Testicular Tumours: a Clinico-Pathological Survey

IN 1906 Clevasseau classified tumours of the testis as teratomata, seminomata, interstitial cell tumours and adenomata. He noted the similarity between the seminoma and the epithelium of the seminal tubules, and considered that this type of tumour had its origin in the seminal epithelium. Nicholson (1907), Dew (1925), and Bell (1926) were in agreement with this theory. Since then numerous publications have dealt with the diagnosis, classification, treatment and prognosis of testicular tumours. Ferguson (1933), in a large series of tumours, showed a correlation between the quantitative estimation of prolan-A in the urine, and the histological diagnosis. He found a reduction in prolan-A excretion following regression of the tumour due to radiotherapy, and a further elevation if there was a recurrence of the tumour or metastasis. He considered that a substance secreted by the tumour stimulated the pituitaryto produce gonadotropin, which in turn further stimulated tumour growth. This attractive and simple, though poorly explained, theory failed to consider the work of Evans and Simpson (1929), and also of Engle in the same year. These authors demonstrated two distinct types of urinary gonadotropin in association with tumours of the testis, a chorionic gonadotropin, similar to that found in the urine of pregnancy, and a pituitary gonadotropin which exists in the urine of the normal human, but in large amounts in the castrate state. Leonard (1933) was able to confirm these findings. Further research by Jones, Gey & Gey (1943), using in vitro material, showed conclusively that cells from the human placenta, and also cells from a chorionic carcinoma, produced chorionic gonadotropin. Brewer (1946) reported two cases of testicular tumour which were diagnosed histologically, on removal, as seminoma and teratoma respectively. Both patients showed a high level of urinary chorionic gonadotropin, and at post-mortem examination both had massive metastatic deposits of chorionic carcinoma. Considering this finding, Brewer stressed the necessity to differentiate between chorionic and pituitary gonadotropin, both of which might occur in these patients.