Materiały źródłowe

• #1 Evaluation of Scrotal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0501/p723.html

  Scrotal masses are caused by a variety of disorders, ranging from benign conditions to those requiring emergent surgical intervention. […] Scrotal masses are a common presentation in primary care, and a painful scrotum accounts for 1% of emergency department visits. Some causes of scrotal masses require rapid diagnosis and treatment to avoid loss of fertility or other complications. […] Testicular malignancies cause pain in 15% of cases. If ultrasonography shows an intratesticular mass, timely urology referral is indicated. […] Epididymitis is the most common cause of scrotal pain in adults and is characterized by acute unilateral pain and swelling. […] Testicular cancer usually presents as a firm, unilateral nodule. […] Urgent referral to a urologist is indicated for patients with intratesticular masses, even though smaller masses are less likely to be cancerous.

• #2

• #3 Prevalence and Management of Incidental Testicular Masses—A Systematic Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9573452/

  Management of incidentally diagnosed small testicular masses (STM) is controversial. […] This study aims to systematically evaluate the evidence regarding prevalence of STMs, their benign or malignant histology and their management. […] Testicular masses were detected in 1.74% of patients undergoing US examination. […] Regarding STMs removed by surgery, 41.12% were benign. […] Small testicular masses are often benign. […] Clinical and US patterns are not accurate enough for including patients in surveillance protocols and TSS paired with FSE is pivotal for precluding the removal of testicles bearing benign lesions. […] The incidence of STMs on US among men consulted for infertility (2.86%) appeared to be significantly higher than in men examined for various indications (1.41%).

• #4 The role of radiological surveillance in the conservative management of incidental small testicular masses: A systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8158180/

  Objective: The increasing use of scrotal ultrasonography (US) for non-cancerous indications has led to greater detection of incidental, small testicular masses. […] Operative intervention is currently the mainstay of treatment for all testicular tumours; however, despite the low malignant potential of small, incidental masses, little is known about conservative management using radiological surveillance. […] A total of 293 patients across six studies underwent radiological surveillance for an incidental small testicular mass. […] A total of 37 patients (12.6%) underwent surgical exploration during follow-up, with only 10 (3.4%) found to have malignant disease at histology. […] Radiological surveillance of incidental small testicular masses is safe when used for select patient groups due to the high probability of benign disease, although optimal patient selection criteria and a well-defined protocol are lacking.

• #5 Nonpalpable Intratesticular Mass in a Young Man With a History of Contralateral Retractile Testis

  https://www.cancernetwork.com/view/nonpalpable-intratesticular-mass-young-man-history-contralateral-retractile-testis

  We present the case of a 24-year-old man with a symptomatic, nonpalpable tumor of the left testicle, with normal serum tumor markers and a history of right orchidopexy for retractile testis-and the resulting treatment decision dilemma. The overall prevalence of testicular cancer is low-1% to 2%-but it represents the most common malignancy in males aged 15 to 45 years. […] Males who present with a palpable testis tumor harbor a malignant germ cell tumor in 90% of cases. […] Thus, radical orchiectomy remains the standard of care for intratesticular tumors. […] However, small nonpalpable testis tumors are increasing in prevalence as a result of the widespread use of high-resolution ultrasound. […] Unlike with palpable tumors, 80% of nonpalpable testicular lesions diagnosed with ultrasound are thought to be benign.

• #6 Prevalence and Management of Incidental Testicular Masses—A Systematic Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9573452/

  The trend for predominance of benign lesions was more noticeable in studies reporting only incidental lesions, with an average percentage of 63.24% of these selected tumors having benign histology. […] We found that FSE is consistent and provides up to 100% sensitivity for the detection of malignancy (average 93.05% across all studies). […] TSS coupled with FSE is a reliable option for the management of STMs and is crucial to preclude the removal of testicles bearing benign lesions.

