Cryptic presentations of germ cell tumors.

The records of 636 patients who were treated for carcinoma of the testis were reviewed. Of these patients, 61 (9.6 percent) presented with extratesticular complaints. In order of decreasing frequency, the complaints were pain (abdominal, back or groin), gynecomastia or mastodynia, pulmonary complaints, enlarged lymph nodes or a nontesticular mass, swelling of the lower extremity or neurologic changes. A substantial number of these patients were initially misdiagnosed and underwent a surgical procedure. Of importance, most of these patients had either abnormal testicular examination results, elevated markers or a history of cryptorchidism. The data suggest that patients with germ cell tumors, even when presenting with cryptic complaints, can readily be diagnosed if a high level of suspicion is maintained, a careful testicular examination is performed and tumor markers obtained. This frequently makes a diagnostic abdominal exploration or other surgical interventions unnecessary.