ATYPICAL PRESENTING SYMPTOMS IN PATIENTS WITH TESTICULAR GERM-CELL TUMORS

The cardinal syndrome of a testicular germ cell tumour is typically sc rotal enlargement. The present paper compares the group of patients wi th typical scrotal presentation and those who present with atypical sy mptoms caused by metastases. Among 284 retrospectively studied patient s, 34 (12%) presented with extrascrotal symptoms. The most important w ere abdominal pain (n=16) and pulmonary symptoms (n=10). The group of patients with extrascrotal symptoms was characterized by the following parameters: percentage of pure seminoma in 35% (versus 56% in the pat ients with typical presentation), elevation of alpha-fetoprotein in 47 % (versus 27%), and elevation of beta-HCG in 61% (versus 29%). The out come was letal in 35% of the patients with atypical presentation, as o pposed to 6% of those with typical presentation. In 22 patients with e xtrascrotal presenting signs a palpable testicular mass was found on c linical examination. Occult testicular tumour proved to be present in 9 patients, and burned-out tumours in 3. Unawareness of testicular can cer is a significant factor in diagnostic delay. Scrotal palpation sho uld be part of every clinical examination in younger male patients wit h cancer from an unknown primary.