Gynecomastia: An Uncommon but Important Clinical Manifestation for Testicular Tumors
Zhanyong Bing, Shuting Bai
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DOI: 10.4236/ojpathology.2012.21002   PDF    HTML     12,344 Downloads   21,604 Views   Citations

Abstract

Abstract: Gynecomastia is a benign enlargement of male breast tissue due to the proliferation of the ductal component. It can be physiological or pathological. Gynecomastia can be a sign for testicular tumors including sex-cord stromal tumors and germ cell tumors. Testicular physical examination in combination with testicular untrasonography and serum germ cell tumor markers when necessary in the presence of gynecomastia can help to reach a correct diagnosis.

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Z. Bing and S. Bai, "Gynecomastia: An Uncommon but Important Clinical Manifestation for Testicular Tumors," Open Journal of Pathology, Vol. 2 No. 1, 2012, pp. 6-13. doi: 10.4236/ojpathology.2012.21002.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] G. D. Braunstein, “Diagnosis and Treatment of Gynecomastia,” Hospital Practice, Vol. 28, No. 10A, pp. 37-46.
[2] G. D. Braunstein, “Clinical Practice, Gynecomastia,” New England Journal of Medicine, Vol. 357, No. 12, 2007, pp. 1229-1237. doi:10.1056/NEJMcp070677
[3] R. E. Johnson, C. A. Kermott and M. H. Murad, “Gynecomastia: Evaluation and Current Treatment Options,” Journal of Therapeutics and Clinical Risk Management, Vol. 7, 2011, pp. 145-148.
[4] H. E. Carlson, P. Kane, Z. M. Lei, X. Li and C. V. Rao, “Presence of Luteinizing Hormone/Human Chorionic Gonadotropin Receptors in Male Breast Tissues,” Journal of Clinical Endocrinology, Vol. 89, No. 8, 2004, pp. 4119-4123. doi:10.1210/jc.2003-031882
[5] J. D. Wilson, “Gynecomastia: A Continuing Diagnostic Dilemma,” New England Journal of Medicine, Vol. 324, No. 5, 1991, pp. 334-335. doi:10.1056/NEJM199101313240510
[6] H. C. Hassan, I. M. Cullen, R. G. Casey and E. Rogers, “Gynaecomastia: An Endocrine Manifestation of Testicular Cancer,” Andrologia, Vol. 40, No. 3, 2008, pp. 152-157. doi:10.1111/j.1439-0272.2007.00815.x
[7] O. M. Al-Agha and C. A. Axiotis, “An In-Depth Look at Leydig Cell Tumor of the Testis,” Archives of Pathology & Laboratory Medicine, Vol. 131, No. 2, 2007, pp. 311-317.
[8] M. A. Rich and M. A. Keating, “Leydig Cell Tumors and Tumors Associated with Congenital Adrenal Hyperplasia,” Urologic Clinics of North America, Vol. 27, No. 3, 2000, pp. 519-528. doi:10.1016/S0094-0143(05)70099-9
[9] N. Suardi, E. Strada, R. Colombo, M. Freschi, A. Salonia, C. Lania, A. Cestari, L. Carmignani, G. Guazzoni, P. Rigatti and F. Montorsi, “Leydig Cell Tumour of the Testis: Presentation, Therapy, Long-Term Follow-Up and the Role of Organ-Sparing Surgery in a Single-Institution Experience,” British Journal of Urology International, Vol. 103, No. 2, 2009, pp. 197-200. doi:10.1111/j.1464-410X.2008.08016.x
[10] L. Carmignani, R. Salvioni, F. Gadda, M. Colecchia, G. Gazzano, T. Torelli, F. Rocco, G. M. Colpi and G. Pizzocaro, “Long-Term Follow-Up and Clinical Characteristics of Testicular Leydig Cell Tumor: Experience with 24 Cases,” Journal of Urology, Vol. 176, No. 5, 2006, pp. 2040-2043. doi:10.1016/j.juro.2006.07.005
[11] D. S. Conkey, G. C. Howard, K. M. Grigor, D. B. McLaren and G. R. Kerr, “Testicular Sex Cord-Stromal Tumours: The Edinburgh Experience 1988-2002, and a Review of the Literature,” Clinical Oncology, Vol. 17, No. 5, 2005, pp. 322-327. doi:10.1016/j.clon.2005.04.009
[12] I. Kim, R. H. Young and R. E. Scully, “Leydig Cell Tumors of the Testis. A Clinicopathological Analysis of 40 Cases and Review of the Literature,” American Journal of Surgical Pathology, Vol. 9, No. 3, 1985, pp. 177-192. doi:10.1097/00000478-198503000-00002