• #7 Testicular Cancer: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/279007-overview

  Testicular cancers are an uncommon malignancy, representing only 0.5% of all new cancer cases in the United States. The American Cancer Society (ACS) estimates that about 9190 new cases of testicular cancer will be diagnosed during 2023 in the United States. The lifetime chance of developing testicular cancer is about one in 250 and the risk of dying is very low about one in 5,000. Most cases occur in men aged 20-34 years; the median age at diagnosis is approximately 32 years. […] In the United States, the incidence increased by 100% from 1988 to 2001. Diagnoses of seminomas increased 124% during that period and diagnoses of nonseminomas increased by 64%. No significant increase occurred in the incidence of early-stage disease in proportion to all diagnoses in this population, indicating that the increase was not due to more widespread screening or earlier detection.

• #8 Testicular Cancer — Cancer Stat Facts

  https://seer.cancer.gov/statfacts/html/testis.html

  Estimated New Cases in 2025 9,720. […] % of All New Cancer Cases 0.5%. […] Estimated Deaths in 2025 600. […] % of All Cancer Deaths 0.1%. […] Testicular cancer represents 0.5% of all new cancer cases in the U.S. […] In 2025, it is estimated that there will be 9,720 new cases of testicular cancer and an estimated 600 people will die of this disease. […] The rate of new cases of testicular cancer was 6.0 per 100,000 men per year based on 20182022 cases, age-adjusted. […] The death rate was 0.3 per 100,000 men per year based on 20192023, age-adjusted. […] Keeping track of new cases, deaths, and survival over time (trends) can help scientists understand whether progress is being made and where additional research is needed to address challenges, such as improving screening or finding better treatments. […] Using statistical models for analysis, age-adjusted rates for new testicular cancer cases have been rising on average 0.7% each year over 20132022. Age-adjusted death rates have been rising on average 2.7% each year over 20142023.

• #9 Testicular Cancer – Genitourinary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/genitourinary-disorders/genitourinary-cancers/testicular-cancer

  Testicular cancer begins as a scrotal mass, which is usually not painful. Diagnosis is by ultrasonography. Treatment is with orchiectomy and sometimes lymph node dissection, radiation therapy, chemotherapy, or a combination, depending on histology and stage. […] In the United States, about 9760 new cases of testicular cancer and about 500 deaths (2024 estimates) occur each year (1). Testicular cancer is the most common solid cancer in males aged 15 to 35. […] Many patients discover the mass themselves during self-examination. Monthly self-examination should be encouraged among young men. […] The origin and nature of scrotal masses must be determined accurately because most testicular masses are malignant, but most extratesticular masses are not; distinguishing between the 2 during physical examination may be difficult.

• #10 Testicular tumors – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/testicular-tumors/

  Testicular tumors are the most common solid malignancy in young men. […] Epidemiological data refers to the US, unless otherwise specified. […] Most common solid malignant tumor in young men. […] Nonseminoma tumors are most common in men aged, while seminomas are most common in men aged 30 years. […] Testicular tumors metastasize early into the retroperitoneum via the lymphatic system (drain to the para-aortic lymph nodes first), with the exception of early hematogenous metastasizing choriocarcinomas. […] The overall prognosis of testicular tumors is excellent, with a high cure rate and 5-year survival rates of 95%. […] Even in advanced, metastatic stages, testicular tumors are often curable. […] The United States Preventive Services Taskforce and the National Cancer Institute do not recommend routine screening in asymptomatic adults due to the low incidence and high survival rates of testicular cancer.

• #11 Testicular cancer | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/testicular-cancer?lang=us

  Testicular cancers are the most common malignancy in men between the ages of 20 and 34 years. […] Testicular cancer is uncommon, accounting for less than 1% of all internal organ malignancies. […] The commonest histology of the tumor varies with the age of affected individuals. Over 90% of all tumors of the testes are primary germ cell tumors, and as such young adults are the overall most frequently involved group.

