malignant tumor of undescended testis

Malignant Tumors in Undescended Testes

Undescended testes, also known as cryptorchidism, are a risk factor for the development of malignant tumors in the testicles. These tumors can be benign or malignant and are more common in individuals with undescended testes.

Types of Malignant Tumors

The most common types of malignant tumors found in undescended testes include:

• Testicular Germ Cell Tumors (TGCTs): These tumors arise from the germ cells in the testicle and are more common in individuals with a history of cryptorchidism. TGCTs can be further divided into two main subtypes:
  • Seminomas: These are the most common type of TGCT and are typically slow-growing.
  • Non-seminomatous tumors: These include other types of germ cell tumors, such as yolk sac tumors, embryonal carcinomas, and choriocarcinomas.

Symptoms

Malignant tumors in undescended testes can be asymptomatic or may present with symptoms such as:

• A painless lump in the testicle
• Testicular swelling or enlargement
• Abdominal pain or discomfort

Risk Factors

Individuals with a history of cryptorchidism are at increased risk for developing malignant tumors in their undescended testes. The risk is higher if the testis has not been surgically corrected.

References:

• [2] Among men who have had undescended testis, the risk of cancer is increased two to eight times.
• [7] Clinical features of malignant transformation in undescended testes range from an asymptomatic, incidentally-discovered mass to acute abdomen resulting from tumor rupture or torsion.
• [8] Malignant alteration in the undescended testis is a typical condition in addition to infertility, inguinal hernia, and torsion.

Understanding Testicular Cancer

Testicular cancer is a type of cancer that forms in the tissues of one or both testicles. It's essential to be aware of the signs and symptoms, as early detection can significantly improve treatment outcomes.

Common Signs and Symptoms

• A painless lump in the testicle (most common sign)
• Swelling of the testicle, with or without pain
• A feeling of weight in the scrotum
• A dull ache in the lower abdomen or groin

These symptoms may also be accompanied by a change in how the testicle feels or a lump or swelling in either testicle.

Risk Factors

Having an undescended testicle (cryptorchidism) increases the risk of developing testicular cancer, even if surgery was performed to correct the condition. This is because the testes form in the belly during fetal development and may not have fully descended into the scrotum before birth.

Importance of Early Detection

According to Dr. Thomas Schwaab, MD, PhD, "The sooner the better" when it comes to detecting testicular cancer. A small tumor has a better prognosis than a large one, and with almost all patients, we can cure the patient even if they present with metastatic disease or stage 4 testis cancer.

Additional Risk Factors

• Being born with undescended testicles may increase the risk of developing testicular cancer
• Malignancy in an undescended intra-abdominal testis is a rare presentation of testicular cancer, requiring sharp correlation between clinical and pathological findings for diagnosis

It's crucial to be aware of these signs and symptoms and seek medical attention if you or someone you know experiences any of them. Early detection can significantly improve treatment outcomes.

References

• [1] Testicles that don’t drop are called undescended testicles and may require surgery.
• [2] “The sooner the better. A small testis tumor has a better prognosis than a large testis tumor,” says Thomas Schwaab, MD, PhD.
• [3] A painless lump in the testicle, which is the most common sign; Swelling of the testicle, with or without pain;
• [4] Apr 20, 2024 — A painless lump or swelling in either testicle · A change in how the testicle feels
• [5] Malignancy in an undescended intra-abdominal testis is a rare presentation of testicular cancer, requiring sharp correlation between clinical and pathological findings for diagnosis.

Diagnostic Tests for Malignant Tumor of Undescended Testis

The diagnosis of a malignant tumor in an undescended testis can be challenging, but several diagnostic tests can help identify the condition. Here are some of the key tests used:

• Ultrasound: Ultrasound has 45% sensitivity, 78% specificity, and 88% accuracy for localization of undescended testis (Source: [12]). It is more accurate than clinical examination in detecting an undescended testis.
• Physical Examination: A physical exam can be difficult to perform on an undescended testis, but it is still a useful tool. If a normal testis cannot be definitely identified, consultation should be considered (Source: [13]).
• Blood Tests: Serum tumor markers (STM) such as alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH) can be used to detect malignant tumors in the testis. These tests should be drawn and measured prior to any treatment, including orchiectomy (Source: [14]).
• Computed Tomography (CT): CT scans of the abdomen and pelvis may be used to detect metastasis to the lymph nodes or other organs.
• Laparoscopy: Laparoscopy is a minimally invasive surgical procedure that can be used to locate an undescended testis. It involves inserting a small tube with a camera on it through a small cut in the belly.

