24-2 Tumors o£ the Testis 



Clinical 



Although found at all ages, tumors of the testis occur most frequently in 

 early adult life, mostly between the ages of 20 and 40 years. As might be ex- 

 pected, most of the tumors occurring in infants and boys are of the mixed- 

 cell type (teratomata). As a rule all tumors run a rapid course and death is 

 frequent within a year from the time of discovery. Occasionaly a malignant 

 timior has been present for two or three years before the patient has sought 

 medical advice, but the accuracy of the patient's observation in respect to onset 

 may well be questioned as there may have been another condition to start with 

 and the tumor have appeared secondarily. On rare occasions the primary 

 growth in the testis could not be discovered on physical examination before 

 metastases appeared. Some of these patients came to autopsy and the true 

 nature of the metastases were then discovered. In a few instances, in our own 

 experience, biopsy of metastases disclosed the character of the growth and 

 subsequent careful physical examination of the testis revealed a suspicious 

 nodule, or it was found after orchidectomy. All these hidden growths were 

 chorionepitheliomata. Clinical diagnosis is based solely on the findings made 

 by palpation except in the rare instances of a high content of hormone in 

 the urine with negative findings on palpation. Ordinarily the testicle and its 

 epididymis are distinguishable. In small growths an area of induration can 

 be made out, but in larger growths the general shape of the testicle, as a rule, 

 is maintained as in gumma. The examiner receives the impression, however, 

 of an increase in weight or perhaps more nearly an increase in the specific 

 gravity of the enlarged testicle. Even in advanced growths the epididymis can 

 still be separated from the mass and difficulties in differential diagnosis usually 

 arise only when this becomes impossible, or when gumma is present, or when 

 the condition is complicated by coexistant hydrocele, epididymitis, etc. Care- 

 ful search for metastases should always be made. The earliest site of metastasis 

 of tumor of the testicle is the preaortic lymph zone but the time of occurrence 

 is so uncertain that this fact has been abandoned as an indication for radical 

 operation (orchidectomy with complete removal of the primary lymph zone 

 of that side). Clinically it may be found that cells have crossed to the opposite 

 lymph zone without giving evidence of their presence in the primary one. In 

 one patient recently a large tumor developed on the right side months after 

 a left orchidectomy for tumor of the testis. Supraclavicular glands on the left 

 appeared a year after the removal of this retroperitoneal metastasis, at which 

 time no masses could be felt on the other (left) side of the aorta and vena cava. 

 In fact, metastases to the supraclavicular gioup of glands called "Virchow's 

 nodes" are not at all infrequent with tumors of the testis. Metastases also 

 occur to the viscera by way of the blood vessels. It is of course important to 

 determine at the time of examination the presence or absence of any of these 

 types of metastasis as well as their extent. 



The treatment of tumors of the testis has narrowed itself to simple orchidec- 