• #12 Testicular cancer – Wikipedia

  https://en.wikipedia.org/wiki/Testicular_cancer

  Globally testicular cancer resulted in 8,300 deaths in 2013 up from 7,000 deaths in 1990. Testicular cancer has the highest prevalence in the U.S. and Europe, and is uncommon in Asia and Africa. Worldwide incidence has doubled since the 1960s, with the highest rates of prevalence in Scandinavia, Germany, and New Zealand. […] Germ cell tumors of the testis are the most common cancer in young men between the ages of 15 and 35 years. […] In the United States, about 8,900 cases are diagnosed a year. The risk of testicular cancer in white men is approximately 45 times the risk in black men, and more than three times that of Asian American men. The risk of testicular cancer in Latinos and American Indians is between that of white and Asian men. The cause of these differences is unknown. […] In the UK, approximately 2,000 people are diagnosed a year. Over a lifetime, the risk is roughly 1 in 200 (0.5%). It is the 16th most common cancer in men. It accounts for less than 1% of cancer deaths in men (around 60 men died in 2012).

• #13 Testicular Cancer: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/279007-overview

  According to Surveillance, Epidemiology, and End Results (SEER) data from 18 geographic areas, the age-adjusted annual incidence of testicular cancer from 2016-2020 was 6.0 per 100,000 men. […] Studies of testicular cancer in selected global populations from 1973-2007 have shown a clear trend toward an increased incidence in most populations evaluated. In recent years, however, rates have plateaued in some areas and even decreased in a few. […] Epidemiologic observations have suggested that environmental factors are instrumental in determining risk for testicular cancers. However, epidemiologic evidence does not consistently support any specific risk factor.

• #14 Epidemiology and risk factors for testicular cancer – UpToDate

  https://www.uptodate.com/contents/epidemiology-and-risk-factors-for-testicular-cancer

  Epidemiology and risk factors for testicular cancer […] The epidemiology and risk factors for the development of testicular germ cell tumors are discussed here. […] EPIDEMIOLOGY […] Incidence — Testicular cancer is the most common solid malignancy affecting males between the ages of 15 and 35. In the United States, approximately 9800 males are diagnosed with testicular cancer each year. Due to effective multimodality therapy, there are only 600 deaths annually due to testicular cancer. Most patients with testicular cancer present with disease confined to the testicle (stage I disease). […] Worldwide, there are approximately 75,000 cases of testicular cancer and over 9000 deaths per year. Geographic areas with the lowest incidence of testicular GCT in 2020 include Africa and Asia (age standardized incidence rate [ASIR] of 0 to 1.7), areas with an intermediate incidence include North America and Eastern Europe (ASIR of 1.7 to 5.8), and areas with the highest incidence include the Scandinavian countries, Western Europe, parts of South America, and Australia-New Zealand (ASIR of 5.8 to 13.2). […] The incidence of testicular cancer has been increasing globally, but the cause is unclear.

• #15 LearnOncology

  https://www.learnoncology.ca/modules/testicular-cancer

  The National Institute of Healths Surveillance, Epidemiology, and End Results Program (SEER) similarly predicts that 0.4% of men will be diagnosed with testicular cancer in their lifetime. […] Testicular cancer incidence is not uniform around the world. It is the lowest in Africa and Asia and is highest in Scandinavian countries as well as Germany, Switzerland and New Zealand for unknown reasons.

• #16 Testicular Cancer – Diagnosis & Disease Information for HCPs

  https://www.cancertherapyadvisor.com/ddi/testicular-cancer/

  Testicular cancer is rare, accounting for 1% of all cancers diagnosed in men but is the most common type of solid tumor among males age 15 to 35 years. In the United States, there are approximately 9000 cases of testicular cancer each year. In the US and other Western countries, the incidence of testicular cancer has been increasing over the past few decades, ranging from 3 to 11 new cases per 100,000 males each year. The highest rates are among men who are White, with much lower rates in men who are Black or Asian. In 2024, approximately 500 men in the US will die from testicular cancer. […] Because relapses occur mostly within the first 2 years, close surveillance during this period is required.

