Testicular cancer differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shadan Mehraban, M.D.[2]


Testicular cancer must be differentiated from epididymitis, hematocele, hydrocele, spermatocele, granulomatous orchitis, and varicocele.

Differentiating Testicular cancer from other Diseases


AFP: Alpha-fetoprotein, B-hCG: Beta-human chorionic gonadotropin, P-ALP: Placental- Alkaline phosphatase

Diseases Benign/ Malignant Unilateral/Bilateral History/demography Metastasis Genetics Clinical manifestations Para-clinical findings
Symptoms Physical examination Lab findings Imaging Histopathology
Pain Mass AFP Beta hCG p-ALP
Germ Cell tumors
Seminoma[1][2] Stains positively for: - + N/A N/A Ultrasound
Embryonal carcinoma[3] Early metastasis to: Stains positively for:

May stain positively for :

+ ± ↑* N/A Ultrasound
Yolk sac tumor[4][5]
  • Unilateral
  • Uncommon
Stains positively for: + + N/A N/A Ultrasound


  • Schiller-Duval bodies (perivascular structures)
  • Hyaline-type globules
  • Unilateral
  • May present in both prepubertal and adult men
  • Uncommon in benign ones among prepubertal men

Stains positively for:

- + N/A Ultrasound
Choriocarcinoma[8][9] Early metastasis: Stains positively for: + ± N/A N/A Ultrasound
Mixed germ cell tumors[10][11]
  • Unilateral
  • May stain positive based on underlying components
± + N/A
  • Imaging findings based on underlying components
Carcinoma in situ (intratubular germ cell neoplasia )[12][13][14]
  • Unilateral
  • Bilateral

Stain positively for:

- -
  • N/A
  • N/A
Diseases Benign/ Malignant Unilateral/Bilateral History/Demography Metastasis Genetics Pain Mass Physical exam AFP Beta hCG p-ALP Imaging Histopathology
Non-germ cell tumors
Leydig cell tumor[15]
  • Unilateral

Stains positively for:

- + N/A N/A N/A Ultrasound
Sertoli cell tumor ( Androblastoma)[16][17][18]
  • Unilateral
  • Bilateral
Stain positively for: - + N/A N/A N/A Ultrasound
  • Large cell calcifying variant
  • Hypoechoic
Testicular lymphoma[19][20][21]
  • Unilateral
  • Bilateral ( mostly up to 35% of cases)
Common metastasis to : Stains positively for: - + ↑ or ↓ ↑ or ↓ N/A Ultrasound
Granulosa cell tumors[22][23]
  • Unilateral

Juvenile type associated with:

Stains positively for: - + N/A N/A N/A Ultrasound

* May stain positively when mixed.


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  2. Miller FH, Whitney WS, Fitzgerald SW, Miller EI (1999). "Seminomas complicating undescended intraabdominal testes in patients with prior negative findings from surgical exploration". AJR Am J Roentgenol. 172 (2): 425–8. doi:10.2214/ajr.172.2.9930796. PMID 9930796.
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