[13] S. D. Billings, L. M. Roth and T. M. Ulbright, “Microcystic Leydig Cell Tumors Mimicking Yolk Sac Tumor: A Report of Four Cases,” American Journal of Surgical Pathology, Vol. 23, No. 5, 1999, pp. 546-551. doi:10.1097/00000478-199905000-00008
[14] J. C. Cheville, T. J. Sebo, D. J. Lager, D. G. Bostwick and G. M. Farrow, “Leydig Cell Tumor of the Testis: A Clinicopathologic, DNA Content, and MIB-1 Comparison of Non Metastasizing and Metastasizing Tumors,” American Journal of Surgical Pathology, Vol. 22, No. 11, 1998, pp. 1361-1367. doi:10.1097/00000478-199811000-00006
[15] R. H. Young, “Testicular Tumors—Some New and a Few Perennial Problems,” Archives of Pathology & Laboratory Medicine, Vol. 132, No. 4, 2008, pp. 548-564.
[16] G. J. Bosl and R. J. Motzer, “Testicular Germ-Cell Cancer,” New England Journal of Medicine, Vol. 337, No. 4, 1997, pp. 242-253. doi:10.1056/NEJM199707243370406
[17] G. D. Braunstein, “Gynecomastia,” New England Journal of Medicine, Vol. 328, No. 7, 1993, pp. 490-495. doi:10.1056/NEJM199302183280708
[18] L. Foppiani, D. Bernasconi, P. Del Monte, A. Marugo, C. Toncini and M. Marugo, “Leydig Cell Tumour-Induced Bilateral Gynaecomastia in a Young Man: Endocrine Abnormalities,” Andrologia, Vol. 37, 2005, pp. 36-39. doi:10.1111/j.1439-0272.2004.00648.x
[19] S. Zarrilli, G. Lombardi, L. Paesano, C. Di Somma, A. Colao, V. Mirone and M. De Rosa, “Hormonal and Seminal Evaluation of Leydig Cell Tumour Patients before and after Orchiectomy,” Andrologia, Vol. 32, No. 3, 2000, pp. 147-154. doi:10.1046/j.1439-0272.2000.00356.x
[20] M. Fijak, S. Bhushan and A. Meinhardt, “Immunoprivileged Sites: The Testis,” Methods in Molecular Biology, Vol. 677, 2011, pp. 459-470. doi:10.1007/978-1-60761-869-0_29
[21] R. H. Young, “Sex Cord-Stromal Tumors of the Ovary and Testis: Their Similarities and Differences with Consideration of Selected Problems,” Modern Pathology, Vol. 18, Suppl. 2, 2005, pp. S81-S98. doi:10.1038/modpathol.3800311
[22] R. H. Young, D. D. Koelliker and S. E. Scully, “Sertoli Cell Tumors of the Testis, not Otherwise Specified: A Clinicopathologic Analysis of 60 Cases,” American Journal of Surgery Pathology, Vol. 22, No. 6, 1998, pp. 709-721. doi:10.1097/00000478-199806000-00008
[23] J. D. Henley, R. H. Young and T. M. Ulbright, “Malignant Sertoli Cell Tumors of the Testis: A Study of 13 Examples of a Neoplasm Frequently Misinterpreted as Seminoma,” American Journal of Surgery Pathology, Vol. 26, No. 5, 2002, pp. 541-550. doi:10.1097/00000478-200205000-00001
[24] T. D. Jones, T. M. Ulbright, J. N. Eble, L. A. Baldridge and L. Cheng, “OCT4 Staining in Testicular Tumors: A Sensitive and Specific Marker for Seminoma and Embryonal Carcinoma,” American Journal of Surgery Pathology, Vol. 28, No. 7, 2004, pp. 935-940. doi:10.1097/00000478-200407000-00014
[25] D. Cao, J. Li, C. C. Guo, R. W. Allan and P. A. Humphrey, “SALL4 is a Novel Diagnostic Marker for Testicular Germ Cell Tumors,” American Journal of Surgery Pathology, Vol. 33, No. 7, 2009, pp. 1065-1077. doi:10.1097/PAS.0b013e3181a13eef
[26] I. Gashaw, O. Dushaj, R. Behr, K. Bierman, R. Brehm, H. Rubben, R. Grobholz, K. W. Schmid, M. Bergmann and E. Winterhager, “Novel Germ Cell Markers Characterize Testicular Seminoma and Fetal Testis,” Molecular Human Reproduction, Vol. 13, No. 10, 2007, pp. 721-727. doi:10.1093/molehr/gam059
[27] E. C. Jones, S. K. Murray and R. H. Young, “Cysts and Epithelial Proliferations of the Testicular Collecting System,” Seminars in Diagnostic Pathology, Vol. 17, No. 4, 2000, pp. 270-293.