• #17 The role of radiological surveillance in the conservative management of incidental small testicular masses: A systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8158180/

  This approach could be considered in patients with incidental, impalpable testicular masses of 5 mm in diameter displaying no significant size increase or internal vascularity on US and with negative tumour markers, as the probability of malignancy in these patients is low. […] Despite the widely acknowledged likelihood of benign disease in patients undergoing routine investigation for infertility or scrotal pain with no palpable testicular mass, a consensus is yet to be reached regarding non-operative management and a well-defined, evidence-based protocol for radiological surveillance is lacking. […] Across all six studies, surgical intervention was indicated during the surveillance period in only 37 patients and only 10 of those (3.4% of total patients) were diagnosed with malignant disease.

• #18 Sonography better to monitor small testicular lesions

  https://www.cancernetwork.com/view/sonography-better-monitor-small-testicular-lesions

  There is a lack of scientific evidence about the risk of testicular cancer associated with testicular lesions, but the conventional treatment approach has been immediate surgical removal because of the possibility of malignancy. A more conservative approach has served one Canadian institution well when it comes to active surveillance of small, incidentally discovered testicular masses. […] For nearly a decade, ultrasound (US) surveillance has been offered to men as an alternative to surgical treatment at the University of Toronto, and, thus far, the approach has spared many patients from unnecessary surgery. […] The authors concluded that most small, incidental, nonpalpable testicular masses could be safely followed with serial ultrasound and did not show significant growth requiring surgery.

• #19 Sonography better to monitor small testicular lesions

  https://www.cancernetwork.com/view/sonography-better-monitor-small-testicular-lesions

  „Our findings support a conservative approach involving active surveillance with ultrasound monitoring in men who have an incidental finding of a small testicular mass on ultrasound,” said Dr. Toren, a urology resident. […] He recommended that most men with a small nonpalpable lesion on their initial testicular ultrasound have a second ultrasound one month later and then again every three months for at least six months. Surgery should be limited to men whose lesional growth points to a malignancy and men with positive tumor markers, Dr. Toren said.

• #20 The role of radiological surveillance in the conservative management of incidental small testicular masses: A systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8158180/

  The risk of secondary hypogonadism following TSS for impalpable masses is reportedly very low in men with normal testosterone, although it is still a documented risk following partial orchidectomy, particularly in malignant cases. […] It is reasonable to conclude from the available evidence that a correlation can be drawn between the size of a testicular lesion and its malignant status, a factor that may play a large role in defining lesions suitable for radiological surveillance over surgical intervention. […] In addition to size of the testicular mass lesion, several qualitative US features of testicular lesions have been shown to correlate with malignant status. […] The use of multiparametric US can therefore aid diagnostic accuracy as demonstrated by Isidori et al. who highlighted the important role of contrast-enhancement in conjunction with conventional US. […] The present review highlights the need for further research in this field to confirm the safety and efficacy of such a conservative approach in the management of incidental STMs.

• #21 EAU Guidelines on Testicular Cancer – Uroweb

  https://uroweb.org/guidelines/testicular-cancer/chapter/diagnostic-evaluation

  Testicular cancer usually presents as a painless testicular mass or incidental finding on ultrasound (US). Pain, either scrotal or abdominal/back, may occur and result in delayed diagnosis. […] High-frequency (10 MHz) testicular US is recommended. Scrotal US is also recommended for all men with retroperitoneal or visceral masses with/or without elevated serum -hCG or Alpha-fetoprotein (AFP) in the absence of a palpable testicular mass. […] Small, usually non-palpable incidental masses, may be incidental findings on scrotal US which may be benign. Of lesions with small diameter, virtually all 3mm, 87% of those 5mm, and 70% 10mm are benign. […] Scrotal magnetic resonance imaging (MRI) provides higher sensitivity and specificity than US in the diagnosis of TC, but its high cost does not justify its routine use for this purpose.

• #22

  https://link.springer.com/article/10.1007/s00330-024-10981-4

  To determine whether small, incidentally detected testicular lesions can be safely followed up, by assessing growth rate and volume threshold for benign vs. malignant lesions. […] The best cut-off values of the growth indicators to differentiate between malignant and non-malignant histology were 3.47103%volume/day, 179 days, 10103mm/day, and 5103mm/day for SGR, DT, Dmax, Dav, respectively. […] Malignant and non-malignant small incidentalomas can be effectively differentiated based on growing parameters, even though overlap exists. An increase of the maximum diameter of about 1mm and 2mm in three months and in six months, respectively, suggests malignancy. […] Growing parameters allow an educated assessment of benign and malignant small testicular incidentalomas. Non-aggressive management is justified and safe when follow-up includes self-examination and tumour marker assessment to reduce the risk of interval tumour growth.

