                References
                                Tables

                                Tables

                                KEY FACTS

                                • Terminology

                                  • Imaging

                                    • Clinical Issues

                                      • Diagnostic Checklist

                                        TERMINOLOGY

                                        • Synonyms

                                          • Yolk sac tumor (YST): Endodermal sinus tumor, orchioblastoma
                                          • Teratoma: Differentiated or mature teratoma, undifferentiated or immature teratoma
                                          • Mixed germ cell tumor (MGCT): Polyembryoma
                                          • Leydig cell tumor: Interstitial cell tumor
                                          • Sertoli cell tumor: Androblastoma
                                        • Definitions

                                          • Primary testicular tumors: Germ cell tumors (GCTs) vs. non-GCTs
                                          • GCTs: ~ 2/3 of pediatric testicular tumors
                                            • YST: Histologically recapitulates yolk sac, allantois, & extraembryonic mesenchyme
                                            • Teratoma: Contains elements of all 3 germinal layers (endoderm, mesoderm, & ectoderm)
                                              • Mature contains only well-differentiated tissues; immature adds fetal elements
                                              • Epidermoids: Monodermal cysts (not neoplasms) filled with keratinizing stratified squamous epithelium
                                            • Embryonal carcinoma: Malignant tumor of anaplastic undifferentiated cells similar to those seen in very early embryo
                                            • Choriocarcinoma: Rare, highly malignant tumor composed of placenta-like tissues
                                            • Mixed GCTs: Malignant tumor of 2 or more germ cell types
                                            • Seminoma: Malignant tumor of germ cell origin lacking any embryonic elements
                                          • Non-GCTs: ~ 1/3 of pediatric testicular tumors
                                            • Leydig cell tumors: Recapitulate normal development of Leydig cells (stromal cells that produce androgens)
                                            • Sertoli cell tumors: Recapitulate normal development of Sertoli cells (sex cord cells that support spermatogonial stem cells)
                                            • Juvenile granulosa cell tumors: Extremely rare stromal tumor that resembles ovarian graafian follicles
                                          • Lymphoma & leukemia can also involve testes

                                        IMAGING

                                        • General Features

                                          • Ultrasonographic Findings

                                            • MR Findings

                                              • Imaging Recommendations

                                                DIFFERENTIAL DIAGNOSIS

                                                  PATHOLOGY

                                                  • Staging, Grading, & Classification

                                                    CLINICAL ISSUES

                                                    • Presentation

                                                      • Demographics

                                                        • Natural History & Prognosis

                                                          • Treatment

                                                            DIAGNOSTIC CHECKLIST

                                                            • Image Interpretation Pearls

                                                              Selected References

                                                              1. Davis JT et al: Imaging of childhood urologic cancers: current approaches and new advances. Transl Androl Urol. 9(5):2348-57, 2020
                                                              2. Yu CJ et al: Incidence characteristics of testicular microlithiasis and its association with risk of primary testicular tumors in children: a systematic review and meta-analysis. World J Pediatr. 16(6):585-97, 2020
                                                              3. Wu D et al: Prepubertal testicular tumors in China: a 10-year experience with 67 cases. Pediatr Surg Int. 34(12):1339-43, 2018
                                                              4. Alkhori NA et al: Pediatric scrotal ultrasound: review and update. Pediatr Radiol. 47(9):1125-33, 2017
                                                              5. Marte A et al: Long-term follow-up of testicular microlithiasis in children and adolescents: multicenter prospective cohort study of the Italian Society of Pediatric Urology. Eur J Pediatr Surg. 27(2):155-60, 2017
                                                              6. Trout AT et al: Association between testicular microlithiasis and testicular neoplasia: large multicenter study in a pediatric population. Radiology. 285(2):576-83, 2017
                                                              7. Yılmaz R et al: Sonography and magnetic resonance imaging characteristics of testicular adrenal rest tumors. Pol J Radiol. 82:583-8, 2017
                                                              8. Murcia-Pascual FJ et al: Testicular and paratesticular tumors in children. Arch Esp Urol. 69(10):691-7, 2016
                                                              9. Woo LL et al: The role of testis-sparing surgery in children and adolescents with testicular tumors. Urol Oncol. 34(2):76-83, 2016
                                                              10. Cornejo KM et al: Yolk sac tumor of the testis in infants and children: a clinicopathologic analysis of 33 cases. Am J Surg Pathol. 39(8):1121-31, 2015
                                                              11. Kao CS et al: Juvenile granulosa cell tumors of the testis: a clinicopathologic study of 70 cases with emphasis on its wide morphologic spectrum. Am J Surg Pathol. 39(9):1159-69, 2015
                                                              12. Chung JM et al: Overview of pediatric testicular tumors in Korea. Korean J Urol. 55(12):789-96, 2014
                                                              13. Leonhartsberger N et al: Organ-sparing surgery is the treatment of choice in benign testicular tumors. World J Urol. 32(4):1087-91, 2014
                                                              14. Lock G et al: Contrast-enhanced ultrasound and real-time elastography for the diagnosis of benign Leydig cell tumors of the testis - a single center report on 13 cases. Ultraschall Med. 35(6):534-9, 2014
                                                              15. Wang X et al: Prepubertal testicular and paratesticular tumors in China: a single-center experience over a 10-year period. J Pediatr Surg. 47(8):1576-80, 2012
                                                              16. Hisamatsu E et al: Prepubertal testicular tumors: a 20-year experience with 40 cases. Int J Urol. 17(11):956-9, 2010
                                                              17. Nerli RB et al: Prepubertal testicular tumors: our 10 years experience. Indian J Cancer. 47(3):292-5, 2010
                                                              18. Parenti GC et al: Imaging of the scrotum: role of MRI. Radiol Med. 114(3):414-24, 2009
                                                              19. Chen YS et al: Prepubertal testicular germ cell tumors: 25-year experience in Taipei Veterans General Hospital. J Chin Med Assoc. 71(7):357-61, 2008
                                                              20. Taskinen S et al: Testicular tumors in children and adolescents. J Pediatr Urol. 4(2):134-7, 2008
                                                              21. Kim W et al: US MR imaging correlation in pathologic conditions of the scrotum. Radiographics. 27(5):1239-53, 2007
                                                              22. Ebele JN et al: World Health Organization Classification of Tumours. Pathology & Genetics of Tumours of the Urinary System & Male Genital Organs. Lyon: IARC Press, 2004
                                                              23. Woodward PJ et al: From the archives of the AFIP: tumors and tumorlike lesions of the testis: radiologic-pathologic correlation. Radiographics. 22(1):189-216, 2002