Gynaecomastia and extragonadal symptoms leading to diagnosis delay of germ cell tumours in young men.

We report two young men with gynaecomastia in whom the underlying causative metastatic germ cell malignancies were not diagnosed for prolonged time periods. Despite the fact that cancer is an uncommon cause of gynaecomastia, doctors should consider germ cell malignancy, even in the absence of testicular symptoms or signs, in previously healthy young men with recent gynaecomastia or other unusual symptoms or signs. Serum beta human chorionic gonadotrophin and other germ cell malignancy markers (alpha fetoprotein and lactic dehydrogenase) should always be assayed. If a testicular primary site is not clinically apparent, there should be early recourse to scrotal ultrasonography.