[28] C. A. Stratakis, “Clinical Genetics of Multiple Endocrine Neoplasias, Carney Complex and Related Syndromes,” Journal of Endocrinological Investigation, Vol. 24, No. 5, 2001, pp. 370-383.
[29] S. S. Kratzer, T. M. Ulbright, A. Talerman, J. R. Srigley, L. M. Roth, G. R. Wahle, M. Moussa, J. K. Stephens, A. Millos and R. H. Young, “Large Cell Calcifying Sertoli Cell Tumor of the Testis: Contrasting Features of Six Malignant and Six Benign Tumors and a Review of the Literature,” American Journal of Surgery Pathology, Vol. 21, No. 11, 1997, pp. 1271-1280. doi:10.1097/00000478-199711000-00002
[30] B. Chang, J. G. Borer, P. E. Tan and D. A. Diamond, “Large-Cell Calcifying Sertoli Cell Tumor of the Testis: Case Report and Review of the Literature,” Urology, Vol. 52, No. 3, 1998, pp. 520-522. doi:10.1016/S0090-4295(98)00246-5
[31] F. F. Nogales, M. Andujar, A. Zuluaga and J. L. Garcia-Puche, “Malignant Large Cell Calcifying Sertoli Cell Tumor of the Testis,” Urology, Vol. 153, No. 6, 1995, pp. 1935-1937. doi:10.1016/S0022-5347(01)67361-0
[32] T. M. Ulbright, M. B. Amin and R. H. Young, “Intratubular Large Cell Hyalinizing Sertoli Cell Neoplasia of the Testis: A Report of 8 Cases of a Distinctive Lesion of the Peutz-Jeghers Syndrome,” American Journal of Surgery Pathology, Vol. 31, No. 6, 2007, pp. 827-835. doi:10.1097/PAS.0b013e3180309e33
[33] G. D. Braunstein, “Aromatase and Gynecomastia,” Endocrine-Related Cancers, Vol. 6, No. 2, 1999, pp. 315- 324. doi:10.1677/erc.0.0060315
[34] E. Harris, P. Mahendra, H. H. McGarrigle, D. C. Linch and R. Chatterjee, “Gynaecomastia with Hypergonadotrophic Hypogonadism and Leydig Cell Insufficiency in Recipients of High-Dose Chemotherapy or Chemo-Radiotherapy,” Bone Marrow Transplant, Vol. 28, No. 12, 2001, pp. 1141-1144. doi:10.1038/sj.bmt.1703302
[35] H. Barroca, M. J. Gil-da-Costa and C. Mariz, “Testicular Juvenile Granulosa Cell Tumor: A Case Report,” Acta Cytologica, Vol. 51, No. 4, 2007, pp. 634-636. doi:10.1159/000325815
[36] R. Fagin, E. Berbescu, S. Landis, K. Strumpf and U. Patil, “Juvenile Granulosa Cell Tumor of the Testis,” Urology, Vol. 62, No. 2, 2003, p. 351. doi:10.1016/S0090-4295(03)00355-8
[37] F. Gun, B. Erginel, I. Klcaslan, S. Anak, O. Ziylan and A. Celik, “A Rare Neonatal Testicular Tumor: Juvenile Granulosa Cell Tumor of Infant Testis: A Report of 3 Cases,” Journal of Pediatric Hematology/Oncology, Vol. 32, No. 4, 2010, pp. E158- E159. doi:10.1097/MPH.0b013e3181d69afa
[38] K. H. Hammerich, S. Hille, G. E. Ayala, T. M. Wheeler, R. Engers, R. Ackermann and V. Mueller-Mattheis, “Malignant Advanced Granulosa Cell Tumor Ofthe Adult Testis: case Report and Review of the Literature,” Human Pathology, Vol. 39, No. 5, 2008, pp. 701-709. doi:10.1016/j.humpath.2007.09.015
[39] J. A. Hanson and A. B. Ambaye, “Adult Testicular Granulosa Cell Tumor: A Review of the Literature for Clinicopathologic Predictors of Malignancy,” Archives of Pathology & Laboratory Medicine, Vol. 135, No. 1, 2011, pp. 143-146.