• #23

  https://link.springer.com/article/10.1007/s00330-024-10981-4

  According to the ESUR recommendations, patients with small testicular incidentalomas should be monitored every three months for 12 months and then annually. […] Our data suggest that malignant small, non-palpable incidentalomas are mostly seminomas (17/18 in our series, 94%). All were identified and removed within 18 months after discovery, and all were stage IA tumours. […] We believe that based on these data and disease prevalence, a non-aggressive management of small testicular incidentalomas is justified, and should be considered safe when follow-up includes self-examination and tumour marker assessment, in order to reduce the risk of interval tumour growth.

• #24 Surveillance for stage I testicular germ cell tumors following orchiectomy – UpToDate

  https://www.uptodate.com/contents/surveillance-for-stage-i-testicular-germ-cell-tumors-following-orchiectomy

  Surveillance for stage I testicular germ cell tumors following orchiectomy […] Testicular germ cell tumor (GCT) is a highly curable cancer, with five-year survival rates of over 95 percent. For most patients with stage I GCTs (table 1A-B) who are treated with orchiectomy, surveillance is the preferred approach given low relapse rates, excellent long-term overall survival, and avoidance of unnecessary toxicity. […] Patients with clinical stage I testicular seminoma who undergo orchiectomy are preferably managed with active surveillance; other options include adjuvant chemotherapy or adjuvant radiation therapy. Patients with clinical stage I nonseminomatous germ cell tumor (NSGCT) who undergo orchiectomy are preferably managed with surveillance; other options include adjuvant chemotherapy or retroperitoneal lymph node dissection (RPLND). Active surveillance has not been directly compared with these other treatment strategies in randomized trials. […] The role of surveillance in stage I testicular GCTs (both seminoma and NSGCT) treated with orchiectomy is presented here. Other treatment strategies for stage I testicular seminoma and NSGCTs are discussed separately.

• #25 EAU Guidelines on Testicular Cancer – Uroweb

  https://uroweb.org/guidelines/testicular-cancer/chapter/diagnostic-evaluation

  No high-level evidence studies supporting screening programs exists. In contrast, young males should be informed about the importance of testicular self-examination. Testicular self-examination is recommended in high-risk groups which include a history of cryptorchidism, as well as those with a personal or family history of TC.

• #26 Scrotal masses – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/scrotal-masses/symptoms-causes/syc-20352604

  Scrotal masses are lumps or swelling in the scrotum, the bag of skin that holds the testicles. […] It’s key to get a scrotal mass checked by a health care professional, even if you don’t have pain or other symptoms. Some masses could be cancer. Or they could be caused by another medical condition that affects the health of the testicles and how well they work. […] Each month, check your scrotum for any changes. Also get the area checked during regular health checkups. This can help you spot masses early, when many treatments work better. […] Many health conditions can cause a scrotal mass or an unusual change in the scrotum. These include: […] Testicular cancer. This is cancer that starts in the testicles. It often causes a painless lump or swelling in the scrotum. But some people with testicular cancer don’t have any symptoms. See your doctor or other health care professional if you notice a new lump in your scrotum.

• #27 Testicular carcinoma misdiagnosed as hydrocele: lesson to learn

  https://www.pjms.com.pk/issues/octdec207/article/casereport3.html

  Testicular cancer accounts for about 1% of cancers in men, with increase in the incidence over some last decades. […] The peak incidence occurs in men aged 25-35 years. However, despite the rise in incidence, mortality from testicular cancer has fallen the overall cure rate is now over 90%. […] Proper pre-operative assessment and diagnosis has the key role in the life expectancy of patient. […] Accurate diagnosis pre-operatively can change the operative approach like instead of scrotal approach inguinal will be adapted which in turn has a great effect on prognosis of patient as there is less chances of metastasis and a high cure rate cannot be anticipated with equal frequency in those patients with high-volume non-seminomatous germ cell tumors of testicle. […] These two cases other a lesson which is sometimes forgotten that detailed clinical history and good physical examination is the most important in reaching correct diagnoses resulting in appropriate treatment.

