Testicular carcinoma most commonly presents as a testicular mass. Approxiately 10-15% of patients, however, present with manifestations of metastatic disease. The reported clinical presentations of metastatic testicular carcinoma are varied and include abdominal mass, hemoptysis, adenopathy, respiratory difficulty, anorexia, nausea, vomiting, lumbar back pain, and lower extremity swelling. A comprehensive review of the literature indicated that testicular carcinoma presents as a testicular abnormality 90% of the time. In 10% of cases, however, the patients will present with nontesticular manifestations of metastatic disease. The authors provide a summary of reported nontesticular presentations of testis cancer and describe a unique case wherein the clinical presentation was spontaneous ejaculatory failure.
1. Sarosdy M: Testicular cancer: An overview. In, Crawford ED, Das, S (eds.): Current Genitourinary Cancer Surgery. Philadelphia: Lea and Febiger, 1990;306-318.
2.
2. BosI GE, Goldman A, Lance PH: Impact of delay in diagnosis on clinical stage of testicular cancer. Lancet1981;2:970-972.
3.
3. Richie JP: Advances in the diagnosis and treatment to testicular cancer. Cancer Investigation1993; 1 (6):670-675.
4.
4. Peretsman SJ, Thompson IM Jr: Cryptic presentation of germ cell tumors. J Am Coll Surg1994;178:261-265.
5.
5. Bennet CJ, Seager SW, Vasher EA, McGuire EJ: Sexual dysfunction and electroejaculation in men with spinal cord injury: Review. J Urol1988; 139:453-457.
6.
6. Raina V, Shukla NK, Rath GK, et al: Clinical profile and problems of management of 108 cases of germ cell tumours of testis at Insitiute Rotary Cancer Hospital, All India Institute of Medical Sciences New Delhi 1985-1990. Brj Cancer1993;67:573-577.
7.
7. Dieckmann KP, Becker T, Bauer HW: Testicular tumors: Presentation and role of diagnostic delay. Urol Int1987; 42(4):241-247.
8.
8. EI-senoussi MA, Bissada NK, El-Akkad S, Bedikian AY, Morcos R, Bull C: Epidemiology and clinical characteristics of testicular tumors in Saudi Arabia: King Faisal Specialist Hospital and Research Centre Experience. J Surg Oncol1987;35:39-41.
9.
9. Sandeman TF: Symptoms and early management of germinal tumours of the testis. Med JAust1979;2:281-284.
10.
10. Baldetorp L-A, Henrikson H, Ingemansson S, Ling L: Tumours of the testis. Int Urol Nephrol1976;8(4):295-307.
11.
11. Cantwell B, Mannix KA, Harris AL: Back pain A presentation of metastatic testicular germ cell tumours. Lancet1987;1:262-264.
13. Gleason PE, Elliott DS, Zimmerman D, Smithson WA, Kramer SA: Metastatic testicular choriocarcinoma and secondary hyperthyroidism: case report and review of the literature. J Urol1994;151:1063-1064.
14.
14. Sharifi R, Ray P. Schade SG, Lee M: Inferior vena cava thrombosis: Unusual presentation of testicular tumor. Urology1988;32(2):146-150.
15.
15. Cantwell BMJ, Richardson PG, Campbell SJ: Gynaecomastia and extragonadal symptoms leading to diagnosis delay of germ cell tumours in you men. Postgrad Med J1991;67:675-677.
16.
16. Flood JG, Lightman SL, Francic N: Unusual presentation of a testicular tumour. BrJ Urol1991;68:549-556.
17.
17. Veen HF, Bruining HA: Gastrointestinal bleeding and malignancy of the testis. Acta Chir Scand1979;145:363-365.
18.
18. Stokes EW, Perkins C: Testicular choriocarcinoma: An unusual presentation as occult gastrointestinal blood loss. J Adolesc Health Care1988; 10: 146-150.
19.
19. Evans CC, Kaufman HD: Unusual presentation of seminoma of the Testis. BrJ Surg1971;58(9):703-704.
20.
20. Borge N, Fossa SD, Stenwig AE: Metastatic testicular cancer and extrgonadal germ cell tumor presenting with neurological symptoms. J Neurooncol1990; 8:145-148.
21.
21. Ahern GL, O'Connor M, Dalmau J, et al: Paraneoplastic temporal lobe epilepsy with testicular neoplasm and atypical amnesia. Neurology1994;44:1270-1274.
22.
22. Fung LCT, Honey RJ, Gardiner GW: Testicular seminoma presenting with features of androgen excess. Urology1994;44(6):927-930.
24. McGowan MP, Pratter MR, Nash G: Primary testicular choriocarcinoma with pulmonary metastases presenting as ARDS. Chest1990;97:1258-1259.
25.
25. Moul W, Moellman JR: Unnecessary mastectomy for gynecomastia in testicular cancer patient. Mil Med1992; 157(8):443-434.
26.
26. Geffen DB, Kaneti J, Hendler N, Hertzanu Y: Testicular carcinoma with inferior vena cava thromboisis extending into the right atrium treated with chemotherapy and anticoagulation. Eur Urol1992;21:82-84.
28. Bennet CJ, Ohi DA: Electroejaculation after retroperitoneal lymph node disection. Adv Urology1989;2:89-96.
29.
29. Thornhill JA, Fennelly JJ, Kelly DG, Walsh A, Fitzpatrick JM: Patients' delay in the presentation of testis cancer in Ireland. Brj Urol1987;59:447-451.
30.
30. Schults HP, Arends J, et al: Testicular carcinoma in Denmark 1976-1980. Acta Radiol Oncol1984; 23: 249-253.
31.
31. Stein M, Reisner S, et al: Intracardiac mass as the initial manifestation of metastatic germ cell tumor. Int J Cardiol1994;45:230-232.
32.
32. Perez MJ: Testicular tumor presenting with torsion of the testicle. J Urol1990; 144:995-996.
