Treatment of Malignant Tumors of the Testis

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The incidence of malignant testicular tumors is relatively low. It has been estimated by Cade that they constitute 1 to 1.5 per cent of all malignant tumors in males and that they make up about 3 per cent of neoplasms of the genito-urinary tract. Pack and LeFevre reported an incidence of 1 per cent among 16,565 patients with malignant tumors seen at Memorial Hospital, New York, while Dean at the same institute in 1935 found 2.09 per cent of all malignant neoplasms in males to be testicular tumors. In regard to all male hospital admissions, it may be mentioned that Tanner in 1922 found one testicular tumor for every 2,000 patients. The present study is based on the tumors of the testis treated at the University of Minnesota Hospitals from 1926 to 1943 inclusive. The total number amounted to 100 and they were placed in three groups: 34 cases were not classified as to type, while 37 were seminomas and 29 were carcinomatous mixed tumors. Etiology The average age in this series was for seminoma 37.6 years and for carcinomatous mixed tumors 29.4 years. This is in agreement with the statement of Cade that teratomatous tumors occur chiefly between twenty and forty years, and the seminomas between thirty and fifty. A history of trauma was obtained in 15 per cent of the cases. This is somewhat lower than in series reported by other authors. Russell Howard obtained a history of trauma in 5 cases out of 27, Nash and Leddy in 21 out of 103. The figures of some authors are as high as 50 per cent. Cryptorchidism was present in 8 cases. Nash and Leddy reported an incidence of 8.7 per cent and Dean found 35 cases in a series of 245, or 14.3 per cent. Hydrocele was observed in 6 patients, and in 3 of these a malignant tumor of the testis was discovered during the operation for hydrocele. Classification Classification of malignant tumors of the testis is a confused subject, and opinions vary greatly. At the University of Minnesota Hospitals we follow E. T. Bell's classification. Bell states: “Testicular tumors may be divided into four groups: adult teratomas, carcinomatous mixed tumors, seminomas, and chorionepitheliomas. “1. Adult teratomas may be typical dermoid cysts containing hair, fatty material, teeth, etc., or they may consist of many small cysts separated by solid tissue. These tumors are rare, develop slowly over many years, and offer relatively good prognosis. “2. Carcinomatous mixed tumors are soft cellular growths consisting chiefly of epithelium in form of cysts or solid masses of carcinomatous structure. Cartilage and myxomatous tissue may be found scattered through the tumor. “3. Seminoma is the most common form of testicular neoplasm. It consists chiefly of rounded or polyhedral clear cells arranged in thick solid cords and bearing some resemblance to testicular tubules. Little or no cartilage is present. “4. Chorionepithelioma is a malignant tumor arising from chorionic epithelium.