Micrograph (high magnification) of a seminoma. H&E stain. The main way<unk>  is diagnosed is via a lump or mass inside a testis. More generally, if a young adult or adolescent has a single enlarged testicle, which may or may not be painful, this should give doctors reason to suspect<unk> . Mixed germ cell tumor containing embryonal carcinoma, seminoma, and yolk sac tumor. The embryonal carcinoma component (upper left, upper right, and lower left) shows pseudoglandular growth with high-grade features of large, epithelioid, anaplastic cells with prominent nucleoli, indistinct cell borders with nuclear overlapping, pleomorphism, and frequent mitoses. The seminoma component (upper center) shows large, round-polyhedral cells with distinct cell membranes, abundant clear/watery cytoplasm, large central nuclei and prominent nucleoli. The yolk sac component (lower right, hugging the embryonal component) exhibits microcystic/reticular growth pattern. Other conditions may also have symptoms similar to<unk> : * Epididymitis or epididymoorchitis * Hematocele * Varicocele * Orchitis * Prostate infections or inflammations (prostatitis), bladder infections or inflammations (cystitis), or kidney (renal) infections (nephritis) or inflammations which have spread to and caused swelling in the vessels of the testicles or scrotum * Testicular torsion or a hernia * Infection, inflammation, retro-peritonitis, or other conditions of the lymph nodes or vessels near the scrotum, testicles, pubis, anorectal area, and groin * Benign tumors or lesions of the testicles * Metastasis to the testicles from another, primary tumor site(s) The nature of any palpated lump in the scrotum is often evaluated by scrotal ultrasound, which can determine exact location, size, and some characteristics of the lump, such as cystic vs solid, uniform vs heterogeneous, sharply circumscribed or poorly defined. The extent of the disease is evaluated by CT scans, which are used to locate metastases. The differential diagnosis of<unk>  requires examining the histology of tissue obtained from an inguinal orchiectomy - that is, surgical excision of the entire testis along with attached structures (epididymis and spermatic cord). A biopsy should not be performed, as it raises the risk of spreading<unk>  cells into the scrotum. Inguinal orchiectomy is the preferred method because it lowers the risk of<unk>  cells escaping. This is because the lymphatic system of the scrotum, through which white blood cells (and, potentially,<unk>  cells) flow in and out, links to the lower extremities, while that of the testicle links to the back of the abdominal cavity (the retroperitoneum). A transscrotal biopsy or orchiectomy will potentially leave<unk>  cells in the scrotum and create two routes for<unk>  cells to spread, while in an inguinal orchiectomy only the retroperitoneal route exists. Blood tests are also used to identify and measure tumor markers (usually proteins present in the bloodstream) that are specific to<unk> . Alpha-fetoprotein, human chorionic gonadotropin (the "pregnancy hormone"), and LDH-1 are the typical tumor markers used to spot testicular germ cell tumors. A pregnancy test may be used to detect high levels of chorionic gonadotropin; however, the first sign of<unk>  is usually a painless lump. Note that only about 25% of seminomas have elevated chorionic gonadotropin, so a pregnancy test is not very sensitive for making out<unk> . Screening The American Academy of Family Physicians recommends against screening males without symptoms for<unk> . Staging After removal, the testicle is fixed with Bouin's solution because it better conserves some morphological details such as nuclear conformation. Then the testicular tumor is staged by a pathologist according to the TNM Classification of Malignant Tumors as published in the AJCC<unk>  Staging Manual.