THE PATHOLOGIC, CLINICAL AND 

 BIOCHEMICAL CORRELATION OF TUMORS 



OF THE TESTIS 



Introduction 



TUMORS of the testis always have presented a confusing picture. Their patho- 

 genesis remains uncertain and they have never been classified satisfactorily. 

 When the contemporary pathologic, clinical, and biochemical contributions, 

 however, are brought into relation with each other, a clearer picture is pre- 

 sented than ever before. 



As elsewhere a neoplasm may arise in the testis from any tissue cell present 

 there and may be benign or malignant. For practical purposes, however, they 

 are all malignant, so exceptional are the benign tumors. In earlier pathologic 

 studies homologous or monocellular growths were distingiushed from heterol- 

 ogous or multicellidar growths and in each group certain types were defined. 

 At first, the tumor of the one-cell pattern was identified commonly as a sar- 

 coma. Now we know that a pure mesoblastic growth of the testis is very rare. 

 These same monocellular tumors were next designated as seminomata or 

 spermatocytomata, unrelated to sarcoma, and supposedly originating from 

 sperm cells. More recently they have been called either embryonal carcinoma, 

 with or without lymphoid stroma, or large clear-cell carcinoma, and the origin 

 of any of them from adult sperm cells is questioned. The tumors of variegated- 

 cell pattern, the mixed or heterologous growths called teratomata, were 

 grouped as benign or malignant and the latter were subdivided according to 

 the type of malignant cell. Such types, for example, as adenocarcinoma, 

 spheroidal-cell scirrhous carcinoina, etc., and chorionepithelioma were rec- 

 ognized. This dual classification with its subdivisions proved most unsatisfac- 

 tory. Now and then a tumor appeared which failed to fit into any part of the 

 classification. Years ago Ewing suggested that all testicular tumors, with the 

 obvious few exceptions, probably arose from a totipotent cell. Recent clinical 

 observations confirm this view^ Perhaps tumors of the testis may better be 

 regarded by the clinician not only as malignant but as being one tvpe of 

 growth, the varieties arising from the different stages or phases of transition 

 at which they are observed. In teratoma, groups of cells are found which are 

 identical with the common unicellular types, and frequently careful exami- 

 nation of serial sections of the supposedly pure-cell type uncovers other \ ari- 

 eties of cell, thus proving its heterogenicity. Distinction between the one-cell 

 and the mixed-cell patterns serves no practical purpose. Rather, confusion 

 arises in attempting such distinction. Of much more clinical value is the 

 microscopic recognition of primitive or adult characteristics. The primitive 

 cell is embryonal in appearance, the adult cell seems fully differentiated. Even 



C 237 1 