[40] I. A. Al-Bozom, S. R. El-Faqih, S. H. Hassan, A. E. El-Tiraifi and R. F. Talic, “Granulosa Cell Tumor of the Adult Type: A Case Report and Review of the Literature of a Very Rare Testicular Tumor” Archives of Pathology & Laboratory Medicine, Vol. 124, No. 10, 2000, pp. 1525-1528.
[41] J. Arzola, R. L. Hutton, S. M. Baughman and R. V. Mora, “Adult-Type Testicular Granulosa Cell Tumor: Case Report and Review of the Literature,” Urology, Vol. 68, No. 5, 2006, pp. E13-E16. doi:10.1016/j.humpath.2007.09.015
[42] P. Ditonno, G. Lucarelli, M. Battaglia, V. Mancini, S. Palazzo, S. Trabucco, C. Bettocchi and F. Paolo Selvaggi, “Testicular Granulosa Cell Tumor of Adult Type: A New Case and a Review of the Literature,” Urology Oncology, Vol. 25, No. 4, 2007, pp. 322-325. doi:10.1016/j.urolonc.2006.08.019
[43] T. Guzzo, M. Gerstein and J. H. Mydlo, “Granulosa Cell Tumor of the Contralateral Testis in a Man with a History of Cryptorchism,” Urology, Vol. 72, No. 1, 2004, pp. 85-87. doi:10.1159/000075281
[44] M. Hisano, F. M. Souza, D. M. Malheiros, A. C. Pompeo and A. M. Lucon, “Granulosa Cell Tumor of the Adult Testis: Report of a Case and Review of the Literature,” Clinics, Vol. 61, No. 1, 2006, pp. 77-78. doi:10.1590/S1807-59322006000100013
[45] J. I. Lopez, “Adult-Type Granulosa Cell Tumor of the Testis: Report of a Case,” Tumori, Vol. 93, No. 2, 2007, pp. 223-224.
[46] A. Suppiah, M. M. Musa, D. R. Morgan and A. D. North, “Adult Granulosa Cell Tumour of the Testis and Bony Metastasis: A Report of the First Case of Granulosa Cell Tumour of the Testicle Metastasising to Bone,” Urology, Vol. 75, No. 1, 2005, pp. 91-93. doi:10.1159/000085936
[47] B. Y. Wang, D. S. Rabinowitz, R. C. Granato Sr. and P. D. Unger, “Gonadal Tumor with Granulosa Cell Tumor Features in an Adult estis,” Diagnostic Pathology, Vol. 6, No. 1, 2002, pp. 56-60. doi:10.1053/adpa.2002.30607
[48] J. Cohen and I. Diamond, “Leontiasis Ossea, Slipped Epiphyses, and Granulosa Cell Tumor of Testis with Renal Disease: Report of a Case with Autopsy Findings,” AMA Arch Pathology, Vol. 56, No. 5, 1953, pp. 488-500.
