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Anatomy and pathology of testicular tumors

Michelle S Hirsch, MD, PhD
Section Editor
Philip W Kantoff, MD
Deputy Editor
Michael E Ross, MD


Testicular neoplasms comprise the most common solid malignancy affecting males between the ages of 15 and 35, although they represent only approximately 1 percent of all solid tumors in men [1]. The two main categories of testicular tumors are germ cell tumors (GCTs), which account for 95 percent of cases, and sex cord-stromal tumors.

Testicular pathology is a nosologically complex subject because of the spectrum of histologic subtypes and variable clinical behavior, particularly among GCTs. Prediction of biologic behavior depends upon the type(s) of tumors present, as well as clinical features, including the age of the patient and primary site (ie, testicular versus retroperitoneal), since histologically identical tumors can behave differently depending upon these clinical parameters. Accurate histologic evaluation and staging will help determine if a patient should be treated surgically (orchiectomy, retroperitoneal lymph node dissection) and whether chemotherapy is indicated.

A second source of confusion is the nonuniform and often complex classification schemes for testicular tumors. Separation of a few of the major subtypes can be somewhat subjective (eg, there can be morphologic overlap between various subtypes of GCTs) [2,3]; however, in many cases these distinctions may not be pivotal in the choice of therapy and management. The classification scheme used herein is relatively simple, practical, widely accepted, and of proven clinical utility (table 1).

Pathologic evaluation is generally performed on the entire testis rather than on a biopsy sample. Examination of the entire testis allows identification of the histopathologic tumor type, as well as an assessment of the stage and extent of the disease, both of which have an important bearing on subsequent management and prognosis (table 2A-B). Histologic features help to determine higher stage include vascular or lymphatic invasion and spread beyond the tunica albuginea or into the spermatic cord [4].

The management of testicular tumors is discussed separately. (See "Overview of the treatment of testicular germ cell tumors".)

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Literature review current through: Nov 2017. | This topic last updated: Sep 27, 2017.
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