• #28 Diagnosis and Treatment of Early-Stage Testicular Cancer: AUA Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/testicular-cancer-guideline

  In 2019, an estimated 9,500 men will be diagnosed with testis cancer in the United States, and 400 will die from the disease. Testis cancer is the most common solid malignancy among men aged 20 to 40 years. The incidence rate is highest among Caucasians, lowest among African-Americans, and most rapidly increasing in Hispanic populations. Age-adjusted incidence has nearly doubled over the last 4 decades for unknown reasons, from 3.7 per 100,000 in 1975 to 6.4 per 100,000 in 2014. A stage migration of GCT has been observed, presumably due to increased awareness and earlier diagnosis. Between 1973 and 2014, the percentage of tumors diagnosed at a localized stage increased from 55% to 68% in the United States. Currently, less than 15% of men present with stage III disease (to the lungs, viscera, or non-regional lymph nodes).

• #29 Scrotal masses – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/scrotal-masses/symptoms-causes/syc-20352604

  Things that can raise the risk of a scrotal mass include: […] Undescended testicle. An undescended testicle doesn’t leave the stomach area and move down into the scrotum before birth or in the months afterward. […] Conditions present at birth. Some people are born with irregular changes in the testicles, penis or kidneys. These might raise the risk of a scrotal mass and testicular cancer later in life. […] History of testicular cancer. If you’ve had cancer in one testicle, your risk of getting cancer in the other testicle is higher. Having a parent or a sibling who’s had testicular cancer also raises your risk.

• #30 Diagnosis and Treatment of Early-Stage Testicular Cancer: AUA Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/testicular-cancer-guideline

  Risk factors for developing testis cancer include germ cell neoplasia in situ (GCNIS), history of undescended testis (UDT)/ cryptorchidism, family history, and a personal history of testis cancer. Infertility is associated with the presence of GCT, though this association is thought to arise from inherent testicular dysfunction. GCNIS is the precursor lesion from which the majority of GCTs arise. Among men with invasive GCT, GCNIS is found in adjacent testicular parenchyma in 80-90%. Among men with GCNIS, the risk of developing invasive GCT is approximately 50% within 5 years. Men with cryptorchidism have a four to six fold increased risk of developing testis cancer in the affected testicle, but the relative risk (RR) falls to two to three fold if orchiopexy is performed before puberty. […] Testis cancer is the most common solid malignancy in young males. The vast majority of men with testis cancer have low-stage disease (limited to the testis and retroperitoneum; clinical stages I-IIB); survival rates are high with standard therapy. A priority for those patients with low-stage disease is limiting the burden of therapy and treatment-related toxicity without compromising cancer control. Thus, surveillance has assumed an increasing role among those with cancer clinically confined to the testis.

• #31 Testicular tumours in children: an approach to diagnosis and management with pathologic correlation | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00867-6

  Testicular microlithiasis (TM) defined by five or more non-shadowing intratesticular echogenic calcific foci have shown association with testicular tumours in children, although the contribution of TM to the risk of malignancy is controversial and there is not any agreement for the management and monitoring of children with TM. […] An approach to the TT diagnosis is based on ultrasonographic findings, clinical and endocrinological data and tumour marker levels as alpha-phetoproteine (AFP), beta-human gonadotropin chorionic (B-HCG), lactate dehydrogenase (LDH) or testosterone. […] TTs usually manifest as painless testicular mass (8290%) and less than 10% as painful mass secondary to haemorrhage or necrosis. […] US is the first imaging technique to study testicular masses, with a sensitivity of almost 100% but with low specificity because the differentiation between benign and malignant neoplasms is difficult in most cases.

