CRYPTIC PRESENTATIONS OF GERM-CELL TUMORS

The records of 636 patients who were treated for carcinoma of the test is were reviewed. Of these patients, 61 (9.6 percent) presented with e xtratesticular complaints. In order of decreasing frequency, the compl aints were pain (abdominal, back or groin), gynecomastia or mastodynia , pulmonary complaints, enlarged lymph nodes or a nontesticular mass, swelling of the lower extremity or neurologic changes. A substantial n umber of these patients were initially misdiagnosed and underwent a su rgical procedure. Of importance, most of these patients had either abn ormal testicular examination results, elevated markers or a history of cryptorchidism. The data suggest that patients with germ cell tumors, even when presenting with cryptic complaints, can readily be diagnose d if a high level of suspicion is maintained, a careful testicular exa mination is performed and tumor markers obtained. This frequently make s a diagnostic abdominal exploration or other surgical interventions u nnecessary.