Early Detection and Management

Early detection and management of an undescended testicle are crucial to preserve fertility and improve early detection of testicular malignancy (Source: [13]). Correction of undescended testis makes the diagnosis of cancer easy and avoids unnecessary delays in diagnosis and prompts initiation of therapy (Source: [15]).

References

[12] Ultrasound has 45% sensitivity, 78% specificity, and 88% accuracy for localization of undescended testis. [13] Physical examination of the testicle can be difficult; consultation should be considered if a normal testis cannot be definitely identified. [14] Serum tumor markers (STM) such as alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH) can be used to detect malignant tumors in the testis. [15] Correction of undescended testis makes the diagnosis of cancer easy and avoids unnecessary delays in diagnosis and prompts initiation of therapy.

Treatment Options for Malignant Tumors in Undescended Testes

Malignant tumors in undescended testes can be challenging to treat, but various options are available depending on the stage and type of cancer. According to search results [3] and [5], correction of undescended testis through orchiopexy may simplify further management, should a patient develop testicular cancer.

Chemotherapy

Chemotherapy is often used as a treatment option for malignant tumors in undescended testes. The type and number of chemotherapies combined can vary, with one, two, or three chemotherapies being used [4]. These drugs are typically given in cycles, with the exact duration and frequency depending on the specific treatment plan.

Hormonal Treatment

In some cases, hormonal treatment may be considered to stimulate testicular descent. However, this approach has a relatively low efficacy rate of less than 20% for undescended testes [8]. As such, it is typically not the first line of treatment for malignant tumors in this condition.

Other Treatment Options

Treatment options for malignant tumors in undescended testes also include surgery and radiation therapy. The specific approach will depend on the stage and type of cancer, as well as individual patient factors.

References:

• [3] Correction of undescended testis makes the diagnosis of cancer easy and avoids unnecessary delays in diagnosis and prompts initiation of therapy...
• [4] One, two or three chemotherapies may be combined for testicular cancer treatment.
• [5] Thus, orchiopexy may confer a favourable outcome and simplifies further management, should a patient with undescended testis develop testicular ...
• [8] In summary, hormonal treatment yields an overall efficacy rate of less than 20% for undescended testes.

The differential diagnosis for a malignant tumor of an undescended testis can be quite complex, but based on the search results, here are some possible conditions that should be considered:

• Testicular mixed germ cell tumor: This type of tumor is composed of different types of germ cells and can include teratomas, yolk sac tumors, and choriocarcinoma. According to a study by ÖZ Sert in 2019 [3], testicular mixed germ cell tumor was found in a patient with an undescended testis.
• Yolk sac tumor: This is a type of malignant germ cell tumor that can occur in the testes, including those that are undescended. According to Q Xia's article in 2023 [1], yolk sac tumors are one of the histologies found in testicular tumors with an undescended testis.
• Choriocarcinoma: This is another type of malignant germ cell tumor that can occur in the testes, including those that are undescended. According to Q Xia's article in 2023 [1], choriocarcinoma is one of the histologies found in testicular tumors with an undescended testis.
• Teratoma: This is a type of benign tumor that can occur in the testes, including those that are undescended. However, it's worth noting that teratomas can also be malignant [1].
• Epididymo-orchitis: This is an inflammation of the epididymis and testis, which can sometimes be mistaken for a tumor. According to search result 2, this condition should be considered in the differential diagnosis.
• Hematoma: A hematoma is a collection of blood that can occur in the testes, including those that are undescended. This condition should also be considered in the differential diagnosis [2].
• Leukemia: Leukemia is a type of cancer that affects the blood and bone marrow. According to search result 2, leukemia should be considered in the differential diagnosis.
• Metastasis from other cancers: Metastasis refers to the spread of cancer cells from one part of the body to another. According to search result 2, metastasis from other cancers such as lung cancer, melanoma, prostate cancer should be considered in the differential diagnosis.

It's worth noting that the probability of a malignancy occurring in an undescended testis is 30-50 times greater than in a normal scrotal testis [4]. Therefore, it's essential to consider these conditions in the differential diagnosis when evaluating a patient with an undescended testis.

References: [1] Q Xia (2023) [2] Search result 2 [3] ÖZ Sert (2019) [4] M Muttarak (2004)