• #32 Testicular tumours in children: an approach to diagnosis and management with pathologic correlation | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00867-6

  Testicular cancer has staging systems based on pathology after orchiectomy or tumourectomy, radiology with chest CT and abdominopelvic MR, and serum tumour markers. […] After being clinically suspected and once the ultrasonographic exam confirms an intratesticular lesion, the determination of serum markers (AFP, B-HCG), hormonal levels (testosterone) and LDH are necessary to guide the diagnosis and the treatment. […] Testicular sparing surgery should be used in children with a TT in which the normal testicular tissue seems salvageable on US and with normal tumoural markers. […] The high resolution of ultrasonography imaging enables the detection of an increasing number of incidental impalpable testicular lesions often smaller than 510mm. It is not possible to differentiate between benign or malignant small lesion, especially when clinical and tumoural markers are normal. […] TTs are rare in children. The benign tumours of the testis are more common in children and teratoma is the most frequent histological subtype. US has a sensitivity of almost 100% for the detection of a testicular mass.

• #33 Testicular tumours in children: an approach to diagnosis and management with pathologic correlation | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00867-6

  Testicular tumours are rare in children. Painless scrotal mass is the most frequent clinical presentation. Tumoural markers (alpha-fetoprotein, beta-human gonadotropin chorionic) and hormone levels (testosterone) contribute to the diagnosis and management of a testicular mass in boys. Ultrasonography is the best imaging modality to study testicular tumours. Benign tumours are more frequent in prepuberal boys and malignant tumours in pubertal boys. Mature teratoma prepubertal-type is the most common histologic type. Testicular sparing surgery is the choice in benign tumours. Radical inguinal orchiectomy is indicated in malignant tumours. Prognostic is excellent. […] Testicular tumours (TTs) are rare in children under 15, then accounting for 24% of all childhood cancers. They have two peaks of incidence in paediatric population: neonatal and puberty. This rise of incidence over the age of 9 could be due to the high hormone levels at puberty. The malignant potential of germinal cell tumours (GCTs) increases rapidly after this age, while benign tumours are more frequent in younger boys.

• #34 Uncommon tumors of the testis – WCRJ

  https://www.wcrj.net/article/248

  The behaviour of testis tumors in the elderly is completely different from the younger patient one. The most frequent histological type are spermatocytic seminoma, malignant Leydig tumors and lymphomas in the testis and sarcomas in the paratesticular region. Despite the low incidence of these tumors, the testis is the first site of genitourinary involvement for sarcomas in the elderly. […] Testicular cancer represents between 1% and 1.5% of male neoplasms and 5% of urological tumours. The vast majority of tumours are diagnosed in the third and fourth decade of life. […] The incidence of germinal cell tumors (GCTs) declines markedly towards the age of 50, and tumours in patients above the age of 60 are extremely rare, while the incidence of spermatocytic seminoma (a distinct GCT with a generally benign behavior), primary lymphoma, stromal tumors, usually of the Leydig cell type, and rarely metastasis progressively increases.

• #35 Uncommon tumors of the testis – WCRJ

  https://www.wcrj.net/article/248

  Although uncommon, these tumors have been recorded as the main urogenital site of sarcomas in the elderly, whereas primary sarcoma of the testis is a rare entity in which a diagnosis is made only after the exclusion of the more common paratesticular neoplasm. […] Primary testicular lymphoma (PTL) is an uncommon disease that comprises only 1-9% of testicular neoplasm. However, it is the most common malignancy in men older than 50 years of age and 85% of cases are diagnosed in men beyond the sixth decade. […] The diagnosis of TL is better made on orchiectomy samples rather than on fine needle biopsy. In addition, orchiectomy provides good local tumor control and facilitates the removal of a sanctuary site, as the blood-testis barrier makes testis tumors a chemotherapy sanctuary. […] Paratesticular sarcoma is an uncommon disease. It is so difficult to provide series of sufficient cases to document the natural history of these tumors and the treatment results. According to the Memorial Sloan- Kettering Cancer Center large case series, 2.1% of soft tissue sarcomas arise in the genitourinary tract, and almost 44% are paratesticular.

