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Case History
Teenage male with right scrotal pain and mass.
Case Detail
| Anatomy: Genitourinary |
 Joseph Junewick, MD FACR |
| Diagnostic Category: Neoplasia Malignant |
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| Created: over 8 years ago |
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| Updated: over 7 years ago |
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| Tags:
PEDS
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| Modality/Study Types:
US
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Activities:  PDF  ImageJA |
Case Images
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Reveal Clinical Notes
Laboratory – hCG = 135 (H) and alphafetoprotein = 60.9 (H).
Pathology – Mixed germ cell tumor (90% embryonal, 7% immature teratoma, 2% choriocarcinoma and 1% yolk sac tumor)
Reveal Findings
US – Hypovascular macrolobulated predominantly solid mass with occasional cystic regions arising from the lower pole of the right testicle.
Reveal Discussion
Germ cell tumors account for 95% of all testicular tumors. Seminoma is the most common pure germ cell tumor of the testis and accounts for 35%–50% of all germ cell tumors. Mixed germ cell tumors are malignant neoplasms that contain more than one germ cell tumor component. Embryonal carcinoma is the most common component and is often combined with teratoma, seminoma, or yolk sac tumor.
Patients with these tumors typically present with testicular enlargement, which is sometimes associated with pain. The average age of males presenting with mixed germ cell tumors is 30 years, and these tumors rarely occur in prepubertal patients. Serum marker elevation is common and is reflective of the individual components of the tumor;alphafetoprotein and/or beta hCG levels are often elevated.
Areas of necrosis, hemorrhage, and cystic degeneration are often seen and reflect the different histologic components of the tumor. US typically demonstrates a unilateral, mixed solid and cystic mass. Calcifications occur in almost half of patients. MR imaging has been proposed as a useful diagnostic tool for cases in which the results of physical examination and US are inconclusive. Although US is highly sensitive in the detection of testicular masses, it is nonspecific for the diagnosis of tumor. US does not have sufficient resolution for reliable visualization of the testicular septations and tunica albuginea. MR imaging provides higher resolution and sensitivity for differentiation of testicular tissue, capabilities that facilitate improved depiction of small tumors that may not be detectable with US, or may complement US findings. Mixed germ cell tumors are inhomogeneous in signal intensity, depending on the histologic components and presence of hemorrhage.
Reveal Diagnosis
Testicular Mixed Germ Cell Tumor