Gynecomastia: An Uncommon but Important Clinical Manifestation for Testicular Tumors

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.

Which patients with gynaecomastia require more detailed investigation?

“…Germ cell tumours account for 95% of testicular tumours and affect men in the third and fourth decades of life . The gynaecomastia in germ cell tumours is associated with hCG secretion.…”

“…These account for 0.8%‐3% of all testicular tumours and can occur at any age, but particularly in prepubertal boys (5‐10 years) and in adults (30‐60 years) . Leydig cell tumours can directly secrete oestradiol .…”

“…Serum gonadotrophin levels may not be suppressed in patients with Leydig cell tumours . Approximately 15%‐30% of Leydig cell tumours present with gynaecomastia . Leydig cell tumours are malignant in 10% of adult cases…”

“…Large‐cell calcifying Sertoli cell tumours (a histological variant) may be associated with the Carney complex and Peutz‐Jeghers syndrome . Approximately 10% of large‐cell calcifying Sertoli cell tumours are associated with gynaecomastia . Malignancy is found in approximately 17% of patients with large‐cell calcifying Sertoli cell tumours …”

“…These are extremely rare. Most cases of adult granulosa cell tumours present as a painless testicular mass; however, gynaecomastia may be present due to the synthesis of oestradiol by the tumour . In a review of 29 reported cases of adult testicular granulosa cell tumours, five (17%) had gynaecomastia and six (21%) demonstrated definitive metastases.…”