• #36 Updates in the management of benign and malignant scrotal conditions: issues on surgical ablation and reconstruction – Hofer – AME Medical Journal

  https://amj.amegroups.org/article/view/5483/html

  Malignant tumors of the scrotum are rare. Despite their low incidence, squamous cell carcinoma (SCC) is the most common scrotal cancer with a propensity for recurrence and distant spread. […] Limited and sparse information on epidemiology, treatment and outcomes of scrotal cancer has been published in the last three decades, probably due to its low incidence, except, to our knowledge, for three studies with relatively small patient cohorts. […] Although long noted for its historical relevance, scrotal cancer has not received great attention and, therefore, has not been well characterized. Most previous studies have been restricted to case reports and small case series evaluating exposure to environmental risk factors. Sparse studies have dealt with epidemiology of scrotal SCC. […] Studies from the mid-to-late 1990s reported SCC to account for 80-100% of all scrotal malignancies. However, more recent studies mention this histology is responsible for one third only of all scrotal malignancies. Nonetheless, scrotal SCC still remains the most common malignant histology.

• #37 Updates in the management of benign and malignant scrotal conditions: issues on surgical ablation and reconstruction – Hofer – AME Medical Journal

  https://amj.amegroups.org/article/view/5483/html

  Verhoeven et al. reported the age-standardized incidence rate of scrotal SCC in the Netherlands from 1986 to 2006 and found that it varied between 0.34 and 0.44/1,000,000 male person-years with no statistically significant change over time. […] Wright et al. reported on the age-adjusted incidence rate of scrotal SCC in the United States over a similar period of time and noticed an increase from 0.49/1,000,000 males in 1973 to 0.95/1,000,000 in 2002. […] The emergence of new risk factors, such ultraviolet A phototherapy for the treatment of skin diseases and human papilloma virus (HPV) has been the source of speculation for this sustained incidence despite avoidance of known occupational carcinogens. […] Survival according to histologic subtypes was studied by Johnson et al. […] Several authors have linked the psoralens and ultraviolet A radiation (PUVA) used for the treatment of psoriasis and other skin diseases with the development of scrotal SCC.

• #38 Updates in the management of benign and malignant scrotal conditions: issues on surgical ablation and reconstruction – Hofer – AME Medical Journal

  https://amj.amegroups.org/article/view/5483/html

  Matoso et al. found a 24.1% association risk between scrotal SCC and high-risk HPV by in situ hybridization evaluation in a series of 29 patients. […] Chronic mechanical irritation has also been associated with scrotal SCC. […] An increased risk of a second malignancy, either preceding or following scrotal SCC has been reported.

• #39 Imaging of Testicular and Scrotal Masses: The Essentials | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-319-75019-4_24

  In the absence of unequivocally benign imaging findings, it is important to clearly convey the suspicion for a malignant neoplasm to the referring physician. […] Patients with treated testicular cancer are at 10-fold increased risk for developing contralateral metachronous cancer with a 15-year cumulative incidence of 1.9%. […] Most recurrences occur within the first 2 years after treatment. […] The most common sites of recurrence are the retroperitoneal lymph nodes. […] The role of imaging testicular and scrotal masses will vary according to the clinical scenario. […] Imaging is helpful to establish or narrow the differential diagnoses.

• #40 Imaging of Testicular and Scrotal Masses: The Essentials | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-319-75019-4_24

  For many radiologists, requests for imaging evaluation of testicular or scrotal symptoms and physical exam findings may cause some degree of uneasiness, for two main reasons: first, the number of tumor entities and tumor-like lesions in the testes and scrotum is relatively large and their histopathologic classification is complex and second, case volume of scrotal studies for non-emergency indications may be relatively low in some centers. […] The first key to a meaningful radiology report is to be aware of the clinical indication for which the imaging study was requested. […] About one third of scrotal/testicular malignancies can present with scrotal pain. […] In this scenario, the first and most important task of imaging is localizing the mass to differentiate testicular from extra-testicular origin.

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