[49] J. Matoska, D. Ondrus and A. Talerman, “Malignant Granulosa Cell Tumor of the Testis Associated with Gynecomastia and Long Survival,” Cancer, Vol. 69, No. 7, 1992, pp. 1769-1772. doi:10.1002/1097-0142(19920401)69:7<1769::AID-CNCR2820690719>3.0.CO;2-V
[50] F. K. Mostofi, E. A. Theiss and D. J. Ashley, “Tumors of Specialized Gonadal Stroma in Human Male Patients, Androblastoma, Sertoli Cell Tumor, Granulosa-Theca Cell Tumor of the Testis, and Gonadal Stromal Tumor,” Cancer, Vol. 12, 1959, pp. 944-957. doi:10.1002/1097-0142(195909/10)12:5<944::AID-CNCR2820120515>3.0.CO;2-T
[51] F. K. Mostofi and V. M. Bresler, “Tumours of the Testis,” IARC Scientific Publications, Bhopal, 1976.
[52] L. P. Jimenez-Quintero, J. Y. Ro, A. Zavala-Pompa, M. B. Amin, B. Tetu, N. G. Ordonez and A. G. Ayala, “Granulosa Cell Tumor of the Adult Testis: A Clinicopathologic Study of Seven Cases and a Review of the Literature,” Human Pathology, Vol. 24, No. 10, 1993, pp. 1120-1125. doi:10.1016/0046-8177(93)90193-K
[53] S. T. Schumer and S. A. Cannistra, “Granulosa Cell Tumor of the Ovary,” Journal of Clinical Oncology, Vol. 21, No. 6, 2003, pp. 1180-1189. doi:10.1200/JCO.2003.10.019
[54] M. P. Laguna, G. Pizzocaro, O. Klepp, F. Algaba, L. Kisben” European Urology, Vol. 40, No. 2, 2001, pp. 102-110. doi:10.1159/000049759
[55] P. Albers, W. Albrecht, F. Algaba, C. Bokemeyer, G. Cohn-Cedermark, A. Horwich, O. Klepp, M. P. Laguna and G. Pizzocaro, “Guidelines on Testicular Cancer” European Urology, Vol. 48, No. 6, 2005, pp. 885-894. doi:10.1016/j.eururo.2005.06.019
[56] S. P. Bowers, N. W. Pearlman, R. C. McIntyre Jr., C. A. Finlayson and S. Huerd, “Cost-Effective Management of Gynecomastia,” American Journal of Surgery 1, Vol. 176, No. 6, 1998, pp. 638-641.
[57] I. R. Daniels and G. T. Layer, “Testicular Tumours Presenting as Gynaecomastia,” European Journal of Surgery Oncology, Vol. 29, No. 5, 2003, pp. 437-439. doi:10.1016/S0748-7983(03)00004-0
[58] A. A. Ismail and J. H. Barth, “Endocrinology of Gynaecomastia,” Annals of Clinical Biochemistry, Vol. 38, 2001, pp. 596-607. doi:10.1258/0004563011900993
[59] E. H. Hernes and K. Harstad Fossa, “Changing Incidence and Delay of Testicular Cancer in Southern Norway (1981-1992),” European Urology, Vol. 30, No. 3, 1996, pp. 349-357.
[60] L. J. Hands and M. J. Greenall, “Gynaecomastia,” British Journal of Surgery, Vol. 78, No. 8, 1991, pp. 907-911. doi:10.1002/bjs.1800780805
[61] A. V. Stepanas, N. A. Samaan, P. N. Schultz and P. Y. Holoye, “Endocrine Studies in Testicular Tumor Patients with and without Gynecomastia: A Report of 45 Cases,” Cancer, Vol. 41, No. 1, 1978, pp. 369-376. doi:10.1002/1097-0142(197801)41:1<369::AID-CNCR2820410150>3.0.CO;2-Y
[62] A. Tseng Jr., S. J. Horning, F. S. Freiha, K. J. Resser, J. F. Hannigan Jr. and F. M. Torti, “Gynecomastia in Testicular Cancer Patients. Prognostic and Therapeutic Implications,” Cancer, Vol. 56, No. 10, 1985, pp. 2534-2538. doi:10.1002/1097-0142(19851115)56:10<2534::AID-CNCR2820561036>3.0.CO;2-Q
[63] R. E. Emerson and T. M. Ulbright, “Intratubular Germ Cell Neoplasia of the Testis and Its Associated Cancers: The Use of Novel Biomarkers,” Pathology, Vol. 42, No. 4, 2010, pp. 344-355. doi:10.3109/00313021003767355
[64] N. E. Skakkebaek, “Atypical Germ Cells in the Adjacent “Normal” Tissue of Testicular Tumours,” Acta Pathology Microbiology Scand A, Vol. 83, No. 1, 1975, pp. 127-130.