<unk>  is categorized as being in one of three stages (which have subclassifications). The size of the tumor in the testis is irrelevant to staging. In broad terms,<unk>  is staged as follows: * Stage I: the<unk>  remains localized to the testis. * Stage II: the<unk>  involves the testis and metastasis to retroperitoneal and/or paraaortic lymph nodes (lymph nodes below the diaphragm). * Stage III: the<unk>  involves the testis and metastasis beyond the retroperitoneal and paraaortic lymph nodes. Stage 3 is further subdivided into non-bulky stage 3 and bulky stage 3. Further information on the detailed staging system is available on the website of the American<unk>  Society. Classification Relative incidences of testicular tumors. Although<unk>  can be derived from any cell type found in the testicles, more than 95% of<unk> s are germ cell tumors (GCTs). Most of the remaining 5% are sex cord–gonadal stromal tumours derived from Leydig cells or Sertoli cells. Correct diagnosis is necessary to ensure the most effective and appropriate treatment. To some extent, this can be done via blood tests for tumor markers, but definitive diagnosis requires examination of the histology of a specimen by a pathologist. Most pathologists use the World Health Organization classification system for testicular tumors: * Germ cell tumors * Precursor lesions * Intratubular germ cell neoplasia * Unclassified type (carcinoma in situ) * Specified types * Tumors of one histologic type (pure forms) * Seminoma * Variant - Seminoma with syncytiotrophoblastic cells * Spermatocytic tumor * Variant - spermatocytic tumor with sarcoma * Embryonal carcinoma * Yolk sac tumor * Trophoblastic tumors * Choriocarcinoma * Variant - monophasic choriocarcinoma * Placental site trophoblastic tumour * Cystic trophoblastic tumor * Teratoma * Variant - Dermoid cyst * Variant - Epidermoid cyst * Variant - Monodermal teratoma (Carcinoid), Primitive neuroectodermal tumor (PNET), Nephroblastoma-like tumor, others. * Variant - Teratomic with somatic-type malignancy * Tumours of more than one histologic type (mixed forms) * Embryonal carcinoma and teratoma * Teratoma and seminoma * Choriocarcinoma and teratoma.embryonal carcinoma * Others * Sex cord/Gonadal stromal tumors * Leydig cell tumor * Sertoli cell tumor * Lipid rich variant * Scleriosing variant * Large cell calcifying variant * Intratubular sertoli cell neoplasia in Peutz–Jeghers syndrome * Granulosa cell tumor * Adult type * Juvenile type * Thecoma fibroma group * Thecoma * Fibroma * Sex cord/gonadal stromal tumor - incompletely differentiated * Sex cord/gonadal stromal tumor - mixed types * Mixed germ cell and sex cord/gonadal stromal tumors * Gonadoblastoma * Germ cell-sex cord/gonadal stromal tumor, unclassified * Miscellaneous tumours of the testis * Lymphomas * Primary testicular diffuse large B-cell lymphoma * Mantle cell lymphoma of the testes * extranodal marginal zone B cell lymphoma of the testes * Extranodal NK/T-cell lymphoma, nasal type of the testes * Peripheral T-cell lymphoma of the testes * activin receptor-like kinase-1–negative anaplastic large cell lymphoma of the testes * pediatric-type follicular lymphoma of the testes * Carcinoid * Tumors of ovarian epithelial types * Serous tumor of borderline malignancy * Serous carcinoma * Well differentiated endometrioid tumor * Mucinous cystadenoma * Mucinous cystadenocarcinoma * Brenner tumor * Nephroblastoma * Paraganglioma * Haematopoietic tumors * Tumours of collecting ducts and rete * Adenoma * Carcinoma * Tumors of the paratesticular structures * Adenomatoid tumor * Malignant and benign mesothelioma * Adenocarcinoma of the epididymis * Papillary cystadenoma of the epididymis * Melanotic neuroectodermal tumor * Desmoplastic small round cell tumor * Mesenchymal tumors of the spermatic cord and testicular adnexae * Lipoma * Liposarcoma * Rhabdomyosarcoma * Aggressive angiomyxoma * Angiomyofibroblastoma-like tumor (see Myxoma) * Fibromatosis * Fibroma * Solitary fibrous tumor * Others * Secondary tumors of the testis
Testicular cancer
Epididymitis
Testicular torsion
Spermatocele
Inguinal hernia
Appendix of testis
Hydrocele testis
Hydrocele