Question

Testicular cancer is the most common malignant tumor affecting adolescent young men. Testicular tumors are solid growths of malignant cells and are not fluid-filled cystic structures, a characteristic that figures into the patient’s initial evaluation. Testicular cancers have several histological appearances, but almost all are curable if detected early.

AJ is a 26-year-old, recent college graduate who has just begun working for a startup software company and really likes the job. When not behind a computer, he’s either on his bike or out hiking. Several months ago, while showering, he noticed that his left testicle seemed slightly larger than his right. There was no pain and no obvious mass, so he decided to wait and see if things would change. About a month later, it had become obvious that his left testicle had continued to increase in size, but still there was no pain or redness. As a fan of Lance Armstrong, he knew of Lance’s testicular malignancy, so he called his doctor. After mentioning the reason for his call, he was given an appointment the next day

Diagnosis

Read the report and answer questions.

The doctor’s examination confirmed that AJ’s left testicle was larger than the right and a distinct mass was evident. Then the doctor did an interesting thing. He took a small flashlight and placed it behind AJ’s scrotal mass so as to shine light through the area of testicular enlargement. With the room lights turned off, the flashlight made a powerful beam. However, the mass did not glow (transilluminate). The doctor was checking to see if the mass was a fluid-filled cyst (almost certainly benign), or a solid growth (highly suspicious for malignancy). The complete lack of any transmission of light indicated the mass was indeed a solid tumor. (Photo shows an example of transillumination of a benign scrotal cyst in a young child.)

AJ’s doctor arranged for an ultrasound of the scrotal mass, which showed it to be a solid tumor largely replacing the left testicle. A detailed ultrasound of the right testis showed no abnormality. Three days later, AJ had his left testis and about six inches of his left spermatic cord surgically removed. Microscopic examination of the tumor confirmed it was malignant.

AJ’s tumor proved to be one of the more common types, a seminoma, and a computerized tomography (CT) scan of his abdomen did not show evidence of lymphatic spread. Because the testes develop within the abdomen, and during embryogenesis migrate to the scrotum, they pull their vascular and lymphatic supply along with them. This means that tumors arising in a testis will spread by lymphatic channels that go directly into the abdomen and retroperitoneum.

1. What is the cause of AJ’s testicular malignancy?
2. The cause of testicular malignancy is?

Answer 1