[65] N. E. Skakkebaek, “Carcinoma in Situ of the Testis: Frequency and Relationship to Invasive Germ Cell Tumours in Infertile Men,” Histopathology, Vol. 2, No. 3, 1978, pp. 157-170. doi:10.1111/j.1365-2559.1978.tb01706.x
[66] C. Winter and P. Albers, “Testicular Germ Cell Tumors: Pathogenesis, Diagnosis and Treatment,” Nature Reviews Endocrinology, Vol. 7, No. 1, 2011, pp. 43-53. doi:10.1038/nrendo.2010.196
[67] S. Gori, S. Porrozzi, F. Roila, G. Gatta, U. De Giorgi and M. Marangolo, “Germ Cell Tumours of the Testis,” Critical Reviews in Oncology/Hematology, Vol. 53, No. 2, 2005, pp. 141-164. doi:10.1016/j.critrevonc.2004.05.006
[68] N. Javadpour, K. R. McIntire and T. A. Waldmann, “Human Chorionic Gonadotropin (HCG) and Alpha-Fetopr- otein (AFP) in Sera and Tumor Cells of Patients with Testicular Seminoma: A Prospective Study,” Cancer, Vol. 42, No. 6, 1978, pp. 2768-2772. doi:10.1002/1097-0142(197812)42:6<2768::AID-CNCR2820420636>3.0.CO;2-Z
[69] C. Duparc, G. Boissiere-Veverka, H. Lefebvre, A. La- querriere, P. Vuillermet, A. Landreat, R. Ivell, N. DeRoux and J. M. Kuhn, “An Oestrogen-Producing Seminoma Responsible for Gynaecomastia,” Hormone and Metabolic Research, Vol. 35, No. 5, 2003, pp. 324-329. doi:10.1055/s-2003-41310
[70] T. Yamashiro, Y. Iraha, H. Kamiya, T. Nakayama, S. Unten and S. Murayama, “Testicular Seminoma Presenting with Mediastinal Lymphadenopathy and Gynecomastia,” Radiation Medicine, Vol. 25, No. 6, 2007, pp. 303- 305. doi:10.1007/s11604-007-0137-3
[71] D. Kammerer-Doak, K. Baurick, W. Black, D. M. Barbo and H. O. Smith, “Endodermal Sinus Tumor and Embryonal Carcinoma of the Ovary in a 53-year-old Woman,” Gynecology Oncology, Vol. 63, No. 1, 1996, pp. 133-137. doi:10.1006/gyno.1996.0292
[72] T. Motoyama, H. Watanabe, T. Yamamoto and M. Sekiguchi, “Production of Beta-Human Chorionic Gonadotropin by Germ Cell Tumors in vivo and in vitro,” Acta Pathologica Japonica, Vol. 38, No. 5, 1988, pp. 577-590.
[73] M. Harris, S. Rizvi, J. Hindmarsh and R. Bryan, “Testicular Tumour Presenting as Gynaecomastia,” British Medical Journal, Vol. 332, No. 7545, 2006, p. 837. doi:10.1136/bmj.332.7545.837
[74] W. S. Hendry, W. H. Garvie, A. K. Ah-See and A. P. Bayliss, “Ultrasonic Detection of Occult Testicular Neoplasms in Patients with Gynaecomastia,” British Journal of Radiology, Vol. 57, No. 679, 1984, pp. 571-572. doi:10.1259/0007-1285-57-679-571

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